Of the 994 PowerPoint files reviewed, 4331 distinct ICD-10 codes were identified that could be incorporated into lectures. As shown in
Table 1, the total number and average number of codes per lecture identified for each block varied considerably. The breakdown of courses taught during each block and the corresponding number of opportunities for an ICD-10 code to be associated with each course within each block is shown in
Table 2. Microbiology, genetics, and immunology courses were specific to the Block 1 curriculum. However, Block 1 curriculum omitted pharmacology and clinical medicine courses, which were incorporated into subsequent blocks. In Block 3, the neuroscience course was defined as a combination of neuroanatomy and physiology, which are represented as a combined category in
Table 2. The frequency of ICD-10 codes per course allows us to examine the areas of medical education that have the biggest impact on diagnostic and procedural instruction. The courses containing the most ICD-10 codes are clinical medicine, with a total of 1868 codes, and pathology, with a total of 1026 codes.
The ability to break the lectures down into their components and observe the frequency of disorders or procedures within a subject is recorded in an Excel spreadsheet, a portion of which is shown in
Figure 1. As an example, in the clinical medicine course from Block 2, the same ICD-10 code that encompassed various types of muscular dystrophy outlined in the lecture material was observed in subsequent slides and lectures. The consecutive use of codes was apparent not only within the same subject but among other subjects, as well as among each block. As a result, it was possible to use previously determined codes for disorders to match to the same diagnosis taught in subsequent lectures, and it gives a measure of the amount of repetition and redundancy experienced by medical students during lectures.
All procedure codes have 7 digits, which are used to obtain the maximum specificity for a procedure or treatment, usually required for proper reimbursement. For example, in Block 2 musculoskeletal system lectures, the osteopathic manipulative medicine (OMM) codes for both upper and lower extremities are shown in
Figure 2. A difference can be seen between the codes varying by 1 number, which distinguishes between either the upper or lower extremity. Therefore, documenting a diagnosis for certain procedures in an extremity requires knowing the 1 numerical code variance for either upper or lower. For example, within the OMM codes, there are differences between techniques used for treatment, such as indirect, fascial release, and muscle energy. A total of 11 indirect, 11 muscle energy, 5 fascial releases, 2 general mobilizations, and 2 other methods were correlated with the osteopathic manipulative treatment (OMT) techniques taught during Block 2.
The majority of codes related to OMT and the diagnosis of somatic dysfunctions were found during Block 2 because of the systems-based focus on musculoskeletal conditions. As more systems are added, it is postulated that more OMT codes will emerge in conjunction with the findings of somatic dysfunctions in the diagnostic criteria taught to accompany specific treatment options.
The ICD Logger application and standard Google web searches for keywords are essential to thoroughly correlate every ICD-10 code appropriately. Both search tools enabled us to identify diagnoses and procedures by their formal ICD-10 name or a variety of synonyms, including their generic or trade names.