Diagnostic codes for low back pain, nomenclature or noise? A descriptive study of disease classification system coding of low back pain

Abstract

Aim To compare and contrast the diagnostic codes for spinal causes of low back pain (LBP) in 3 disease classification systems (International Classification of Diseases [ICD]‐10, International Classification of Primary Care [ICPC]‐2 PLUS and Systematized Nomenclature of Medicine Clinical Terms ‐ Australia [SNOMED CT‐AU]) and consider how well they are aligned with the diagnostic approach recommended in contemporary clinical practice guidelines for LBP. Method This was a descriptive study which included 3 disease classification systems: ICD‐10, ICPC‐2 PLUS and SNOMED CT‐AU. Two independent authors extracted relevant LBP codes from each system and mapped the codes to 3 guideline‐endorsed categories of spine‐related diagnoses for LBP (specific spinal pathology, radicular syndromes, and non‐specific LBP) and the various clinical conditions (sub‐categories) within each of the 3 categories. Results ICD‐10, ICPC‐2 PLUS, and SNOMED CT‐AU had 126, 118 and 100 codes for LBP, respectively. All systems provided codes that would cover the 3 guideline‐endorsed categories of spine‐related diagnoses for LBP. On the basis of contemporary guidelines, the authors developed lists of discrete sub‐categories of specific spinal pathology (56 sub‐categories), radicular syndromes (7 sub‐categories), and non‐specific LBP (10 sub‐categories). Each of the classification systems was then mapped against these sub‐categories to tally redundancy and determine exhaustiveness. However, no system covered all 73 sub‐categories of LBP, and within each system, there was substantial redundancy with up to 22 codes for the same clinical condition. Conclusion LBP diagnostic codes used in popular disease classification systems are out of touch with current approaches to diagnosis, as reflected in contemporary LBP guidelines. Our findings suggest these disease classification systems need revision, but precisely how they should be revised is unclear.

Prevalence and characteristics of musculoskeletal complaints in primary care: an analysis from the population level and analysis reporting (POLAR) database

“…In addition, many of the diagnostic labels describe the same condition (e.g., rotator cuff syndrome, supraspinatus tendinitis, inflammation of rotator cuff tendon), while others describe presumed or actual imaging findings that may or may not be clinically relevant (e.g., degeneration) or a specific treatment rather than a diagnosis (e.g., laminectomy, arthroscopy). This lack of mutually exclusive categories and redundancy has been observed in a study of low back pain coding [ 33 ]. Revision of the SNOMED CT-AU classification system to reduce redundancy while ensuring all conditions can be labelled may improve consistency and allow comparison across studies that use this system.…”

Prevalence and characteristics of musculoskeletal complaints: an analysis from the POpulation Level and Analysis Reporting (POLAR) database

“…This lack of mutually exclusive categories and redundancy has been observed in a study of low back pain coding. 32 Revision of the SNOMED CT-AU classi cation system to reduce redundancy while ensuring all conditions can be labelled may improve consistency and allow comparison across studies that use this system. GP involvement in assigning diagnostic codes from a list generated in real-time using clinical natural language processing may help to address these issues, but this approach would need to be validated in practice.…”

Predictors of response in PROMIS-global in a chronic low back pain specialty clinic: STarTBack and chronic overlapping pain conditions

“…The study received in-98 stitutional review board approval. were identified through diagnosis codes [21,22] tial visit to characterize pain intensity (NRS), duration of pain, other pain locations, and presence of clinician diagnosed weakness. In addition, all other available features available within the electronic health record (EHR) at time of referral were collected.…”