Objective: To compare Veterans Health Administration (VHA) chiropractors’ self-report of the most common conditions seen and services provided with electronic health record (EHR) data from VHA chiropractic visits.
Methods: A cross-sectional analysis of VHA administrative data from fiscal year 2019 (October 1, 2018 through September 30, 2019) was conducted to assess the International Classification of Diseases, Tenth Revision (ICD-10) and Current Procedural Terminology® (CPT®) codes of all on-station chiropractic visits. The 100 most common ICD-10 and CPT® code were organized into categories and the proportion of codes in each category was calculated for both diagnoses and procedure. Additionally, a secondary analysis of data from a previous VHA chiropractor survey was conducted to calculate relative frequencies of provider-reported conditions managed and services provided.
Results: Low back pain without radiculopathy (LBPwo) was the most frequent ICD-10 code in administrative data (47.7%) and was also rated the most common condition seen by provider self-report (3.75/4 relative frequency). The frequency of ICD-10 codes for neck pain without radiculopathy (NPwo, 19.99%) was less than half of that for LBPwo, yet DCs’ self-reported NPwo relative frequency (3.66/4) was essentially the same as LBPwo. Even greater disparity existed between the very low frequencies of ICD-10 codes for headache and extremity conditions, and the relatively higher rates at which DCs report seeing these conditions. The most frequent CPT® code grouping in administrative data was chiropractic manipulative therapy (CMT), representing 42.7% of all CPT® codes. This was concordant with chiropractor self-report, which placed CMT at the highest relative frequency rating of 3.86/4. Chiropractors reported providing therapeutic exercise, self-management, and patient education at high frequencies, yet CPT® codes for these therapies were rare.
Conclusion: There is some agreement and much discrepancy between VHA chiropractors’ report of practice characteristics and VHA EHR data. Additional work is needed to better understand the extent of documentation agreement, and its impact on patient and system outcomes.
Author keywords: Chiropractic; Veterans Health Administration; Utilization
Author affiliations: BAY: Department of Physical Medicine & Rehabilitation, VA Connecticut Healthcare System, West Haven, Connecticut, United States; AJL, KLC: Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut, United States; SMH: Department of Physical Medicine & Rehabilitation, WG Hefner VA Medical Center, Salisbury, North Carolina, United States
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