Primary Care Providers (PCPs) are the cornerstone of healthcare, acting as the first point of contact for patients and families. They are essential in population health management and preventive care, building lasting relationships with patients to provide effective and personalized treatments. Their role extends to chronic care management, coordinating specialist referrals, and promptly evaluating new health concerns. Without consistent access to a PCP, individuals face a higher risk of delayed diagnoses, potentially leading to more severe health outcomes and increased healthcare costs.
Using comprehensive data from Definitive Healthcare’s Atlas All-Payor Claims database, we’ve identified the top ten most frequent primary care diagnoses in the U.S. for the year 2022. This analysis, based on millions of medical claims, provides crucial insights into the main primary care diagnoses encountered by PCPs nationwide.
Top 10 Most Common Primary Care Diagnoses in 2022
| Rank | ICD-10 code | ICD-10 description | % of total primary care diagnoses in U.S. | % of total primary care charges in U.S. |
|---|---|---|---|---|
| 1 | I10 | Essential (primary) hypertension | 5.5% | 2.1% |
| 2 | E785 | Hyperlipidemia, unspecified | 2.4% | 2.1% |
| 3 | Z0000 | Encounter for general adult medical examination without abnormal findings | 2.0% | 0.1% |
| 4 | Z23 | Encounter for immunization | 1.6% | 0.1% |
| 5 | E119 | Type 2 diabetes mellitus without complications | 1.6% | 0.6% |
| 6 | E782 | Mixed hyperlipidemia | 1.3% | 0.2% |
| 7 | E039 | Hypothyroidism, unspecified | 1.2% | 0.7% |
| 8 | K219 | Gastro-esophageal reflux disease without esophagitis | 1.1% | 0.9% |
| 9 | E559 | Vitamin D deficiency, unspecified | 1.0% | 0.1% |
| 10 | Z20822 | Contact with and (suspected) exposure to COVID-19 | 0.9% | 2.4% |
Fig. 1 Data from Definitive Healthcare’s Atlas All-Payor Claims product for the calendar year 2022. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Accessed August 2023.
Hypertension Leads as the Most Frequent Primary Care Diagnosis
In 2022, essential (primary) hypertension, widely recognized as high blood pressure, emerged as the leading primary care diagnosis, accounting for 5.5% of all diagnoses. The prevalence of hypertension is striking, with nearly half of U.S. adults affected, according to the CDC. Alarmingly, only a quarter of those with hypertension have it well-managed. Untreated hypertension significantly elevates the risk of serious cardiovascular conditions, including heart disease, heart attacks, and stroke. This highlights the critical role of PCPs in identifying and managing hypertension to mitigate long-term health risks.
Hyperlipidemia, unspecified, was the second most common primary care diagnosis, representing 2.4% of all diagnoses. Hyperlipidemia indicates elevated levels of lipids, such as cholesterol, in the bloodstream. While hyperlipidemia itself may not present immediate symptoms, it is a significant underlying risk factor for severe and potentially fatal diseases. PCPs play a crucial role in screening for and managing hyperlipidemia to prevent the onset of more serious health issues.
Completing the top three main primary care diagnoses was the “encounter for general adult medical examination without abnormal findings,” at 2% of diagnoses. This category reflects routine annual check-ups and physical examinations. These visits are a cornerstone of preventive care, allowing PCPs to monitor patient health, provide wellness advice, and detect potential health issues early, even when patients feel healthy.
Immunizations were the fourth most frequent reason for physician encounters in primary care, comprising 1.6% of diagnoses. This underscores the vital role of PCPs in preventive medicine and population health management. By administering crucial immunizations, such as flu vaccines, PCPs are instrumental in preventing widespread illnesses and safeguarding community health.
Many of the top primary care diagnoses are linked to prevalent chronic conditions in the U.S. population. Due to the widespread nature of these conditions, PCPs regularly manage them in their daily practice. Further down the list, diagnoses like “Type 2 diabetes mellitus without complications” and “Gastro-esophageal reflux disease without esophagitis” also reflect the ongoing management of common chronic illnesses within primary care settings.
Interestingly, “Contact with and (suspected) exposure to COVID-19” ranked tenth, demonstrating the significant impact of the COVID-19 pandemic on primary care. This diagnosis highlights the crucial frontline role PCPs played in identifying, managing, and mitigating the spread of COVID-19 within communities.
Primary Care Diagnosis with the Highest Charges
While hypertension is the most common diagnosis by volume, “Encounter for general adult medical examination without abnormal findings” surprisingly accounts for the highest percentage of total primary care charges. Following closely are high blood pressure and exposure to COVID-19 in terms of financial impact.
This disparity between volume and charges indicates that some less frequent diagnoses can be more resource-intensive to manage. The higher charges associated with general adult medical examinations might reflect the bundled services, preventative screenings, and comprehensive assessments conducted during these visits. Similarly, while COVID-19 exposure is lower in volume ranking, the associated charges could be attributed to testing, initial assessments, and follow-up care.
Top 10 Most Common Primary Care Procedures
| Rank | HCPCS/CPT code | HCPCS/CPT description | % of total primary care procedures in U.S. | % of total primary care charges in U.S. |
|---|---|---|---|---|
| 1 | 36415 | Routine venipuncture | 4.1% | 0.4% |
| 2 | G0299 | Home health service/hospice of RN each 15 min | 2.2% | 2.5% |
| 3 | 3078F | Most Recent Diastolic Blood Pressure Less Than 80 Mm Hg | 2.1% | 0.0% |
| 4 | 3074F | Most Recent Systolic Blood Pressure Less Than 130 Mm Hg | 1.9% | 0.0% |
| 5 | 80053 | Comprehensive metabolic panel | 1.8% | 1.7% |
| 6 | 80061 | Lipid panel | 1.7% | 1.0% |
| 7 | 85025 | Complete CBC with automated differential WBC | 1.7% | 0.7% |
| 8 | 3008F | Body Mass Index (BMI), Documented | 1.7% | 0.0% |
| 9 | 97110 | Therapeutic Exercises | 1.7% | 1.3% |
| 10 | 83036 | Glycosylated hemoglobin test | 1.6% | 0.6% |
Fig. 2 Data from Definitive Healthcare’s Atlas All-Payor Claims product for the calendar year 2022. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Accessed August 2023.
Routine Venipuncture: The Most Common Primary Care Procedure
Routine venipuncture, or blood collection from a vein, was the most frequently performed procedure by PCPs, accounting for 4.1% of all procedures. Blood tests are integral to diagnosing a wide range of conditions and are a standard part of routine check-ups, making venipuncture a common procedure in primary care settings. Many of the top procedures are diagnostic tests or related to monitoring patient health, such as physical therapy services.
Home health service/hospice of RN each 15 min was the second most common procedure, representing 2.2% of all primary care procedures. This reflects the growing trend of home healthcare and the increasing need for skilled nursing services in home and hospice settings. The prevalence of this procedure aligns with the overall increase in demand for home-based healthcare services.
Measuring diastolic blood pressure (Most Recent Diastolic Blood Pressure Less Than 80 Mm Hg) was the third most common procedure, at 2.1%. Similar to venipuncture, blood pressure readings are a routine part of primary care visits, essential for monitoring cardiovascular health and managing conditions like hypertension.
Primary Care Procedure with the Highest Charges
Similar to diagnoses, the ranking of procedures shifts when considering total charges. Home health service/hospice of RN each 15 min ranks highest in charges, followed by comprehensive metabolic panel and therapeutic exercises. These procedures, while not the most frequent by volume, are associated with higher healthcare costs, reflecting the intensity and resources required for home healthcare, complex lab tests, and therapeutic interventions.
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These Healthcare Insights are derived from healthcare commercial intelligence within the Definitive Healthcare platform. For deeper analysis and access to the latest healthcare data on hospitals, physicians, and other providers, start a free trial today.
