Most common primary care diagnoses and procedures in the U.S.

Primary care providers (PCPs) are an integral part of the care continuum. These providers are on the front lines of population health management preventive care, gaining the trust of patients and families to deliver effective, personalized treatments.

PCPs are responsible for chronic care management, specialist referrals, and the evaluation of emerging health issues. Without a PCP, patients are at risk of receiving more serious diagnoses at later stages of illness, which can severely impact care outcomes.

Using data from the Definitive Healthcare Atlas All-Payor Claims product, we’ve compiled lists of the ten most common primary care diagnoses and procedures, ranked by their percentage of all primary care diagnoses and procedures in the U.S. Data is representing claims for the entire year of 2022.

Top 10 most common primary care diagnoses

Fig. 1 Data from the 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.

What is the most common diagnosis in primary care?

In 2022, essential (primary) hypertension, commonly known as high blood pressure, accounted for 5.5% of all U.S. primary care diagnoses, putting it at the top of the list. Hypertension is incredibly common as nearly half of adults have hypertension and only a quarter have it under control according to the CDC.  Left untreated, hypertension can lead to other serious conditions including heart disease, a heart attack, or a stroke.

The second most common primary care diagnosis was hyperlipidemia, unspecified, accounting for 2.4% of all U.S. primary care diagnoses. Hyperlipidemia describes elevated lipid levels, such as cholesterol, within the body. Hyperlipidemia itself does not typically lead to critical symptoms itself, however, having this underlying condition will often lead to serious illnesses that may ultimately lead to death.

Rounding out the top three was encounter for general adult medical examination without abnormal findings, accounting for 2% of all primary care diagnoses last year. Patients typically set up an appointment with their primary care provider around once a year for a routine checkup and physical examination. Oftentimes, the person visiting is perfectly healthy and does not need any further treatment.

Immunizations were the fourth most commonly reported physician encounter in 2022, emphasizing the importance of PCPs in offering preventative medicine and population health management. By providing immunizations for illnesses like the flu to eligible patients, PCPs can help curb preventable threats to population health.

Many of the top diagnoses are for prevalent conditions in the U.S. population. Because of their prevalence, PCPs are likely to encounter these chronic conditions regularly. Further down the list, there are a few more diagnoses for prevalent chronic conditions, including “Type 2 diabetes mellitus without complications” and “Gastro-esophageal reflux disease without esophagitis.”

Interestingly, the tenth code describes exposure to COVID-19, showing the prevalence of COVID-19 and the crucial role that PCPs played during the pandemic.

What is the primary care diagnosis with the most total charges?

Despite some diagnoses being more common than others, a few of the lower codes on this list account for a higher percentage of the total U.S. primary care charges than the ones at the top.

For example, the diagnosis with the most total charges is encounter for general adult medical examination without abnormal findings, followed by high blood pressure, and exposure to COVID-19.

Some diagnoses are more expensive to treat than others, so that’s how exposure to COVID-19 can account for one of the highest percentages of total primary care charges, while also placing 10th on our list based on volume.

Top 10 most common primary care procedures

Fig. 2 Data from the 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.

What procedures are most commonly performed by PCPs?

The procedure most commonly performed by PCPs was a routine venipuncture, or the collection of blood from veins, accounting for 4.1% of all primary care procedures last year. Blood is collected from a patient for a variety of ailments and for routine checkups, so it’s unsurprising that it takes the top spot. Many of the most common primary care procedures include diagnostic tests like this one or physical therapy services.

Accounting for 2.2% of all procedures last year, the second most common primary care procedure performed by PCPs was home health service/hospice of RN each 15 min. This is when the services of a clinical social worker in a home health or hospice setting are required for at least 15 minutes. The popularity of this code corresponds with the recent increase in home health care that has been seen in recent years.

Rounding out the top three is most recent diastolic blood pressure less than 80 Mm Hg, which is when a PCP takes a routine blood pressure reading. This code accounted for 2.1% of primary care procedures last year, and similarly to the top spot, is conducted for a variety of ailments, so its inclusion on this list is unsurprising.

What is the primary care procedure with the most total charges?

Like the list of PCP diagnoses, the list of PCP procedures is also shuffled considerably when ranking by percentage of total primary care charges. At the top of this list would be home health service/hospice of RN each 15 min. comprehensive metabolic panel (a type of blood test), and therapeutic exercises, which originally occupied the second, fifth, and ninth spots based on volume, respectively.

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Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.