Patients were included in the cohort on the basis of a search of VHA electronic health record data sources for the presence of at least one of a possible 1,685 ICD-9 musculoskeletal diagnoses or 27,221 ICD-10 musculoskeletal diagnoses received during two or more outpatient visits within 18 months or one or more inpatient stay(s). Methods Musculoskeletal Diagnosis Cohortĭata were obtained from the Musculoskeletal Diagnosis (MSD) Cohort, a longitudinal cohort of veterans with musculoskeletal diagnoses who received VHA care between January 1, 2000, and Septem(n = 7,133,669). In an exploratory aim, we compared the use of diagnoses across similar top-level groupings of ICD-10 M-codes to assess use patterns across types of conditions by anatomic region and/or condition etiology. We hypothesized that specialty care settings may show relatively greater use of specific ICD-10 codes to describe musculoskeletal conditions, as compared with primary care, because of the model of referral and triage from primary care with a more generalized diagnosis to specialty care for further evaluation and confirmatory or definitive diagnosis. We also examined diagnosis code use in primary and specialty care settings. The primary aim of this analysis was to describe the most frequently assigned musculoskeletal condition diagnoses across visits and across unique patients in VHA care. We examined the use of ICD-10 diagnostic “M-codes,” representing “Diseases of the Musculoskeletal System and Connective Tissue,” in the VHA. VHA data provide the advantage of being relatively independent from third-party payer influence as compared with other health systems. The burden of musculoskeletal disorders is well established in veterans receiving health care in the VHA. As the largest integrated health care system in the United States with a research division devoted to health services research and system-level examination of electronic health record data, the Veterans Health Administration (VHA) provides a unique resource for describing the use of ICD-10. We recognize the transition to ICD-10 as an opportunity in health services research to examine early use of ICD-10 codes within a single health system. “Diseases of the Musculoskeletal System and Connective Tissue” are now represented by more than 6,400 ICD-10 codes, compared with 892 similar ICD-9 codes. Musculoskeletal conditions are one example of a diagnostic subgroup where changes in the number and specificity of codes (i.e., including codes to identify condition laterality and anatomic site involvement) occurred in the transition from ICD-9 to ICD-10. Describing actual use patterns within a diagnostic subgroup provides data on what conditions are being treated most frequently in a health system and the treatment setting in which patients are diagnosed (e.g., primary care vs specialty care). There have been no studies describing the actual use patterns of ICD-10 diagnostic codes or the most frequently used codes in the clinical setting. The rationale for this transition included increased diagnostic specification and enhanced data quality for research and public health uses, clinical decision-making, outcomes measurement, and claims processing and reimbursement. The United States adopted the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) on October 1, 2015, which resulted in an expansion from 14,000 diagnostic codes in the Ninth Revision (ICD-9) to nearly 70,000 in ICD-10. International Classification of Diseases, Musculoskeletal Diseases/Diagnosis*, Musculoskeletal Pain/Diagnosis*, Veterans Introduction
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