Azarderakhsh Jasmin, Siebenlist Sebastian, Schneider Olaf, Beck Frauke, Flechtenmacher Johannes
Unternehmensbereich Steuerung, Finanzen & Analytik, AOK Baden-Württemberg, Stuttgart, Deutschland.
Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
Z Orthop Unfall. 2025 Aug;163(4):317-329. doi: 10.1055/a-2437-0981. Epub 2024 Dec 9.
Despite the increasing number of cases in recent years, there are currently no data available on the disease and care situation for degenerative shoulder diseases and shoulder injuries, as well as on the ICD-10 coding behaviour of the treating physicians. This paper presents, for the first time, a descriptive analysis based on billing data from 2022 of coded shoulder diseases affecting 4.9 million insured individuals of a statutory health insurance in Baden-Württemberg. The study distinguishes between accident-related shoulder injuries and diseases caused by degenerative changes in the shoulder. In ICD-10 coding, a distinction is made between specific codes (using key numbers of the underlying disease) and non-specific codes that only encode the symptom. According to billing data, women were slightly more affected by shoulder diseases than men (7.3% vs. 6.9%), with women being significantly older on average at the time of diagnosis. For fractures, the gender difference averaged 20 years. The analysis of coding behaviour revealed that general practitioners coded non-specific shoulder diseases, such as joint pain or impingement syndrome, more frequently than other specialist groups. The analysis of the claiming of benefits showed that only one-third of the evaluated patients received imaging, and only 40% received a prescription for physiotherapy due to a shoulder diagnosis. The investigation of comorbidities found that patients with degenerative shoulder diseases were more frequently affected by metabolic diseases and hypertension than those without shoulder diseases. These results regarding the frequency of coded shoulder diseases in various health sectors demonstrate their importance in the Federal Republic of Germany for both men and women. In summary, the evaluations-despite methodological limitations-suggest that there may be potential for more specific coding in the diagnosis and prescription of therapeutic measures. A more precise understanding of the actual cause of claiming health services can be helpful for the provider to initiate specific diagnostic and therapeutic measures and identify a potentially increased need for care within the health system in the Federal Republic of Germany.
尽管近年来病例数量不断增加，但目前尚无关于退行性肩部疾病和肩部损伤的疾病及护理情况，以及治疗医生的国际疾病分类第十版（ICD - 10）编码行为的数据。本文首次基于2022年巴登 - 符腾堡州法定医疗保险中490万参保人的肩部疾病编码账单数据进行描述性分析。该研究区分了与事故相关的肩部损伤和由肩部退行性变化引起的疾病。在ICD - 10编码中，区分了特定代码（使用基础疾病的关键编号）和仅对症状进行编码的非特定代码。根据账单数据，女性比男性受肩部疾病影响略多（7.3%对6.9%），女性在诊断时的平均年龄显著更大。对于骨折，性别差异平均为20岁。编码行为分析表明，全科医生比其他专科医生组更频繁地对非特定肩部疾病进行编码，如关节疼痛或撞击综合征。福利申领分析显示，在评估的患者中，只有三分之一接受了影像学检查，因肩部诊断而接受物理治疗处方的患者仅占40%。合并症调查发现，患有退行性肩部疾病的患者比没有肩部疾病的患者更频繁地患有代谢性疾病和高血压。这些关于不同医疗领域中编码肩部疾病频率的结果表明，它们在德意志联邦共和国对男性和女性都很重要。总之，尽管存在方法上的局限性，但评估表明在诊断和治疗措施处方中可能存在更具体编码的潜力。更精确地了解申领医疗服务的实际原因有助于医疗服务提供者启动特定的诊断和治疗措施，并识别德意志联邦共和国医疗系统内潜在增加的护理需求。
