Musculoskeletal Injury Surveillance in the U.S. Military: Analysis of the ICD-10-CM Transition and Descriptive Report of Health Care Utilization at Four Sites Adopting MHS GENESIS

Introduction: The U.S. Military Health System (MHS) transitioned to the ICD-10-CM coding scheme in October 2015 and began the phased rollout of a new electronic health record system, MHS GENESIS, in October 2017. Both changes have the potential to affect the observed prevalence and health care utilization associated with musculoskeletal injuries (MSKIs) in service members. The purpose of this article was to (1) determine the effect of the ICD-10-CM transition on the observed prevalence of select MSKI conditions and (2) describe MSKI-related health care utilization in four MTFs during the adoption of MHS GENESIS. Materials and Methods: We calculated monthly prevalence rates for six diagnostic groupings of MSKIs routinely seen in the MHS between October 2011 and February 2020. To determine if the transition to ICD-10-CM influenced prevalence rates, we performed an interrupted time series analysis, using the ICD-10-CM transition date (October 1, 2015) as the interruption point. To assess trends in direct and private sector care encounters during the MHS GENESIS transition, we calculated monthly MSKI-related encounters at four MTFs from November 1, 2015 through September 30, 2021. Results: Three diagnoses had a significant (P < .05) change in the slope, or rate of change, for their monthly prevalence after the introduction of ICD-10-CM (patellofemoral pain syndrome, −0.18; stress fractures, 0.12; subacromial pain, 0.03). These diagnoses also had a significant level change or immediate change in monthly prevalence following the ICD-10CM transition (patellofemoral pain syndrome, 24.2; stress fractures, 0.16; subacromial pain, 0.36). Three of the four sites adopting MHS GENESIS showed reduced 3-month averages (range: −7.1–13.0%) of MSKI-related encounters following the electronic health record transition. For two of the four MTFs, we observed an increased reliance on private sector immediately leading up to and following the change to MHS GENESIS. Conclusions: The observed differences in monthly prevalence for certain MSKIs could be because of the changes in the amount and/or specificity of available codes in ICD-10-CM. Within the six selected diagnostic groupings of MSKIs, we found that patellofemoral pain syndrome, stress fractures, and subacromial pain syndrome demonstrated the greatest changes in prevalence during the ICD-10-CM transition. Those involved in MSKI surveillance should exercise caution when evaluating MSKI prevalence that spans the ICD-10-CM transition. Changes in health care utilization patterns in two of the four MTFs during their adoption of MHS GENESIS suggest that MSKI care may have transferred from direct to private sector care during this period. Future research will be required to validate this finding and determine the impacts on clinical outcomes and military readiness.