Describing Congruence Between ICD-10 Coding and Medical Record Text in Veterans Health Administration Chiropractic Notes.

Objective: The purpose of this study was to describe the congruence between International Classification of Diseases, 10th Ed (ICD-10) codes and documented text diagnoses from chiropractic notes in the Veterans Health Administration (VHA). Methods: This was a cross-sectional analysis of VHA national administrative data. We randomly sampled 1000 on-station VHA chiropractic visits occurring from October 1, 2017, and September 30, 2018 from patients with no such visits within the prior 12 months. ICD-10 and documented text diagnoses were extracted and mapped to 10 defined categories based on body region, presence of radiculopathy, nonspecific musculoskeletal conditions, and nonmusculoskeletal conditions. A rating system evaluated the congruence between ICD-10 and text diagnoses. Results: Of the 978 identified and abstracted notes, ICD-10 and text diagnoses were perfectly congruent in 441 (45.1%). With cases of partial congruence, ICD-10 codes contained less detail/fewer conditions than text in 194 (19.8%) and contained more detail/more conditions than text in 178 (18.2%). Mixed findings were present in 101 cases (10.3%), with ICD-10 and text both containing diagnoses not found in the other. Lastly, there were 64 cases (6.5%) where the 2 groups had no degree of congruence. Conclusion: VHA chiropractic diagnostic coding and text documentation shows considerable congruence with variability in diagnostic detail. This provides a foundation for further study that may ultimately improve the quality of these data for clinical, research, and administrative uses.