ICD-10 Coding of Musculoskeletal Conditions in the Veterans Health Administration

Area of Science:

• Health Services Research
• Musculoskeletal Health
• Veterans Health Administration

Background:

• Musculoskeletal conditions are a leading cause of disability and healthcare utilization among veterans.
• Understanding the patterns of diagnosis coding is crucial for resource allocation and care improvement within the Veterans Health Administration (VHA).

Purpose of the Study:

• To identify and describe the most frequently utilized musculoskeletal diagnoses within the VHA.
• To analyze the number of visits and unique patients associated with common International Classification of Diseases (ICD)-10 codes for musculoskeletal conditions.
• To compare the utilization trends of these codes across primary and specialty care settings.

Main Methods:

• Secondary analysis of a longitudinal cohort study.
• Inclusion of veterans with a musculoskeletal diagnosis between October 1, 2015, and September 30, 2017.
• Extraction and analysis of counts and proportions of all used ICD-10 M-codes and associated unique patients, comparing primary and specialty care settings.

Main Results:

• Out of over 6,400 possible ICD-10 M-codes, 5,723 were used at least once.
• The most frequent code was 'Low Back Pain' (18.3%), followed by 'Cervicalgia' (3.6%).
• The top 100 codes represented 80% of diagnoses, with 95% of patients having at least one of these; common diagnoses like spinal pain, joint pain, and osteoarthritis showed similar usage in primary and specialty care.

Conclusions:

• A small subset of available musculoskeletal diagnosis codes (less than 2%) accounts for a significant majority (80%) of diagnoses recorded in the VHA.
• This pattern of high-frequency code utilization is consistent across both primary and specialty care settings.
• The most common diagnoses reflect the primary reasons veterans seek musculoskeletal care within the VHA system.