BackgroundClinicians who recognize functional neurological disorders (FND) may not share that diagnosis with patients. Poor communication delays treatment and contributes to substantial disability in FND. Diagnostic (ICD-10) coding, one form of medical communication, offers an insight into clinicians’ face-to-face communication. Therefore, quantifying the phenomenon of noncoding, and identifying beliefs and practice habits that reduce coding, may suggest routes to improve medical communication in FND.MethodsWe reviewed all pediatric neurology consultations in our hospital from 2017 to 2020, selecting those in which neurologists explicitly stated an FND-related diagnosis (N = 57). We identified the neurological symptoms and ICD-10 codes assigned for each consultation. In parallel, we reviewed all encounters that utilized FND-related codes to determine whether insurers paid for this care. Finally, we assessed beliefs and practices that influence FND-related coding through a nationwide survey of pediatric neurologists (N = 460).ResultsAfter diagnosing FND, neurologists selected FND-related ICD-10 codes in only 22.8% of consultations. 96.2% of neurologists estimated that they would code for non-epileptic seizure when substantiated by electroencephalography; in practice, they coded for 36.7% of such consultations. For other FND manifestations, neurologists coded in only 13.3% of cases. When presented with FND and non-FND scenarios with equal levels of information, neurologists coded for FND 41% less often. The strongest predictor of noncoding was the outdated belief that FND is a diagnosis of exclusion. Coding for FND never resulted in insurance nonpayment.ConclusionNoncoding for FND is common. Most factors that amplify noncoding also hinder face-to-face communication. Research based on ICD-10 coding (eg, prevalence and cost) may underestimate the impact of FND by >fourfold.

中文翻译：

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当神经科医生诊断出功能性神经障碍时，他们为什么不对其进行编码？


背景认识功能性神经系统疾病 (FND) 的临床医生可能不会与患者分享该诊断结果。沟通不畅会延误治疗并导致 FND 严重残疾。诊断 (ICD-10) 编码是医疗交流的一种形式，可以深入了解临床医生的面对面交流。因此，量化非编码现象，并识别减少编码的信念和实践习惯，可能会为改善 FND 中的医疗沟通提供建议。 方法 我们回顾了 2017 年至 2020 年我院所有儿科神经科会诊，选择那些神经科医生明确表示不需编码的咨询。 FND 相关诊断 (N = 57)。我们确定了每次咨询的神经系统症状和 ICD-10 代码。与此同时，我们审查了所有使用 FND 相关代码的事件，以确定保险公司是否支付此类护理费用。最后，我们通过对儿科神经科医生进行的全国范围内调查（N = 460）评估了影响 FND 相关编码的信念和实践。结果在诊断 FND 后，神经科医生仅在 22.8% 的咨询中选择了 FND 相关 ICD-10 代码。 96.2% 的神经科医生估计，当脑电图证实时，他们会对非癫痫发作进行编码；实际上，他们对 36.7% 的此类咨询进行了编码。对于其他 FND 表现，神经科医生仅对 13.3% 的病例进行了编码。当呈现具有同等信息水平的 FND 和非 FND 场景时，神经科医生对 FND 进行编码的频率减少了 41%。非编码的最强预测因素是过时的信念，即 FND 是一种排除性诊断。 FND 编码从未导致保险拒付。结论 FND 不编码很常见。大多数放大非编码的因素也会阻碍面对面的交流。 基于 ICD-10 编码（例如患病率和成本）的研究可能会低估 FND 的影响四倍以上。