Coding of medically unexplained symptoms and somatoform disorders by general practitioners

Medically unexplained symptoms (MUS) and somatoform disorders are common in general practices, but there is evidence that general practitioners (GPs) rarely use these codes. Assuming that correct classification and coding of symptoms and diseases are important for adequate management and treatment, insights into these processes could reveal problematic areas and possible solutions [...]


Results

[...] For category a) “benefits

of coding” GPs described that coding is seen as being done for reimbursement

purposes and is not necessarily linked to the content of their reference files

for a specific patient. Others reported to code specific diagnoses only if

longer consultations to explore psychosomatic symptoms or psychotherapy are

intended to be billed. Reasons for b) “restrained coding” were attempting to

protect the patient from stigma through certain diagnoses and the preference

for tentative diagnoses and functional coding. Some GPs admitted to c) “code

inaccurately” attributing this to insufficient knowledge of ICD-10-criteria,

time constraints or using “rules of thumb” for coding.


Conclusions

[...] From GPs points of view ICD-10-coding does not appear to be a necessary requirement for

treating patients and coding might be avoided to protect the patients from

stigma and other negative consequences. Our findings supply a possible

explanation for the commonly seen difference between routine and

epidemiological data. The recent developments in the DSM-5 and the upcoming

ICD-11 will supposedly change acceptance and handling of these diagnoses for

GPs and patients. Either way, consequences for GPs’ diagnosing and coding

behavior are not yet foreseeable.


Coding of medically unexplained symptoms and somatoform disorders by general practitioners - an exploratory focus group study (BMC Family Practice).


DOI: 10.1186/s12875-018-0812-8