Abstract
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.
Keywords
degenerative shoulder diseases - shoulder injuries - epidemiology - ICD10 - health
care situation
