Agreed, would love to see some cites.

I work with insurance claims and post-marketing adverse event reporting data for pharma drugs, and I don't recall seeing anything resembling what OP described when looking at offlabel usage, but it's been awhile. (note: this is not EHR data, but it relates)

Anecdotally I've had a few off label RX's that weren't attached to any DX code in my EHR, same with my wife.

* edit: said 'you' vs. OP

OK I looked into it more. It's more about reducing time spent by doctors appealing health insurance non-payment (IE, if the insurance doesn't allow prescribing medicine X for insurance code Y, the doctor would have to write up some appeals form).