Describing Congruence Between ICD-10 Coding and Medical Record Text in Veterans Health Administration Chiropractic Notes

Abstract

Objective

The purpose of this study was to describe the congruence between International Classification of Diseases, 10th Ed (ICD-10) codes and documented text diagnoses from chiropractic notes in the Veterans Health Administration (VHA).

Methods

This was a cross-sectional analysis of VHA national administrative data. We randomly sampled 1000 on-station VHA chiropractic visits occurring from October 1, 2017, and September 30, 2018 from patients with no such visits within the prior 12 months. ICD-10 and documented text diagnoses were extracted and mapped to 10 defined categories based on body region, presence of radiculopathy, nonspecific musculoskeletal conditions, and nonmusculoskeletal conditions. A rating system evaluated the congruence between ICD-10 and text diagnoses.

Results

Of the 978 identified and abstracted notes, ICD-10 and text diagnoses were perfectly congruent in 441 (45.1%). With cases of partial congruence, ICD-10 codes contained less detail/fewer conditions than text in 194 (19.8%) and contained more detail/more conditions than text in 178 (18.2%). Mixed findings were present in 101 cases (10.3%), with ICD-10 and text both containing diagnoses not found in the other. Lastly, there were 64 cases (6.5%) where the 2 groups had no degree of congruence.

Conclusion

VHA chiropractic diagnostic coding and text documentation shows considerable congruence with variability in diagnostic detail. This provides a foundation for further study that may ultimately improve the quality of these data for clinical, research, and administrative uses.