Real World Retrospective Analysis of Short-Term Disability Claims for the Genitourinary System in the United States

OBJECTIVES: Short Term Disability (STD) is used by 5.6% of United States (US) employees that have the benefit, adding an additional 25% of costs to total medical costs for employees that utilize STD and 6%—7% for the full employee population. This study aims to quantify and identify STD reason codes after the 2016 transition to ICD-10 codes for paid Genitourinary (GU) System Major Diagnostic Category (MDC) claims.

METHODS: Retrospective analysis of STD claims from US self-insured employers in Workpartners’ Research and Reference Database (RRDb) between 2016 and 2020. Claims within the GU MDC were summarized based on ICD-9 and ICD-10 codes. Disability payment calculations used employee-level wage data and inflation adjusted to December 2023 US$. Claims were excluded if costs ≤$0, denied, or had missing ICD-codes.

RESULTS: Across all MDCs, after 2016, 12.5% of STD reason codes were miscoded with ICD-9s (8.8%) or ICD-Current Procedural Terminology codes (1.9%). Miscoding of reason codes varied across self-insured employers. During the study period, 3430 employees had GU STD claims for 114,137 days (ICD-9s: 11.2%, 27 [SD 27] mean-days, 10,991 total-days; ICD-10s: 88.8%, 32 [30] mean-days, 103,146 total-days). Calculus Of Kidney was a top-5 condition for both ICD-9/-10 codes. Other common ICD-9 reasons included: Disorders of Uterus Not Elsewhere Classified (42 employees/$135,032/797 days), Other Specified Symptom Associated w/Female Genital Organs (37/$164,518/868), Unspecified Disorder of Kidney+Ureter (18/$70,905/335), and Other Unspecified Ovarian Cyst (19/$120,356/659). Most common ICD-10 reasons included: Excess+Frequent Menstruation w/Regular Cycle (138/$637,839/4468), Endometriosis Unspecified (146/$581,568/4719), Acute Inflammatory Disease of Uterus (153/$1,132,470/3949), and Hypertrophy of Breast (155/$450,604/4208).

CONCLUSIONS: Retrospective studies using Short-term Disability claims should include comprehensive ICD-9/-10 codes to accurately quantify the burden conditions using data after 2016. Limiting STD analyses for Genitourinary conditions to ICD-10 reason codes misses 11.2% claims, understates total STD costs by 9.5%, and total STD days by 9.6%.