20% of shoulder pain ICD-10 codes lack specific diagnosis, Calif. workers' comp report finds

A California Workers' Compensation Institute report found medical coding submissions still lack key diagnostic characters, in spite of the move toward increased specificity under ICD-10.

California workers' compensation providers had until October 1, 2016, to switch to ICD-10 codes or risk being out of compliance. The CWCI report compared ICD-9 diagnostic codes submitted by California workers' compensation providers during the final nine months those providers used the old coding system to the ICD-10 codes submitted in the first nine months during transition to the new system.

CWCI said codes for lumbar spine injuries, which represented six of the top 10 ICD-10 codes submitted in the first nine months of the transition period, ranged widely in specificity. The No. 1 code submitted during the period was for an unspecific diagnosis of "low back pain."

CWCI's study found more than 20 percent of ICD-10 codes submitted for shoulder pain diagnoses did not include a sixth character to denote which shoulder sustained the injury. In addition, a diagnosis of "injury, unspecified," accounted for 1.6 percent of primary diagnosis codes under ICD-10, which remained unchanged from ICD-9 submissions.

CWCI concluded while the transition to ICD-10 offered California workers' compensation providers "a wider range of codes," many submissions still "lacked the additional characters that better define the injury, identify the type of encounter and improve communication."  

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