Funktionelle und somatoforme Störungen im Spiegel von ICD-10-Routinedaten

Abstract

The ICD-10 offers the possibility of double coding of diagnoses in functional disorders on the one hand, somatoform disorders on the other side. The current S3 guideline for "dealing with patients with non-specific, functional and somatoform physical complaints" states that "[...] in most cases, the specialty of the (initial) examiner and not the clinical constellation seems to define how a diagnosis is made". Based on selective routine data of the Daimler BKK for the years 2008-2010 frequencies of specific functional diagnoses were compared with those of somatoform disorders, additional diagnoses analyzed and compared with epidemiological data from the Federal Health Monitoring System. The incidence found in epidemiological studies of somatoform disorders cannot be found in present routine data. Functional disorders were more frequently diagnosed than somatoform disorders. Certain additional diagnoses that may provide clues to etiological relations are rarely used. As the validity, reliability and purpose of ICD-10 invoicing diagnoses is debatable, there seems to be an imbalance relevant for the health care system. Non-adherence to the guidelines may prevent adequate quality and quantity of patient care.

Coding of medically unexplained symptoms and somatoform disorders by general practitioners – an exploratory focus group study

“…Reasons for not recording MUS/somatoform disorders have not been examined comprehensively before, documented by a lack of studies on (German) GPs’ coding behavior especially in respect to MUS and somatoform disorders. Many quantitative studies [ 16 , 24 , 29 , 30 , 39 ] state that problems regarding morbidity coding exist and make educated guesses about the reasons, but explorative qualitative studies were needed to shed light on this area. To our knowledge this is the first qualitative study (in Germany) to explore this theme.…”

“…Not all patients with (severe) MUS will eventually be diagnosed with a psychiatric somatization disorder (ICD-10 F45.x), as preferences for diagnoses differ according to the specialty [ 14 ]; medical specialties prefer functional somatic syndromes [ 6 ] like fibromyalgia, chronic fatigue syndrome and chronic benign pain syndrome [ 15 ]. There is evidence that coding might be based upon the specialty (e.g., somatic or psychiatric) of the treating physician [ 16 ] and might differ between primary and secondary care [ 17 ]. The classification of somatoform disorders has been revised in the past [ 8 ] and will experience further revisions with the publication of the ICD-11 [ 18 ].…”

“…In contrast, studies show that the reliability of coded diseases in primary [ 24 , 28 – 30 ] and secondary [ 26 , 31 ] health care settings is often poor, including for example the phenomenon of “billing diagnoses” [ 24 ] which have their origin in the German Medicinal Products Directive and are used to legitimate certain prescriptions. Furthermore epidemiological data and routine data on functional and somatoform disorders are not congruent with each other [ 16 ].…”

“…The ICD-10 allows “double-coding” according to etiology and localization of diseases. That means, for example, the same clinical phenomenology without distinct medical explanation (e.g., MUS) can be coded using organ-related codes as a functional disorder (e.g., K58.0 irritable bowel syndrome) or as mental disorders using codes from chapter F on mental and behavioural disorders (e.g., F45.32 somatoform autonomic dysfunction lower gastrointestinal tract) [ 16 ]. Patients with MUS having primarily physical rather than psychological symptoms usually consult general practitioners rather than mental health care specialists first [ 8 ], however, somatoform categories are used less often by general practitioners [ 8 ] and other clinicians (underassignment, p. 143 [ 34 ]).…”