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 [...]
[...] 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.
[...] 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).