In the UK, up to 1,00,000 people see general practitioners (GPs) every day about musculoskeletal complaints. According to a recent GP Online report, the failure of GPs to follow up and code symptoms such as knee pain as osteoarthritis is denying the chance of full diagnosis for patients. As a result, co-morbidities or two or more coexisting medical conditions or diseases such as depression (common in patients with osteoarthritis) are going unidentified. Coding signs and symptoms are a medical necessity and medical coding practices that neglect this prevent physicians from fully assessing the disease burden in their practice. It also prevents patients from getting the information they need to manage their condition better.
Osteoarthritis can pose serious threat to mobility and independence. A new report published by Arthritis Research UK says that the numbers of people who faced osteoarthritis related disabilities in the UK increased by 16% during 1990-2010. With the increasing incidence of obesity and the growth in the elderly population, it is estimated that around 8.3 million people could be affected by knee osteoarthritis in the UK by 2035.
Experts say that GPs are usually reluctant to code pain in parts of the body as an arthritic disease without further tests. However, as mentioned in the Arthritis Research report, there is there is no simple test to determine whether an individual has osteoarthritis. Diagnosis tends to be based on a blend of various patient reported symptoms such as joint pain and restricted movement, radiographic or magnetic resonance imaging (MRI) of the joint, and clinical exclusion of certain rare medical conditions or diseases which might cause similar symptoms. Though damage to joint cartilage and bone thickening typical of osteoarthritis can be evaluated using x-ray, such findings often do not correlate with other symptoms including joint pain. The levels of pain may vary across patients with similar damage to the joint and so the diagnosis of osteoarthritis differs greatly between individual GPs and across general practices. Rather than diagnosing the condition as ‘osteoarthritis’, GPs often use symptom labels such as ‘knee pain’.
All this is will deter standardized data collection and hold back diagnosis rates. Patients do not get a full diagnosis so that they are unaware of how to manage the condition better. For example, depression levels are high in patients with chronic arthritis and GPs who are alert to this can plan their services accordingly.
Primary care experts need to support the efforts to make a positive diagnosis and code this in the patient’s record. The Arthritis Research report recommends that GPs have to minimize variation in diagnosis and coding adopt standardized coding for osteoarthritis in community care and hospital outpatient departments. It also suggests that GPs stay alert to osteoarthritis and musculoskeletal pain in individuals with heart or lung disease or diabetes. There is a view that steps to improve the medical coding on practice computer systems can increase diagnosis rates and help assess the disease burden more effectively.