Table 1

 Subjective assessment of the limitations of the two classification systems for sports medicine diagnoses

Reason for disagreementICD-10-AMOSICS
*Where the correct code had been identified by one coder but was missed by the other two coders.
†Chapter XIII, Diseases of the musculoskeletal system and connective tissue.
‡Chapter XIX, Injury, poisoning and certain other consequences of external causes.
(1) Human error*
(a) Poor organisation of system affected navigation across the documentationComplexity of musculoskeletal system and organisation based on pathology caused fatigue and boredom, as stated by codersPoor hierarchical system No redirection guides Codes alphabetised rather than organised anatomically inside subsections
(b) Relationship of codes to diagnosisCodes in chapter XIII† do not relate to the diagnosis in any recognisable pattern, potentially causing translational errorsCodes relate to the diagnosis (e.g. knee diagnoses start with k) giving some degree of self checking
(c) Lack of formal training in classification system
    (i) Erroneous use of “unspecified” codesCoders chose “unspecified” rather than “not otherwise specified” or “other” codesNot possible to do as very few codes for “other” or “not otherwise specified” diagnoses
    (ii) Omission of part of codeChapter XIII—4th letter specifying body location for “other” codes often omitted
(d) Lack of understanding of sports medicine diagnosisOccurred with expert coder as a result of having no previous experience in the practice of sports medicineAll coders were experienced in the practice of sports medicine
(2) Deficiencies in the codes available
(a) Location of injury
    (i) Codes too specific regarding location of injurye.g. tib. Post. tendon tear—required localising to ankle or foot
    (ii) Codes not specific enough for location of injurye.g. a code for thoracolumbar sprain does not exist, only thoracic or lumbar
(b) Codes do not encompass all details of the diagnosis causing coder to choose:
    (i) Pathology v anatomye.g. haematoma Achilles does not exist—either injury to Achilles (anatomy) or contusion of ankle (pathology)e.g. L5/S1 disc degeneration does not exist—either disc injury L5/S1 (anatomy) or disc degeneration (pathology)
    (ii) 1 of 2 different pathologies in one injuryCombination injuries, e.g. fracture dislocation, do not have a code in either system
    (iii) 1 of 2 structures injured in one body parte.g. ankle sprains—ICD only allows one injury to be coded. Not possible to code for a sprain of more than one ligament
(c) Post-surgical conditionsDilemma of coding pre-surgical v post-surgical condition
(3) Deficiencies in diagnosis given
(a) Location e.g. “lateral ligament injury”Problem—too many “other” codesProblem—no non-specific codes
(b) Diagnosis, e.g. acceleration injuryProblem—too many “other” codesProblem—no “other” codes
(c) Terminology, e.g. hamstring impingement syndromeProblem—too many “other” codesProblem—no “other” codes
(4) Classification system omits or under-represents diagnoses Stress fractures, osteitis pubis, osteochondral injuries, specific tendinopathiesPaediatric conditions, e.g. traction apophysitis and generalised osteoarthritis
(5) Chronicity of injury uncertain Choice of chapter XIII v chapter XIX‡, especially for knee and back
(6) Overuse injuries Confusion whether overuse injuries can be coded in chapter XIX