Federal Notice of next CFSAC meeting, Tuesday 8 and Wednesday 9 November (US)

Federal Notice of next CFSAC meeting, Tuesday 8 and Wednesday 9 November (US)

Shortlink: http://wp.me/p5foE-3kV

Update @ October 19, 2011

An expanded version of the email I received from Mr Emmett Nixon on October 14 has now been posted on the CFSAC site at http://www.hhs.gov/advcomcfs/notices/n101811.html which includes the following:

“We will provide a video recording of the meeting on the CFSAC webpage, http://www.hhs.gov/advcomcfs, which will be posted within one week of the meeting. This recording will be compliant with Section 508 of the Rehabilitation Act and will include captions.”

**********************************************************************************************

Fall CFSAC meeting

The Federal Notice announcing dates for the Fall Chronic Fatigue Syndrome Advisory Committee (CFSAC) meeting was issued on October 5, 2011 and can be read here Federal Notice. At the time of publishing, an agenda for this meeting has yet to be released. I will update when the agenda has been published.

Custom TinyURL: http://tinyurl.com/November2011CFSAC

The two day meeting will be held on Tuesday, November 8, 2011 and Wednesday, November 9, 2011 at a new venue – the Holiday Inn Capitol, Columbia Room, 550 C Street, SW., Washington, DC.

Since May 2009, the entire meeting proceedings have been streamed as live video with videocasts posted online a few days after the meeting has closed. For the November meeting, CFSAC has stated that only a live audio feed will be provided rather than real-time visuals and auto subtitling and that a high quality video will be provided at a later date.

The Federal Notice can be read below and beneath that, a clarification received on October 14, from Mr Emmett Nixon (HHS/OAHS), CFSAC Support Team.

Meeting of the Chronic Fatigue Syndrome Advisory Committee

A Notice by the Health and Human Services Department on 10/05/2011

Summary

As stipulated by the Federal Advisory Committee Act, the U.S. Department of Health and Human Services is hereby giving notice that the Chronic Fatigue Syndrome Advisory Committee (CFSAC) will hold a meeting. The meeting will be open to the public.

Table of Contents

DATES:
ADDRESSES:
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:

DATES:

The meeting will be held on Tuesday, November 8, 2011 and Wednesday, November 9, 2011. The meeting will be held from 9 a.m. to 5 p.m. on November 8, 2011, and 9 a.m. to 4:30 p.m. on November 9, 2011.

ADDRESSES:

Holiday Inn Capitol; Columbia Room; 550 C Street, SW., Washington, DC 20024; Hotel (202-479-4000).

FOR FURTHER INFORMATION CONTACT:

Nancy C. Lee, MD; Designated Federal Officer, Chronic Fatigue Syndrome Advisory Committee, Department of Health and Human Services; 200 Independence Avenue, SW., Hubert Humphrey Building, Room 712E; Washington, DC 20201. Please direct all inquiries to cfsac@hhs.gov .

SUPPLEMENTARY INFORMATION:

CFSAC was established on September 5, 2002. The Committee shall advise and make recommendations to the Secretary, through the Assistant Secretary for Health, on a broad range of topics including (1) The current state of knowledge and research and the relevant gaps in knowledge and research about the epidemiology, etiologies, biomarkers and risk factors relating to CFS, and identifying potential opportunities in these areas; (2) impact and implications of current and proposed diagnosis and treatment methods for CFS; (3) development and implementation of programs to inform the public, health care professionals, and the biomedical academic and research communities about CFS advances; and (4) partnering to improve the quality of life of CFS patients.

The agenda for this meeting is being developed. The agenda will be posted on the CFSAC Web site, http://www.hhs.gov/advcomcfs , when it is finalized. The meeting will be recorded and archived for on-demand viewing through the CFSAC Web site. It will be available by audio on both days and the call-in numbers will be posted on the CFSAC Web site.

Public attendance at the meeting is open. Those attending the meeting will need to sign-in prior to entering the meeting room. Individuals who plan to attend and need special assistance, such as sign language interpretation or other reasonable accommodations, should notify the designated contact person at cfsac@hhs.gov in advance.

Members of the public will have the opportunity to provide oral testimony on both days of the meeting; pre-registration for oral testimony is required. Individuals who wish to address the Committee during the public comment session must pre-register by Wednesday, October 26, 2011, via e-mail to cfsac@hhs.gov. Time slots for public comment will be available on a first-come, first-served basis and will be limited to five minutes per speaker; no exceptions will be made. Priority will be given to individuals who have not presented public comment at previous CFSAC meetings. Individuals registering for public comment should submit a copy of their oral testimony in advance to cfsac@hhs.gov, prior to the close of business on Wednesday, October 26, 2011. If you wish to remain anonymous, please notify the CFSAC support team staff upon submission of your materials to cfsac@hhs.gov.

If you do not submit your written testimony by the close of business Wednesday, October 26, 2011, you may bring a copy to the meeting and present it to a CFSAC support team staff member. Your testimony will be included in a notebook available for viewing by the public on a table at the back of the meeting room.

Individuals who do not provide public comment at the meeting, but who wish to have printed material distributed to CFSAC members for review should submit, at a minimum, one copy of the material to the Designated Federal Officer at cfsac@hhs.gov prior to close of business on Wednesday, October 26, 2011. Submitted documents should be limited to five typewritten pages. If you wish to remain anonymous, please notify the CFSAC support team staff upon submitting your materials to cfsac@hhs.gov .

All testimony and printed material submitted for the meeting are part of the official meeting record and will be uploaded to the CFSAC Web site; this material will be made available for public inspection. Testimony and materials submitted should not include any sensitive personal information, such as a person’s social security number; date of birth; driver’s license number, State identification number or foreign country equivalent; passport number; financial account number; or credit or debit card number. Sensitive health information, such as medical records or other personal identifiable health information, or any non-public corporate or trade association information, such as trade secrets or other proprietary information also should be excluded from any materials submitted.

Dated: September 30, 2011.

Nancy C. Lee,

Designated Federal Officer, Chronic Fatigue Syndrome Advisory Committee.

[FR Doc. 2011-25739 Filed 10-4-11; 8:45 am]

 

On October 14, I received the following clarifications from Mr Emmett Nixon, (HHS/OAHS) CFSAC Support Team, in response to queries first raised with Dr Nancy Lee, on October 11, concerning the arrangements for the recording and streaming of this meeting and the rationale behind the change of venue.

Mr Nixon’s response (October 14, 2011):

“We have heard concerns about changes we have made in the venue and the format of the upcoming 2011 November Chronic Fatigue Syndrome Advisory Committee meeting. Below we provide additional details about the meeting.

“We are working diligently to address major shifts in budget restrictions and protecting the personal safety of the public attending the meeting. We have moved the Fall CFSAC meeting to the Holiday Inn 550 C. St. SW, Columbia Room, Washington, D.C. 20024. This change was made because the HHS Humphrey Building Room 800 cannot accommodate more than 50 persons, and we are required to escort all persons attending the meeting due to security measures in place. The Columbia room at the Holiday inn holds a maximum of 300 people and provides an opportunity for the public to move freely about the hotel, rest in their rooms and use open hotel areas including the hotel cafeteria and restaurant. HHS will continue to provide a quiet area in the rear of the Columbia room to accommodate those needing a place to rest. HHS will not provide any medical services.

“There will be a live audio link to the two day meeting, which allows listeners to hear the entire meeting in real time. Due to budgetary considerations, we are unable to provide a live-video cast as previously arranged. We will provide a video recording of the meeting on the CFSAC webpage http://www.hhs.gov/advcomcfs . This recording will provide a higher quality video at substantially lower cost.

“Time slots for public testimony will be available on a first-come, first-served basis and limited to five minutes per speaker. Priority will be given to individuals who have not given public testimony in previous meetings. Three hours have been allotted for public testimony. As before, we will accommodate persons who want to provide their testimony by telephone.

“The CFSAC Support Team”

 

On October 17, I wrote again to Mr Nixon, CC Dr Nancy Lee and Dr Chris Snell, Chair, CFSAC Committee, requesting that the decision not to provide live video streaming be reviewed, citing the issue of accessability to a public meeting by a patient group with disabilities, sensory processing difficulties and cognitive impairment and that a precedent had been set in May 2009 when video streaming was introduced for these meetings, which are viewed live not just in the US, but internationally.

In raising this issue with CFSAC Support Team, I have presented my concerns as an individual and have no connection with any other initiatives or approaches that might be being made to the Committee in respect of similar concerns over the arrangements for this November meeting.

 

Related material

Discussion of proposals for coding of CFS for ICD-10-CM at May 10-11, 2011 CFSAC meeting

Position statement (ICD-10-CM proposed coding issue)

Position statement (ICD-10-CM proposed coding issue)

Shortlink: http://wp.me/p5foE-3kj

25 September 2011

Since I continue to be misrepresented on at least one platform I am reluctantly publishing a public position statement.

ME agenda is the name of one of several WordPress sites that I own. The site name was registered with WordPress in 2007. ME agenda is also the username I use on Facebook, Twitter and on a number of other internet platforms.

Within the last few days, ME agenda has several times been referred to as “a group” on Phoenix Rising forum and elsewhere. I have already clarified that ME agenda is not a “group” nor any kind of organisation.

On the Disclaimer page of my Dx Revision Watch website it states:

“Dx Revision Watch is not an organisation.

“This site has no connection with and is not endorsed by the American Psychiatric Association (APA), American Psychiatric Publishing Inc., World Health Organisation (WHO) or any other organisation, institution, corporation or company.

“This site has no affiliations with any commercial or not-for-profit organisation. The site operates independently of any patient or advocacy organisation or group.

“This site does not accept advertising, sponsorship, funding or donations and has no commercial links with any organisation, institution, corporation, company or individual.”

On my ME agenda website Disclaimer page it also states:

“ME agenda is not an organisation.

“This site has no connection with and is not endorsed by any organisation, institution, corporation or company. The site has no affiliations with any commercial or not-for-profit organisation and operates independently of any patient or advocacy organisation or group.

“This site does not accept advertising, sponsorship, funding or donations and has no commercial links with any organisation, institution, corporation, company or individual.”

So ME agenda is not “a group”; does not function as “a group” nor as any form of organisation, and the name ME agenda and my websites are associated only with one individual – myself.

The advocacy work that I do under my own name and in association with the name ME agenda is undertaken as an individual with an interest in a specific health area, as a primary carer of a young adult. I do not claim a mandate to represent others and the views and opinions I hold are the views and opinions of a single individual.

I therefore request that neither I nor ME agenda nor my websites are referred to on any platform as “a group”, since this is erroneous and misrepresents me.

It has also been misstated on Phoenix Rising forum and elsewhere, that I am “trying to get CFS reclassified as ME.”

This is not the case and again, misrepresents my position. My position is this:

I consider as an individual, not as any form of “group”, since I am not any form of “group”:

that it will hurt patients if Chronic fatigue syndrome is coded in ICD-10-CM under Chapter 18, the chapter for “Symptoms, signs and ill-defined conditions”, under “R53.82 Chronic fatigue, unspecified > Chronic fatigue syndrome NOS”;

that Chronic fatigue syndrome should be coded to the “G93″ parent class, in line with ICD-10, ICD-10-CA (Canada) and ICD-10-GM (Germany), and in line with ICD-11 proposals that Chronic fatigue syndrome should be classified within Chapter 6: Diseases of the nervous system;

that classifying Chronic fatigue syndrome under the Chapter 18 “R” codes, in ICD-10-CM, will render patients more vulnerable to the proposals of the DSM-5 “Somatic Symptom Disorders” workgroup.

These are views shared by other advocates, patients and carers, internationally, by the US CFSAC Committee (the Chronic Fatigue Syndrome Advisory Committee that provides advice and recommendations to the Secretary of Health and Human Services) and by a number of US 501(c)(3) registered patient advocacy organisations.

At no time have I stated or implied that I am “trying to get CFS reclassified as ME”.

It should also be noted that I have had no involvement in or input into the initiative of the US Coalition4ME/CFS to make representations to the NCHS Committee responsible for updates to the US specific ICD-9-CM and development of ICD-10-CM, which replaces ICD-9-CM in October 2013.

I hope this makes my position clear and I trust that there will be no future misrepresentation of my views or my actions on any platform.

Discussion of the issue of the long-standing proposals for the coding of Chronic fatigue syndrome in ICD-10-CM was on the agenda of the meeting of the ICD-9-CM Coordination and Maintenance Committee which took place on September 14.

An audio of this meeting and PDFs of meeting materials can be accessed from this page on the CDC website:

http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

These materials and links and related ICD-10-CM coding issue material will be added to this site in due course.

Suzy Chapman
_____________________

http://dxrevisionwatch.wordpress.com
http://meagenda.wordpress.com
http://www.facebook.com/MEagenda
http://twitter.com/MEagenda

Posting of revised draft proposals for DSM-5 criteria postponed until August

The APA has postponed the release of revised draft proposals for DSM-5 criteria by three months

Shortlink: http://wp.me/p5foE-3hZ

Slip slidin’ away…

There will be no public review of revised draft criteria for DSM-5 categories this coming May.

APA Field Trials got off to a late start and the DSM-5 timeline continues to slip.

Online posting of draft disorders and criteria proposed by the DSM-5 Work Groups for new and existing mental disorders had been scheduled for May-July, this year. Revised criteria were expected to be posted online in May, for a period of approximately one month to allow the public to review proposals and submit comment.

But according to a revised Timeline on the American Psychiatric Association’s (APA) DSM-5 Development site, this second public review exercise is now postponed until August-September 2011:

“August-September 2011: Online Posting of Revised Criteria. Following the internal review, revised draft diagnostic criteria will be posted online for approximately one month to allow the public to provide feedback. This site will be closed for feedback by midnight on September 30, 2011.”

There are also references within the DSM-5 Timeline to ICD-10-CM and the forthcoming ICD-10-CM Partial Code Freeze, and to ICD-11.

ICD-11 Beta Draft

According to sources, ICD-11 Revision Steering Group are still working towards having a Beta Draft ready for May 2011.

But from a PowerPoint presentation posted briefly on the ICD-11 Revision website at the end of February, but swiftly removed following enquiries, evidently the WHO has been discussing the pros and cons of postponing the release of its own Beta Draft for public input until the autumn, or until the end of 2011, or possibly even May 2012.

Another ICD Revision document: ICD Revision Project Plan v 2.1, projects a date of May 2012 for release of the Beta Draft. Since there is no definitive and recent ICD-11 timeline on any of the WHO’s ICD Revision sites, and since ICD Revision is keeping schtum, it remains unclear at what point in the timeline a Beta Draft for ICD-11 will be released for public scrutiny and input (as opposed to purely internal use, as the Alpha Draft had been). I will update when more information becomes available.

The original dissemination date for ICD-11 had been 2012, with the timelines for the revision of ICD-10 and DSM-IV running more or less in parallel. But in 2007/8, the release date for ICD-11 was shifted to pilot implementation in 2014 and dissemination in 2015. A “pre-final draft” of ICD-11 is projected for March 2013 with submission for WHA endorsement in May 2014. ICD Revision are balancing “incomplete software, unsatisfactory content and incomplete review process” against reduced opportunity for public input and reduced public confidence, if the timeline for the Beta were to be extended.

In December 2009, the APA announced that the publication date for their DSM-5 was being extended to May 2013.

In January 2010, APA President, Alan F Schatzburg, MD, said:

“…the extension will permit better linking of DSM-5 to the U.S. implementation of the ICD-10-CM codes for all Medicare/Medicaid claims reporting, which are scheduled to go into effect on October 1, 2013. APA will also continue to work with the World Health Organization (WHO) to harmonize DSM-5 with the mental and behavioral disorders section of ICD-11, which WHO plans to release no sooner than 2014.”

With a Partial Code Freeze looming this October for ICD-10-CM, the delays in starting field trials and now a three month postponement of publication of revised criteria for the second public review and comment period isn’t going to inspire confidence in a Task Force that has already come in for significant criticism of its oversight of the revision of DSM-IV.

Revised and expanded DSM-5 Timeline

http://www.dsm5.org/about/Pages/Timeline.aspx

(Picking up from July 2010, see webpage for full Timeline.)

[...]

July 2010 – July 2011: Invited Consumer Feedback. Throughout the field trials, feedback will be solicited from consumer and professional groups and during specialty meetings, such as NAMI, the Depression and Bipolar Support Alliance, the Science Advisory Board, Children and Adults.

July 2010 – December 2012: Drafting Text for DSM-5. Members of the DSM-5 Task Force and Work Group will begin drafting their initial text for DSM-5, including possible revisions to text descriptions within each diagnostic chapter. Text of the criteria themselves must wait to be drafted until after the completion of field trials. During this time, case studies will also be developed, which will be published after DSM-5’s release in a series of case books.

January 2011: The APA presented to the National Center for Health Statistics an updated crosswalk between ICD-9-CM/DSM-IV codes and DSM-5 codes for discussion in the biannual ICD-CM revision meetings in March and September 2011 (see “March 2011”, below). Any “new” DSM-5 disorders will be subject to addition or deletion based on field trial data and APA BOT approval.

March-October 2011: Revised Chapter and Diagnostic Coding Structure of DSM-5. The American Psychiatric Association and the World Health Organization are working closely to ensure harmonization between DSM-5 and the forthcoming 10th edition of the International Classification of Diseases-Clinical Modification (ICD-10-CM), which will be adopted for use in the U.S. by Medicare and Medicaid on October 1, 2013. In order allow for adequate time for user training and update of computerized coding systems, ICD-10-CM will freeze to further revisions on October 1, 2011. Final decisions on the chapter organization of DSM-5 will be discussed at the September 2011 National Center for Vital and Health Statistics’ annual ICD-10-CM revision conference. The harmonized DSM-5/ICD-10-CM will serve as a prototype for ICD-11, which is scheduled for publication in 2014. However, since the coding structure for ICD-11 is expected to change, DSM-5 will use the closest approximation of ICD-10-CM codes to the disorders defined by DSM-5. (See my Footnotes)

August-September 2011: Revisions to Proposed Criteria. Based on results from the first phase of field trials and from consumer and advocacy feedback, the DSM-5 Task Force and Work Group members will make revisions to the proposed DSM-5 diagnostic criteria and dimensional measures. These revised criteria and measures will be tested in a second phase of field trials.

August – September 2011: Review of Revised Criteria. Revised proposed criteria will be subjected to internal review, including a review by the DSM-5 Task Force and Research Group and by other relevant work groups.

August-September 2011: Online Posting of Revised Criteria. Following the internal review, revised draft diagnostic criteria will be posted online for approximately one month to allow the public to provide feedback. This site will be closed for feedback by midnight on September 30, 2011.

September 2011 – February 2012: DSM-5 Field Trials, Phase II. The second phase of field trials testing will focus on those diagnostic criteria and dimensional measures that required modification based on the results of the Phase I field trials. This time period will include data collection and analysis.

October 1, 2011: Although ICD-10-CM codes will not go into effect in the U.S. until October 1, 2013, most will be approved by October 1, 2011, to allow insurance companies enough time to reprogram computers for claims data and train health professionals. However, the ICD-10-CM coding system will not be locked in as of

October 1, 2011: Additional code changes will be permitted between October 2011 and October 2013 to introduce “new” disorders or to correct obvious errors of current disorders. In addition, proposals for code changes in ICD-10-CM will be routinely considered on an annual basis in 2014—after ICD-10-CM has been officially adopted.

February – August 2012: Prepare Final Draft Text (including revisions to criteria based on findings from Phase II of DSM-5 Field Trials). The DSM-5 Task Force and Work Groups will prepare the final draft text and criteria for review.

March 2012: Presentation of final DSM-5 chapter organization to APA Board of Trustees.

August 2012: Final Review. The APA will release the revised draft criteria to the APA Assembly and Board of Trustees for final review.

September – November 2012: Final Revisions to Draft Criteria. Work group members will make their last round of revisions to draft criteria based on feedback from APA’s Assembly and Board of Trustees.

November 2012: APA Assembly Approval of DSM-5.

December 2012: APA Board of Trustees Approval of DSM-5. Following approval from the Board of Trustees, the final completed manuscript will be submitted to the APA’s publishing division, American Psychiatric Publishing, Inc.

May 2013: Publication of DSM-5. The release of DSM-5 will take place during the APA’s 2013 Annual Meeting in San Francisco, CA.

October 1, 2013: Mandatory use of ICD-10-CM code numbers in DSM-5 for insurance claims.

Ed: Footnotes: The “harmonization” of DSM-5 and ICD-11

The APA participates with the WHO in the “International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders” (Chapter 5) and a “DSM-ICD Harmonization Coordination Group”.

There is already a degree of correspondence between DSM-IV and Chapter V of ICD-10. For the next editions, the APA and the WHO have committed as far as possible:

“To facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria.”

with the objective that

“The WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.”

But the WHO acknowledges there may be areas where congruency between the two systems may not be achievable.

As the iCAT (the ICD-11 electronic collaborative drafting platform) stood last November, two new categories were listed in the Linearized Chapter 5, F45 – F48.0 (Somatoform Disorders) codes. It is understood from ICD documentation (DIFF File – Changes from ICD-10 [MS Excel doc. Retrieved 29.09.10; no longer available on 01.10.10]) that child categories F45.40 and F45.41 are new entities for ICD-11 [1].

Note the ICD-11 categories between F45 – F48.0, as they stood in the iCAT drafting platform last November, do not mirror current proposals of the DSM-5 “Somatic Symptom Disorder” Work Group for renaming the “Somatoform Disorders” categories of DSM-IV to “Somatic Symptom Disorders” and combining a number of existing categories under a new rubric, “Complex Somatic Symptom Disorder (CSSD)”, and the more recently proposed “Simple Somatic Symptom Disorder (SSSD)” [2][3].

[1] Screenshot iCAT, ICD-11: Chapter 5: F45 – F48.0: http://dxrevisionwatch.files.wordpress.com/2010/05/2icatchapter5f45somatoform.png

[2] Article: Erasing the interface between psychiatry and medicine (DSM-5), Chapman S, 13 February 2011: http://wp.me/pKrrB-Vn

[3] Article: Revisions to DSM-5 proposals on 14.01.11: New category proposed “Simple Somatic Symptom Disorder, Chapman S, 16 January 2011: http://wp.me/pKrrB-St

[4] DSM-5 Development website: http://www.dsm5.org/about/Pages/Timeline.aspx

Ian Swales, MP amends his understanding of government policy on CFS and ME

Ian Swales, MP amends his understanding of government policy on CFS and ME terminology (Three Parliamentary errors)

Shortlink Post: http://wp.me/p5foE-3hH

On 2 February 2011, Ian Swales (Lib Dem, Redcar) addressed a Parliamentary Adjournment Debate on ME. During that debate, the Health Minister, Paul Burstow, had stated that the World Health Organisation (WHO) uses the composite term CFS/ME for this condition.

This was incorrect. The WHO does not use the composite terms “CFS/ME” or “ME/CFS”.

In a Parliamentary Written Answer to Mr Swales, dated 16 February, the Health Minister corrected his error [1].

Mr Burstow had clarified:

“…During the Westminster Hall debate, on 4 February 2011, I said that the World Health Organisation uses the composite term CFS/ME for this condition. This was incorrect.

“The World Health Organisation classes benign myalgic encephalomyelitis and post viral fatigue syndrome under the same classification G93.3 ‘diseases of the nervous system’; subheading ‘other disorders of the brain’.

“The report of the CFS/ME Working Group to the Chief Medical Officer, in January in 2002, suggested that the composite term CFS/ME be used as an umbrella term for this condition, or spectrum of disease. This term is also used by the National Institute for Health and Clinical Excellence for their clinical guidelines.

“We do, however, intend to seek further advice on our classification and will update the hon. Member in due course.”

[Note that although Health Minister, Paul Burstow, gave the date of Ian Swales' Adjournment Debate as "4 February" in his Written Answer of 16 February, the Debate took place on 2 February 2011.]

On 17 February, Mr Swales published a report on his website which went out under the title “Swales wins battle with Government on ME”. This report had claimed:

“Ian Swales MP’s fight for better treatment of myalgic encephalomyelitis (ME) continues as he succeeds in getting the Government to recognise ME and Chronic Fatigue Syndrome (CFS) as different illnesses.”

But Mr Swales had misinterpreted the content of the Written Answer he had received from the Health Minister.

This has caused much confusion amongst ME and CFS patients.

Advocates have raised this misunderstanding with Mr Swales and with his Parliamentary Researcher.

Today, an amended report has been published on Mr Swales’ website under the same URL and date, but with a new title – this time it is called:

“Swales corrects Minister on World Health Organisation definition of ME”

I am appending both versions.

To recap, because this is important, and because there is a further error:

Paul Burstow, Health Minister, incorrectly stated on 2 February, during an Adjournment Debate, that the WHO uses the composite term CFS/ME for this condition. That error was corrected by Mr Burstow in his Written Answer of 17 February.

Ian Swales, MP, then claimed in a website report that he had succeeded in getting the government to recognise ME and Chronic Fatigue Syndrome (CFS) as different illnesses. This was a misinterpretation of Mr Burstow’s own correction and clarification. Mr Swales’ Parliamentary Office has now amended his report.

The Countess of Mar, meanwhile, tabled a Written Question of her own for which a response was provided on 1 March, by Earl Howe [3].

The Countess of Mar had tabled:

“To ask Her Majesty’s Government, further to the statement by the Minister of State for Health, Paul Burstow, on 2 February (Official Report, Commons, col. 327) that the World Health Organisation (WHO) described myalgic encephalomyelitis (ME) as Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME) and that this was the convention followed by the Department, in light of the fact that the WHO International Classification of Diseases 10 lists ME as a neurological disease with post viral fatigue syndrome (PVFS) under G93.3 and CFS as a mental health condition under F48.0 and that the latter specifically excludes PVFS, whether they will adhere to that classification.”

The response received on 1 March, was:

Earl Howe (Parliamentary Under Secretary of State (Quality), Health; Conservative)

“The department will continue to use the composite term chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) for this condition, or spectrum of disease, as suggested by the Chief Medical Officer in his 2002 report. We recognise the condition as neurological in nature.”

But the Countess of Mar’s Written Question also contains an error.

In the International version of ICD-10 (the version used in the UK and over 110 other countries, but not in the US which uses a “Clinical Modification” of ICD-9), CFS is not classified as a mental health condition under F48.0.

Chronic fatigue syndrome is listed in ICD-10 Volume 3: The Alphabetical Index, where it is indexed to G93.3, the same code as Postviral fatigue syndrome.

So in International ICD-10, Postviral fatigue syndrome, Benign myalgic encephalomyelitis and Chronic fatigue syndrome are all three coded or indexed to G93.3 under “G93 Other disorders of brain”, in Chapter VI (6): Diseases of the nervous system.

In International ICD-10, the Mental and behavioural disorders chapter is Chapter V (5).

http://www.who.int/classifications/apps/icd/icd10online/?gf40.htm+f480

Chapter V (5) Mental and behavioural disorders

Neurotic, stress-related and somatoform disorders are coded between (F40-F48)

Neurasthenia
Fatigue syndrome

are classified under (F40-F48) at F48.0, which specifically Excludes

malaise and fatigue ( R53 )

and

postviral fatigue syndrome ( G93.3 )

So now you know what UK government policy is and that Mr Swales had misled himself.

The forthcoming US specific ICD-10-CM

Perhaps the focus can now return to more pressing issues – like the fact that in the US, a Partial Code Freeze is looming for the forthcoming US specific version of ICD-10, known as “ICD-10-CM”.

Under longstanding proposals, the committees developing ICD-10-CM intend to retain Chronic fatigue syndrome in the R codes, and code it under R53 Malaise and fatigue, at R53.82 Chronic fatigue syndrome (NOS), but propose to code for PVFS and ME in Chapter 6, under G93.3.

The R codes chapter (which will be Chapter 18 in ICD-10-CM) is the chapter for

“Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)”

“This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill defined conditions regarding which no diagnosis classifiable elsewhere is recorded.”

Coding CFS patients under R53.82 will consign them to a dustbin diagnosis: there are no guarantees that clinicians will use the unfamiliar ME code or that insurance companies will reimburse for G93.3. It will make patients more vulnerable to the proposals of the DSM-5 Somatic Symptom Disorders Work Group. It will mean that ICD-10-CM will be out of line with at least four versions of ICD-10, including the Canadian “Clinical Modification”, and also out of line with the forthcoming ICD-11, where all three terms are proposed to be coded in Chapter 6 Diseases of the nervous system.

There are only seven months left before the 1 October Code Freeze and the clock is ticking.

 

Here is the first version of Mr Swales’ website report, followed by his amended version.

Version One:

http://ianswales.com/en/article/2011/455560/swales-wins-battle-with-government-on-me

Swales wins battle with Government on ME

February 17, 2011 3:45 PM

Ian Swales MP’s fight for better treatment of myalgic encephalomyelitis (ME) continues as he succeeds in getting the Government to recognise ME and Chronic Fatigue Syndrome (CFS) as different illnesses.

During Ian’s recent parliamentary debate on ME he argued that the Government needs to distinguish between Chronic Fatigue Syndrome and ME to provide better treatment for the different illnesses.

However, Health Minister Paul Burstow MP responded by saying that the World Health Organisation classifies Chronic Fatigue Syndrome and ME as the same illness.

Following an outcry from the ME community about this statement, Ian challenged the Minister on his definition of CFS/ME. The Minister admitted that the definition he used in the debate was “incorrect”.

Commenting, Ian Swales MP said:

“I am pleased that the Government has now recognised that ME and Chronic Fatigue Syndrome are two different illnesses.

“After the debate I received a lot of correspondence from the ME community about the Government’s definition of CFS/ME, so after doing some more research on the matter I decided it was right to clarify this point with the Minister. I know they will be reassured by this news.

“I hope that approaching ME as a distinct condition will help lead to better, more effective treatment for sufferers through better analysis of their possible different causes and symptoms.”

[Ends]

Version Two:

http://ianswales.com/en/article/2011/455560/swales-wins-battle-with-government-on-me

Swales corrects Minister on World Health Organisation definition of ME

February 17, 2011 3:45 PM

Ian Swales MP’s fight for better treatment of myalgic encephalomyelitis (ME) continues as he succeeds in getting the Government to acknowledge that the World Health Organisation does not use the composite term CFS/ME for the condition.

During Ian’s recent parliamentary debate on ME he argued that the Government needs to distinguish between Chronic Fatigue Syndrome and ME to provide better treatment for the different illnesses.

However, Health Minister Paul Burstow MP responded by saying that the World Health Organisation “uses the composite term CFS/ME for the condition”.

Following an outcry from the ME community about this statement, Ian challenged the Minister on his definition of CFS/ME. The Minister admitted that his statement was “incorrect”.

Commenting, Ian Swales MP said:

“I am pleased that the Minister has acknowledged the error he made in the debate.

“After the debate I received a lot of correspondence from the ME community about the Government’s definition of CFS/ME, so after doing some more research on the matter I decided it was right to clarify this point with the Minister. I know they will be reassured by this news.

“I will continue my campaign to get more effective treatment for sufferers of ME through better analysis of its causes and symptoms.”

[Ends]

The text of the Adjournment Debate can be read here, on Hansard
2 Feb 2011 : Column 323WH

Myalgic Encephalomyelitis
4.13 pm

Watch video, here, on BBC News:

http://news.bbc.co.uk/democracylive/hi/house_of_commons/newsid_9382000/9382412.stm

 

References:

[1] Written Answer: Paul Burstow to Ian Swales, 16 February 2011, 16 Feb 2011 : Column 864W:
http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110216/text/110216w0004.htm

[2] Amended Ian Swales website report:
http://ianswales.com/en/article/2011/455560/swales-wins-battle-with-government-on-me

[3] Written Answer: Earl Howe to The Countess of Mar, 01 March 2011:
http://www.theyworkforyou.com/wrans/?id=2011-03-01a.297.1

Hansard for above:
http://www.publications.parliament.uk/pa/ld201011/ldhansrd/text/110301w0001.htm#11030162000766

[4] Hansard, House of Lords Debate: Myalgic Encephalomyelitis, 22 January 2004:
http://www.publications.parliament.uk/pa/ld200304/ldhansrd/vo040122/text/40122-12.htm

[5] Current codings in ICD-10 for Postviral fatigue syndrome; [Benign] myalgic encephalomyelitis and Chronic fatigue syndrome:
http://dxrevisionwatch.wordpress.com/icd-11-me-cfs/

“CFS orphaned in the “R” codes in US ICD-10-CM” and “Erasing the interface between psychiatry and medicine” (DSM-5)

Two new posts on Dx Revision Watch

Shortlink: http://wp.me/p5foE-3h3

“CFS orphaned in the “R” codes in US specific ICD-10-CM”

http://wp.me/pKrrB-V4

and

“Erasing the interface between psychiatry and medicine” (DSM-5)

http://wp.me/pKrrB-Vn

New category proposal for DSM-5: “Simple Somatic Symptom Disorder”

New category proposal for DSM-5: “Simple Somatic Symptom Disorder”

Shortlink: http://wp.me/p5foE-3gz

The most recent proposals of the DSM-5 “Somatic Symptoms Disorders” Work Group plus two key Disorder Description and Rationale PDF documents can be read on the APA’s DSM-5 Development site here:

http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

The two key Somatic Symptoms Disorders Work Group Draft Proposal documents:

    Revised Disorder Descriptions: Version 1/14/11

    Revised Justification of Criteria Version 1/31/11

Images Copyright 2011 ME agenda  No unauthorized reproduction

On 16 January, I reported on my Dx RevisionWatch site that the page for current DSM-5 proposals for the revision of the DSM-IV categories and diagnostic criteria for “Somatoform Disorders” had been updated on 14 January, with a new category proposal called “Simple Somatic Symptom Disorder”.

This proposal is in addition to the recommendations of the Somatic Symptom Disorders Work Group, published in February 2010, for grouping a number of existing Somatoform categories under a common rubric “Complex Somatic Symptom Disorder (CSSD)” and does not replace “CSSD”.

For full details see Dx Revision Watch Post #56: http://wp.me/pKrrB-St

Simple Somatic Symptom Disorder

Updated January-14-2011

See Tab: Proposed Revision:

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491

Simple (or abridged) Somatic Symptom Disorder (e.g. pain)

To meet criteria for Simple Somatic Symptom Disorder, criteria A, B, and C are necessary.

A. One or more highly distressign [sic] and disabling somatic symptoms

B. One of the following symptoms from CSSD (i.e. Disproportionate and persistent concerns about the medical seriousness of one’s symptoms; high level of health-related anxiety; or excessive time and energy devoted to these symptoms or health concerns)

C. Symptom duration is greater than 1 month

For full proposals for “Simple Somatic Symptom Disorder” open the Tabs on this page:

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491

Key links and documents associated with the proposals of the Somatic Symptom Disorders Work Group:

DSM-5 Development website: Somatoform Disorders
http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

Proposal: Complex Somatic Symptom Disorder
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=368

Proposal: Simple Somatic Symptom Disorder
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491

Update @ 7 February 2011

The Justification of Criteria document has now been revised by the SSD Work Group to incorporate the new proposal for SSSD and some further revisions, and is replaced by a document designated DRAFT 1/31/11.

I shall be monitoring the DSM-5 Development website and if there are any further revisions to either document before the DSM-5 beta is published I will update this site.

Two key Somatic Symptoms Disorders Work Group Draft Proposal documents:

    Revised Justification of Criteria Version 1/31/11

  Revised Disorder Descriptions: Version 1/14/11

According to the APA’s DSM-5 Development Timeline, beta draft proposals are scheduled to be published by the DSM-5 Task Force in May-June, with a public review period of only around a month. The public review and comment period for the first draft, last year, had been around ten weeks.

The following patient organisations have been alerted to these revisions and sent copies of the key documents:

UK patient organisations:

Heather Walker, Action for M.E.
Neil Riley, Chair, Board of Trustees, ME Association
25% ME Group
Invest in ME
Jane Colby, The Young ME Sufferers Trust

US patient organisations and professionals:

Dr Alan Gurwitt, Massachusetts Chronic Fatigue and Immune Dysfunction Syndrome/Myalgic Encephalopathy and Fibromyalgia Association (Mass. CFIDS/ME & FM)
Dr Kenneth Friedman, IACFS/ME
Jennie Spotila, CFIDS Association of America
Dr Lenny Jason

International patient organisations and professionals:

ESME (European Society for ME)
Dr Eleanor Stein, Canada

Changes to ME agenda WordPress site

Changes to ME agenda WordPress site

Shortlink: http://wp.me/p5foE-3bP

Yesterday, I posted a House of Lords Written Question that has been tabled by the Countess of Mar, on 21 October, in which questions are raised about the ethical approval of the Dr Esther Crawley led Lightning Process pilot study in children. A Written Answer is expected on 4 November and I shall publish that answer here.

There have also been some developments with the National Research Ethics Service (NRES) which I am not involved in, myself, but I will report on those developments as more information becomes available.

I maintain several WordPress sites and I shall continue to post alerts on this site to new material published on my Dx Revision Watch site – the concept for which developed out of research and awareness raising undertaken throughout 2009 around the forthcoming revisions of two important international disease classification systems: the (APA) American Psychiatric Association Diagnostic and Statistical Manual (DSM) and the World Health Organization International Statistical Classification of Diseases and Related Health Problems (ICD).

Other than that, I do not intend to post further material on ME agenda site.

I don’t like the nonsense that passes for rational discourse so often in our society. I am very much bothered by the inaccuracies, ambiguities, code words, slogans, catch phrases, public relation devices, sweeping generalizations, and stereotypes, which are used (consciously or otherwise) to influence people.

I am bothered by the inability of many to recognize these for what they are. I am bothered by the way people fudge issues, or are unable to clarify them, sometimes because they are inhibited by “collegiality” and other forms of intimidation (sometimes subtle, sometimes not). Most people put up with the nonsense without doing anything about it (unable or unwilling, for whatever reason – inertia, lack, of energy, lack of interest, lack of time, etc.), often falling into cynicism and despair.

I am bothered by the misinformation which gets disseminated uncritically through the media and by the obstructions which prevent correct information from being disseminated. These obstructions come about in many ways – personal, institutional, through self-imposed inhibitions, through external inhibitions, through outright dishonesty, through incompetence – the list is a long one.

I am bothered by the way misinformation, disguised as scholarship, is used in social, political, and educational contexts to affect policy decisions.

I am bothered by the way misinformation is accepted uncritically, and by the way people are unable to recognize it or reject it.

              Serge Lang The File: Case Study in Correction 1977-1979 (1981)

Summary: ICD-11 Alpha Draft and iCAT (PVFS, ME and CFS)

Summary: ICD-11 Alpha Draft and iCAT (PVFS, ME and CFS)

Shortlink: http://wp.me/p5foE-2Ur

Compiled by Suzy Chapman Dx Revision Watch

May be republished if published in full, unedited and with source acknowledged. 

A version of this report was published on Co-Cure on 11 June 2010.

The information in this summary relates to proposals for ICD-11. It does not apply to ICD-10-CM, the forthcoming US “Clinical Modification” of ICD-10, scheduled for implementation in October 2013.

This report provides a summary of the material published on Dx Revision Watch site on 7 June that included screenshots from the iCAT, the wiki-like collaborative authoring platform through which ICD-11 is being drafted.

 

To view proposals as they currently stand, see the 12 screenshots here:

PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform, 7 June 2010, Post # 46: http://wp.me/pKrrB-KK

 

Presentation of an alpha draft to the WHA:

A hard copy “snapshot” of the ICD-11 alpha draft, as it stood at that point, was presented by WHO at the 63rd World Health Assembly meeting, between 17 and 25 May.

According to page 38 of the document “ICD-11 Revision Project Plan”:

“WHO will consider endorsement of the alpha draft, after all concerns of RSG and the Classification TAGs have been duly taken into account. The alpha draft is a frozen state of development of the ICD-11 that will include a large part of the structural changes, and the majority of the definitions. The Alpha draft will be produced in a traditional print and electronic format. The Alpha Draft will also include a Volume 2 containing the traditional sections and including a section about the new features of ICD-11 in line with the style guide. An index for print will be available in format of sample pages. A fully searchable electronic index using some of the ontological features will demonstrate the power of the new ICD” [1].

The date by which WHO anticipates this stage should be reached is unconfirmed.

Caveat

For better understanding, it is important that the brief iCAT Glossary page is read in conjunction with the iCAT screenshots, especially the Glossary entries for ICD-10 Code, ICD Title, Definition, and for the Terms: Synonyms, Inclusions and Exclusions [2].

Read the iCAT Glossary here:
http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html

Secondly, it needs to be understood that the alpha draft is a “work in progress”. Not all content will have been compiled yet and entered into the iCAT and there are many blank fields awaiting population for all chapters and all categories. It also needs to be understood that some text already entered into the various “Details” fields may still be in the process of internal review.

Summary

In ICD-10, there is no textual content for the three terms “Postviral fatigue syndrome”, “Benign myalgic encephalomyelitis” and “Chronic fatigue syndrome” .

There are no definitions and the relationship between the three terms is not specified.

In ICD-11, categories will be defined through the use of multiple parameters: Title & Definition, Terms: Synonyms, Inclusions, Exclusions, Clinical Description, Signs and Symptoms, Diagnostic Criteria and so on, according to a common “Content Model” [3].

The level of detail currently visible in the iCAT isn’t sufficiently specific to enable me to present an unequivocal overview of current proposals for potential changes to hierarchy or for the specification of the relationships between the three terms of interest to us.

Based only on the information visible in the iCAT as it stood at 11 June 2010, it appears that instead of:

ICD-10: Volume 1: The Tabular List (version for 2007)

http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933

Chapter VI (6)

Diseases of the nervous system
(G00-G99)

[...]

Other disorders of the nervous system
(G90-99)

[...]

G93 Other disorders of brain

[...]

G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis

(with Chronic fatigue syndrome indexed to G93.3 in ICD-10: Volume 3: The Alphabetical Index)

what appears to be being proposed at this point for ICD-11 is that:

The classifications coded between G83.9 thru G99.8 in ICD-10 Chapter VI: Diseases of the nervous system, are being reorganised.

For ICD-11, Chapter 6, codings beyond G83.9 are represented by new parent classes numbered GA thru to GN;

example:

Chapter 6 VI Disorders of the nervous system

[...]
G80-G83 Cerebral palsy and other paralytic syndromes
GA Infections of the nervous system
GB Movement disorders and degenerative disorders
GC Dementias
GD Epilepsy and seizures
[...]
GN Other disorders of the nervous system

“GN Other disorders of the nervous system” is parent to five child classes which have been assigned the “Sorting labels” Gj90-Gj94.

(A Sorting label is a string that can be used to sort the children of a category. This is not the ICD code.)

Four of these five Gj9x classes have a complex hierarchy of child and grandchildren classes.

At Gj92, sits “Chronic fatigue syndrome”

“Gj92 Chronic fatigue syndrome” has no child classes of its own.

Next to “Gj92 Chronic fatigue syndrome” is an icon for “Category Notes and Discussions”.

There is one Category Note for Gj92 which records:

“[Reason for change]: Change in hierarchy for class: G93.3 Postviral fatigue syndrome. Parents added: (Gj90-Gj99 Other disorders of the nervous system). Parents removed: (G93 Other disorders of brain). New hierarchy”

(Note that the removal of the parent category “G93 Other disorders of brain” will affect a large number of categories classified under G93 in ICD-10, not just those at G93.3.)

In the iCAT production server, click on “Gj92 Chronic fatigue syndrome” and “Details for Gj92 Chronic fatigue syndrome” will display on the right of your screen (it may take a few seconds for the text to load). Or you can view the screenshots on my site: http://wp.me/pKrrB-KK

“Gj92 Chronic fatigue syndrome” is an ICD Title term with a Details page, a Definition and an Inclusions term (but with no Synonyms, Exclusions or other fields yet populated).

“Benign myalgic encephalomyelitis” is listed under Inclusions (the relationship is not currently specified, eg “Synonym” or “Subclass” or whatever).

Extract: iCAT Glossary

http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html#inclusions

“Inclusion terms appear in the tabular list of the traditional print version and show users that entities are included in the relevant concept. All of the ICD-10 inclusion terms have been imported and accessible in the iCat. These are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy. Since we have synonyms as a separate entity in our ICD-11 content model, the new synonyms suggested by the users should go into the synonyms section. In the future, iCat will provide a mechanism to identify whether an inclusion is a synonym or a subclass.”

————-

In the iCAT ICD Categories list, there is no Gj9x Sorting label listing for “Postviral fatigue syndrome” or “Benign myalgic encephalomyelitis” under “GN Other disorders of the nervous system” or under any other parent or child class, and consequently no Category Details display for either term.

(Whether this is because Inclusion terms would appear in the tabular list version but not in the iCAT version or whether this is because of proposed changes to the hierarchy and/or relationship between the three terms, cannot be determined from the information as it stands at 11 June.)

“Postviral fatigue syndrome” is not currently specified under Inclusions in “Details for Gj92 Chronic fatigue syndrome”.

Again, whether this is because “Postviral fatigue syndrome” would be accounted for in the tabular list version or whether this is because it may be being proposed that the term “Postviral fatigue syndrome” (which has lost its parent class “G93 Other disorders of brain”) should be subsumed into “Chronic fatigue syndrome”, with “Chronic fatigue syndrome” as the new ICD category Title, cannot be determined from the information as it currently stands.

Exclusions

If you pull up the iCAT Details for ICD-11 Chapter 5: F48.0 Neurasthenia (or view the screenshots on my site)

“postviral fatigue syndrome” is listed under Exclusions to Neurasthenia and is referenced thus:

“postviral fatigue syndrome”    G93.3 -> Gj92 Chronic fatigue syndrome

In iCAT Chapter 18: R53 Malaise and Fatigue

“fatigue syndrome postviral” [sic] is also listed under Exclusions, referenced

G93.3 -> Gj92 Chronic fatigue syndrome
 

But that in the absence of further information, it is currently unclear what the proposed hierarchical status of Postviral fatigue syndrome will be in relation to Chronic fatigue syndrome.

————-

When you click on the Category Notes icons for some other categories, the Notes are often more explicit, for example, the Category Note for:

GN Other disorders of the nervous system

> Gj90 Disorders of CSF pressure and flow
         > Gj90.0 Increased intracranial pressure disorders

Reads: [Reason for change]: Create class with name: Increased intracranial pressure disorders, parents: Disorders of CSF Pressure and Flow

replaces G93.5, G93.6, and G93.7

The Category Note for “Gj90 Disorders of CSF pressure and flow” records that this class has been created to replace:

G91, G92, G93.0, G93.2, G94.0, G94.1, G94.2, G96.0, G97.0, G97.1, G97.2

(which also gives an idea of the extent to which the structure of ICD-10 classifications between G90 – G99.8 is being reorganised.)

In the absence of an Alpha Draft, I shall be contacting the chair of the Topic Advisory Group for Neurology for further clarification.

**************************************************

So what can be said is that currently in the iCAT for ICD-11 drafting:

That under Chapter 6 (Neurology):

The parent class “G93 Other disorders of brain” is removed.

“Chronic fatigue syndrome” displays as a Title term in the Categories list.

It is a child to parent class “GN Other disorders of the nervous system”.

It has been assigned the “Sorting label” Gj92.

“Gj92 Chronic fatigue syndrome” has a Definition field populated.

It has an External Definitions field populated which includes definitions imported from other classification systems, the text of which includes “Also known as myalgic encephalomyelitis”.

It has “Benign myalgic encephalomyelitis” specified under Inclusions.

It has no Synonyms, Exclusions or other descriptor fields populated yet.

That at this point and as far as the iCAT version is concerned, neither “Postviral fatigue syndrome” nor “Benign myalgic encephalomyelitis” have been listed as ICD Title terms under the parent class “GN Other disorders of the nervous system” or under any other class.

That at this point and as far as the iCAT version is concerned, there is no accounting for “Postviral fatigue syndrome”, other than that “Postviral fatigue syndrome” is specified under Exclusions to Chapter 5 F48.0 Neurasthenia and to Chapter 18 R53 Malaise and fatigue and is referenced as

“postviral fatigue syndrome” G93.3 -> Gj92 Chronic fatigue syndrome

**************************************************

So please read the iCAT Glossary of Terms page, have a look at the screenshots and then have a poke around in the iCAT – you can’t break anything as members of the public have no editing rights [4].

I shall continue to monitor the iCAT production server closely and report on any changes to proposals for Category listings and on the progress of the population of content. (There has been no change since this report was compiled.)

And if you were thinking of getting a G93.3 tattoo done – well it might be best to hang on for a bit…

References:

[1] ICD-11 Revision Project Plan – Draft 2.0 (v March 10)
Describes the ICD revision process as an overall project plan in terms of goals, key streams of work, activities, products, and key participants:
http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

[2] iCAT Glossary
http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html

[3] Content Model Specifications and User Guide (v April 10)
Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters:
http://tinyurl.com/ICD11ContentModelApril10

[4] iCAT production server and Demo and Training iCAT Platform:
https://sites.google.com/site/icd11revision/home/icat
iCAT production server: http://icat.stanford.edu/
Demo and Training iCAT Platform: http://icatdemo.stanford.edu /

Compiled by Suzy Chapman
http://dxrevisionwatch.wordpress.com
http://meagenda.wordpress.com

US “Clinical Modification” ICD-10-CM: Clarification

US “Clinical Modification” ICD-10-CM: Clarification

Shortlink: http://wp.me/p5foE-2Ul

This post is intended to clarify any confusion between ICD-10, ICD-11 and the forthcoming US Clinical Modification of ICD-10 which will be known as ICD-10-CM.

The WHO published ICD-10 in 1992. The current version of ICD-10 (Version for 2007) is used in the UK and in many countries throughout the world.

ICD-10 is under revision and the development of the structure and content of ICD-11 has been underway since 2007. ICD-11 is scheduled for completion in 2014.

 

Clinical Modifications

Several countries are permitted to publish adaptations of the ICD called “Clinical Modifications” (sometimes known as “national modifications”).

Countries using Clinical Modifications of ICD-10 include Canada (ICD-10-CA), Australia (ICD-10-AM) and Germany (ICD-10-GM).

The United States currently uses an adaptation of the WHO’s now retired ICD-9, called ICD-9-CM, and has been slow to move onto ICD-10.

Rather than skip ICD-10 and move straight onto ICD-11 in 2014+, the US has been developing a modification of ICD 10 called ICD-10-CM which will replace ICD-9-CM.

ICD-10-CM is due for implementation in October 2013.

According to one report, the US should not expect to move on to ICD-11 (or a modification of ICD-11) until well after 2020, assuming that the ICD-11 Beta is published around the 2014-2015 projection:

Why move to ICD-10, if ICD-11 is on the horizon?
http://www.healthcarefinancenews.com/news/why-move-icd-10-if-icd-11-horizon

 

What are the proposed classifications and codings for PVFS, (Benign) ME and Chronic fatigue syndrome for ICD-10-CM?

In March 2001, the document:

“A Summary of Chronic Fatigue Syndrome and Its Classification in the International Classification of Diseases Prepared by the Centers for Disease Control and Prevention, National Center for Health Statistics, Office of the Center Director, Data Policy and Standards”

provided a concise “summary of the classification of Chronic Fatigue Syndrome in the International Classification of Diseases (ICD), ninth and tenth revisions, and their clinical modifications.”

That document is archived here: http://www.co-cure.org/ICD_code.pdf

In 2001, the proposal had been:

“In keeping with the placement in the ICD-10, chronic fatigue syndrome (and its synonymous terms) will remain at G93.3 in ICD-10-CM.”

So at that point, it was being proposed for the forthcoming US ICD-10-CM that PVFS, (Benign) ME and Chronic fatigue syndrome would be coded at G93.3, which would have placed all three terms in Chapter VI: Diseases of the nervous system (the Neurological chapter).

But the current proposals for ICD-10-CM propose classifying Chronic fatigue syndrome in Chapter 18, under R53 Malaise and fatigue, at R53.82.

The “R” codes are classified under

CHAPTER 18 (XVIII)
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill defined conditions regarding which no diagnosis classifiable elsewhere is recorded…

Note: this is not the ICD-10-CM Mental and Behavioural chapter, which is:

CHAPTER 5 (V)
Mental and behavioral disorders (F01-F99)
Includes: disorders of psychological development
Excludes2: symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)

which specifically excludes the R00-R99 codes.

So the current proposal for ICD-10-CM separates CFS and Postviral fatigue syndrome into mutually exclusive categories:

“Chronic fatigue, unspecified” and “Chronic fatigue syndrome not otherwise specified” appear in Chapter 18, under R53 Malaise and fatigue, at R53.82.

Whilst “Postviral fatigue syndrome” and “benign myalgic encephalomyelitis” appear in Chapter 6, under G93 Other disorders of brain, at G93.3.

At some point before October 2013, ICD-10-CM revision will be “frozen” for Centers for Medicare and Medicaid Services (CMS) and insurance companies to prepare for the October 1, 2013 implementation.

See Tom Sullivan at ICD10 Watch.com (no connection with my site) here:

CMS, CDC call for ICD-9 and ICD-10 code freeze
http://icd10watch.com/headline/cms-cdc-call-icd-9-and-icd-10-code-freeze

“CMS, the Centers for Medicare and Medicaid Services, along with CDC, the Centers for Disease Control and Prevention, proposed that both ICD-9-CM and ICD-10-CM/PCS code sets be frozen two years before the compliance deadline.

“What that means: As of October 1, 2011, only limited updates would be instituted into the code sets so that providers, payers, clearinghouses, and health IT vendors, will not have to simultaneously keep pace with code updates while also reconfiguring their existing systems for ICD-10-CM/PCS.” ICD10 Watch.com

During the last ten minutes of the CFSAC meeting on Monday, 10 May, Dr Lenny Jason raised his concerns with the committee that the placement of CFS in ICD-10-CM in the Chapter 18 “R” codes could be problematic.

Videocast of full CFSAC meeting here:
http://videocast.nih.gov/Summary.asp?File=15884

In August 2005, CFSAC had submitted the following recommendation to the Secretary:

http://www.hhs.gov/advcomcfs/recommendations/082005.html

“Recommendation 10: We would encourage the classification of CFS as a ‘Nervous System Disease,’ as worded in the ICD-10 G93.3.”

I suggest that US advocates with concerns about current proposals for the placement of CFS within ICD-10-CM keep a close eye on decisions about the date by which ICD-10-CM is to be frozen.

For the most recent ICD-10-CM proposals see:

http://www.cdc.gov/nchs/icd/icd10cm.htm

The 2010 update of ICD-10-CM is now available and replaces the July 2009 version.

The file for the Tabular List is in a Zipped file which is not that easy to locate on the site. A non Zipped PDF can be downloaded from this site:

http://www.cms.gov/ICD10/12_2010_ICD_10_CM.asp#TopOfPage
http://www.cms.gov/ICD10/Downloads/6_I10tab2010.pdf

or open the PDF on my Dx Revision Watch site, here
http://dxrevisionwatch.files.wordpress.com/2009/12/i10tab2010.pdf

ICD-10-CM CHAPTER 18

Tabular List of Diseases and Injuries Page 1165 (Update for 2010)

R53 Malaise and fatigue

[...]

R53.8 Other malaise and fatigue

Excludes1: combat exhaustion and fatigue (F43.0)
congenital debility (P96.9)
exhaustion and fatigue due to:
depressive episode (F32.-)
excessive exertion (T73.3)
exposure (T73.2)
heat (T67.-)
pregnancy (O26.8-)
recurrent depressive episode (F33)
senile debility (R54)

R53.81 Other malaise

Chronic debility
Debility NOS
General physical deterioration
Malaise NOS
Nervous debility
Excludes1: age-related physical debility (R54)

R53.82 Chronic fatigue, unspecified

Chronic fatigue syndrome NOS
Excludes1: postviral fatigue syndrome (G93.3)

R53.83 Other fatigue

Fatigue NOS
Lack of energy
Lethargy
Tiredness

 

ICD-10-CM CHAPTER 6 Page 325 (Update for 2010)

Diseases of the nervous system (G00-G99)

Excludes2:

[...]
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

[...]

G93 Other disorders of brain

[...]

G93.3 Postviral fatigue syndrome

Benign myalgic encephalomyelitis
Excludes1: chronic fatigue syndrome NOS (R53.82)

For comparison:

German Modification ICD-10-GM
http://www.dimdi.de/static/de/klassi/diagnosen/icd10/htmlgm2010/block-g90-g99.htm

ICD-10-GM Version 2010

Kapitel VI
Krankheiten des Nervensystems
(G00-G99)

G93.- Sonstige Krankheiten des Gehirns

[...]

G93.3 Chronisches Müdigkeitssyndrom

Benigne myalgische Enzephalomyelitis
Chronisches Müdigkeitssyndrom bei Immundysfunktion
Postvirales Müdigkeitssyndrom

For comparison:

Canadian Modification ICD-10-CA

(Version 2009 of ICD-10-CA/CCI replaces version 2006)

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=codingclass_e

Version 2009 ICD-10-CA Tabular List, Volume 1 PDF (4.9MB)
http://secure.cihi.ca/cihiweb/en/downloads/ICD-10-CA_Vol1_2009.pdf

Version 2009 ICD-10-CA Alphabetical Index, Volume 2 PDF (4.3MB)
http://secure.cihi.ca/cihiweb/en/downloads/ICD-10-CA_Vol2_2009.pdf

Chapter VI

Diseases of the nervous system
(G00-G99)

Other disorders of the nervous system
(G90-99)

[...]

G93 Other disorders of brain

[...]

G93.3 Postviral fatigue syndrome

Includes: Benign myalgic encephalomyelitis
Chronic fatigue syndrome

Excludes: fatigue syndrome NOS (F48.0)

For comparison with WHO ICD-10:

Current ICD-10 codings for the three terms are set out on my site, here, together with extracts from Chapter V (the “F” codes) and Chapter XVIII (the “R” codes):

http://dxrevisionwatch.wordpress.com/icd-11-me-cfs/

or go here for the full ICD-10 Volume 1: Tabular List

http://apps.who.int/classifications/apps/icd/icd10online/

ICD-10 Version for 2007 online
http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933

Chapter VI

Diseases of the nervous system
(G00-G99)

Other disorders of the nervous system
(G90-99)

[...]

G93 Other disorders of brain

[...]

G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis

Note that in ICD-10, Chronic fatigue syndrome is not included in Volume 1: The Tabular List, Chapter VI under the parent term:

G93 Other Disorders of brain

but “Chronic fatigue syndrome” does appear in Volume 3: The Alphabetical Index, where it is indexed to G93.3.

In a forthcoming post, I shall be publishing important information about proposals for parent terms, classifications and codings in the ICD-11 Alpha Draft.

 

Related material:

ICD-9-CM

For information on the current codings in ICD-9-CM (US Clinical Modification) see the NAME U.S. page: WHO ICD Codes section

American Psychiatric Association on DSM-5

In a 10 December Press Release, the American Psychiatric Association said:

“Extending the timeline [for DSM-5] will allow more time for public review, field trials and revisions”

and

“The extension will also permit the DSM-5 to better link with the U.S. implementation of the ICD-10-CM codes for all Medicare/Medicaid claims reporting, scheduled for October 1, 2013. Although ICD-10 was published by the WHO in 1990, the “Clinical Modification” version (ICD- 10-CM) authorized by the U.S. Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control (CDC) is not being implemented in the U.S. until 23 years later.

“The ICD-10-CM includes disorder names, logical groupings of disorders and code numbers but not explicit diagnostic criteria. The APA has already worked with CMS and CDC to develop a common structure for the currently in-use DSM-IV and the mental disorders section of the ICD- 10-CM.

“The International Classification of Diseases (ICD) is published by the WHO for all member countries to classify diseases and medical conditions for international health care, public health, and statistical use. The WHO plans to release its next version of the ICD, the ICD-11, in 2014.

“APA will continue to work with the WHO to harmonize the DSM-5 with the mental and behavioral disorders section of the ICD-11. Given the timing of the release of both DSM-5 and ICD-11 in relation to the ICD-10-CM, the APA will also work with the CDC and CMS to propose a structure for the U.S. ICD-10 CM that is reflective of the DSM-5 and ICD-11 harmonization efforts. This will be done prior to the time when the ICD-10-CM revisions are “frozen” for CMS and insurance companies to prepare for the October 1, 2013, adoption.”

ICD-11 Alpha Draft, iCAT Collaborative Authoring Platform and PVFS, ME, CFS

ICD-11 Alpha Draft, iCAT Collaborative Authoring Platform and PVFS, ME, CFS

Shortlink: http://wp.me/p5foE-2Ui

The information in this report relates to proposals for ICD-11. It does not apply to ICD-10-CM, the forthcoming US “Clinical Modification” of ICD-10.

 

Whither the ICD-11 Alpha Draft?

According to documents published by the ICD Revision Steering Group (RSG) and the Agenda for the iCAMP2 and Revision Steering Group meeting on 19-23 April 2010, it was projected that an alpha draft for ICD-11 would be ready by 10 May 2010 [Key document 1a].

The RSG meeting Agenda proposed that the alpha draft should be presented to the World Health Assembly (WHA) between 17-25 May. A proposal for a press launch was also tabled for discussion.

It is understood that the ICD-11 alpha draft is being created for internal users, was not expected to be complete by May 2010, but released as a “work in progress” towards the beta stage. The beta draft for ICD-11 is scheduled for 2011, which will be subjected to systematic field trials and then made available for public comment.

10 May has come and gone, and there has been no public launch of an alpha draft or the iCAT – the wiki-like collaborative authoring platform through which ICD-11 is being drafted.

As the Minutes of the April RSG meeting are not yet available, it remains unclear how on target the alpha draft is or whether the goals for 2010 have had to be revised. (See Page 7, ICD-11 Revision Project Plan – Draft 2.0 for Project milestones and budget, and organizational overview.)

When the RSG does release information on the status of the alpha draft and the operational status of the iCAT, I will post an update.

In the meantime, I have raised a number of queries around the status of the alpha draft, whether the RSG intends to make a draft available for public viewing, at what point, and in what format(s). I have also asked for information about the availability of Topic Advisory Group proposal forms for stakeholder input, up to what stage in the development process timeline these might be used, and which stakeholders are going to be permitted to make use of proposal forms.

 

iCAT production server

In the posting ICD-11 Alpha Draft scheduled to launch between 10 and 17 May, 6 May, I reported that it is already possible to view a “Demo and Training iCAT Platform” and also access the iCAT production server.

I cautioned that until an official ICD-11 Alpha Draft is released, it cannot be determined how far the various Topic Advisory Groups have progressed with revising classifications and populating textual content according to a common “Content Model” for the ICD Chapters and categories of interest to us [Key document 1b].

I noted that the Demo and Training iCAT Platform, at that point, was sparsely populated for content and that the classifications and codings listed within the various chapters appeared to have been imported from ICD-10, with little discernable change – presumably as the starting point for the drafting process.

A revised Demo and Training iCAT Platform is now accessible, the content of which is also viewable on the iCAT production server and it is to these proposed revisions that I want to draw your attention.

Note that anyone can view the Demo and Training iCAT Platform and iCAT production server but only WHO, ICD Revision and IT personnel and the Managers and members of the various Topic Advisory Groups (TAGS)will have editorial access. External reviewers recruited by TAG Managers will also use the iCAT to upload reviews and comment on proposals and content.

I have compiled a series of screenshots and very brief notes on what is viewable at the moment for the chapters and categories of interest to us.

Note: Screenshots are taken from the Demo and Training iCAT Platform and iCAT production server as they stood at 24 May 2010. Alpha drafting is an ongoing process and what currently appears may be subject to revision, refinement and additions before an official Alpha Draft is released. Not all the classification and content work currently undertaken may have been entered into the iCAT.

Note also that when viewing the iCAT in your browser, the left hand side of the screen displays the ICD Categories listings with the category Definition, Term, Clinical Description, Diagnostic Criteria etc displaying on the right of the screen. Because this view is too wide to display on my website template, the screenshots have had to be split in two. On your screen the iCAT will look like this:

 

When you have read this report and familiarised yourself with the way the iCAT functions, I suggest you poke around – you can’t break anything as members of the public have no editing access.

All screenshots as they stood at 24 May 2010

A wiki-like Collaborative Authoring Tool (known as the iCAT)) is being used for the initial authoring of the alpha draft.

The iCAT production server and Demo and Training iCAT Platform can be accessed here:

https://sites.google.com/site/icd11revision/home/icat

iCAT production server at: http://icat.stanford.edu/

Demo and Training iCAT Platform at: http://icatdemo.stanford.edu/

Load either (they may take a minute or more to load and appear less inclined to hang in Firefox).

One loaded, you will be presented with an Entry Page – this is the My ICD Tab

Welcome to iCAT – the Initial ICD 11 Collaborative Authoring Tool!

Select the ICD Content Tab and ICD Categories by chapter will populate down the left side of the screen.

Scroll down and open up the + next to 06 VI Diseases of the nervous system

ICD Categories:

 

Scroll down and note that ICD-10 codings between G83.9 and G99.8 are being reorganised and have been assigned the labels GA thru GN (some of which, like GN, are parent categories with child and grandchildren categories).

Open up the + next to GN Other disorders of the nervous system

which is a parent to category Gj92 Chronic fatigue syndrome

(Note: Gj92 is known as a “Sorting label”. A Sorting label is a string that can be used to sort the children of a category. This is not the ICD code.)

Note that Postviral fatigue syndrome and Benign myalgic encephalomyelitis are not currently accounted for in the ICD Categories List as children of the parent category GN Other disorders of the nervous system. Only Chronic fatigue syndrome is listed and assigned the Sorting Label “Gj92″. [See Glossary: Inclusions]

 

 

Click on the double speech bubble icon next to Gj92 Chronic fatigue syndrome which will display 1 Category Discussion Note (Click Expand to display the full note. Discussion Notes can also be accessed via the Category Notes and Discussions Tab, from which the screenshot below, orginates).

Discussion Note for Gj92 Chronic fatigue syndrome:

This Discussion Note records a Change in hierarchy for class: G93.3 Postviral fatigue syndrome because its parent category (G93 Other disorders of brain) is removed.

Note that the removal of the parent G93 Other disorders of brain will affect other categories also classified under G93 in ICD-10, not just G93.3. Open up the double speech bubble icons next to other category listings and you can view the Discussion Notes on proposed restructuring for other G8x and G9x categories.

Next, with the ICD Content Tab selected, click on Gj92 Chronic fatigue syndrome and the Details for Gj92 Chronic fatigue syndrome will display on the right side of the screen. Allow a few moments for the text in the boxes to load.

With the Title & Definition Tab selected (the Tab may read Definition only, depending on whether you are viewing the iCAT production server or the Demo iCAT), you can view the

Details for Gj92 Chronic fatigue syndrome

To view a Glossary of Terms page, which defines the terms in the Tabs click on the blue question mark icons which will load the iCAT Glossary.

Content for Gj92 Chronic fatigue syndrome:

[See Glossary: Definition] The full text of External Definitions (imported from affiliate classification publications) which is partly hidden in the screenshot, is appended at end of this post. According to discussion on the iCAT Users Google Group, it is proposed that External Definitions might be given less prominence when displaying in the iCAT.

 

Now click on the Terms Tab.

Terms for Gj92 Chronic fatigue syndrome:

Benign myalagic encephalomyelitis currently appears listed under Inclusions to Gj92 Chronic fatigue syndrome.

Note that Postviral fatigue syndrome is not listed under Inclusions and that Synonyms and Exclusions for Gj92 Chronic fatigue syndrome have yet to be populated. [See Glossary: Synonyms, Inclusions, Exclusions]

Very few of the other Content Tabs have been populated but it is envisaged that they will be in due course.

I provide no screenshots for Benign myalagic encephalomyelitis or Postviral fatigue syndrome because these are not listed in the ICD Categories List. [See Glossary: ICD Title, Synonyms, Inclusions, Exclusions]

Extract from the iCAT Glossary

6. Inclusions

Short definition: Inclusion terms are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy.

Details: Inclusion terms appear in the tabular list of the traditional print version and show users that entities are included in the relevant concept. All of the ICD-10 inclusion terms have been imported and accessible in the iCat. These are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy. Since we have synonyms as a separate entity in our ICD-11 content model, the new synonyms suggested by the users should go into the synonyms section. In the future, iCat will provide a mechanism to identify whether an inclusion is a synonym or a subclass.

7. Exclusions

Short definition: Exclusion terms help users eliminate entities that should be assigned to a different ICD category because of differences in meaning or terminology.

Details: Exclusion terms help users eliminate entities that should be assigned to a different ICD category because of differences in meaning or terminology.

 

I am including some screenshots of other Chapters which will be of interest.

Chapter 5 (V) Somatoform Disorders at F45 (currently same as or near ICD-10):

 

Neurasthenia remains in Chapter 5 (V) at F48.0:

 

Inclusions and Exclusions for Neurasthenia:

 

Chapter 18 (XVIII) displaying R53 Malaise and fatigue (this is the Chapter under which the US Clinical Modification, ICD-10-CM, proposes classifying Chronic fatigue syndrome, at R53.82):

 

Inclusions and Exclusions for R53 Malaise and fatigue:

 

Here are the two Category discussion Notes that appear directly beneath 06 VI Diseases of the nervous system (no ICD10 concepts from Chapter 06 VI are currently moved into either of these “holding pens”).

1 Discussion Note for: Needing a decision to be made

 

1 Discussion Note for: To be retired

________________________________________________________________________

  

External Definitions: (Imported from affiliate classification publications, these remain the same as my 6 May posting.)

External Definitions for Gj92 Chronic fatigue syndrome

A syndrome of unknown etiology. Chronic fatigue syndrome (CFS) is a clinical diagnosis characterized by an unexplained persistent or relapsing chronic fatigue that is of at least six months duration, is not the result of ongoing exertion, is not substantially alleviated by rest, and results in substantial reduction of previous levels of occupational, educational, social or personal activities. Common concurrent symptoms of at least six months duration include impairment of memory or concentration, diffuse pain, sore throat, tender lymph nodes,headaches of a new type, pattern, or severity, and nonrestorative sleep. The etiology of CFS may be viral or immunologic. Neurasthenia and fibromyalgia may represent related disorders. Also known as myalgic encephalomyeltis.

Ontology ID UMLS/NC12007_05
E

distinctive syndrome characterized by chronic fatigue, mild fever, lymphadenopathy, headache, myalgia, arthralgia, depression, and memory loss: candidate eitiological agents include Epstein-Barr and other herpesviruses.

Ontology ID UMLS/CSP2006

A syndrome characterized by persistent or recurrent fatigue, diffuse musculoskeletal pain, sleep disturbances, and subjective cognitive impairment of 6 months duration or longer. Symptoms are not caused by ongoing exertion; are not relieved by rest; and result in a substantial reduction of previous levels of occupational, educational, social or personal activities. Minor alterations of immune, neuroendocrine, and automatic function may be associated with this syndrome. There is also considerable overlap between this condition and FIBROMYALGIA.
(From Semin Neurol 1998;18(2):237-42: Ann Intern Med 1994 Dec 15;121(12):953-9)

Ontology ID UMLS/MSH2008_2
008_02_04

 

Based only on the information visible in the iCAT as it stood at 24 May 2010, it appears that instead of:

ICD-10 (version for 2007) Tabular List

http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933

Chapter VI (6)

Diseases of the nervous system
(G00-G99)

[...]

Other disorders of the nervous system
(G90-99)

[...]

G93 Other disorders of brain

[...]

G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis

(with Chronic fatigue syndrome indexed to G93.3 in Volume 3: The Alphabetical Index)

that what may be being proposed at this point is:

that G83.9-G99.8 codes in ICD-10 Chapter VI: Diseases of the nervous system are being restuctured;

that G93 Other disorders of brain is removed as a parent category for G93.x codings;

that GN Other disorders of the nervous system

is now the parent to a large number of categories previously classified between G83.9 and G99.8

that GN Other disorders of the nervous system is the parent to

Gj92 (Sorting label) Chronic fatigue syndrome

that Gj92 Chronic fatigue syndrome is included in ICD-11 Chapter 06 VI Diseases of the nervous system (Neurology chapter) in the ICD Categories list as an ICD Title term;

that there is currently displaying no Gj9x Sorting label (or any other Sorting label) listing for Postviral fatigue syndrome or Benign myalgic encephalomyelitis in ICD Categories list or any Category Details for either term;

(Whether this is because Inclusion terms appear in the tabular list of the traditional print version but not in the iCAT version, or because of proposed hierarchy changes to the relationship between these three terms or because text remains to be entered into the iCAT for these two terms, cannot be determined from the information available at 10 June – please refer to Glossary of Terms which sets out the relationships between an ICD Title and its inclusion in the iCAT Categories list and between an ICD Title and its Synonyms, Inclusions and Exclusions.)

that Gj92 Chronic fatigue syndrome is an ICD Title term with a Details page, a Definition and an Inclusion term (but with no Synonyms or Exclusions or other fields yet populated);

that Benign myalgic encephalomyelitis is listed as an Inclusion to Gj92 Chronic fatigue syndrome

that Chapter 5 V Details for F48.0 Neurasthenia specifies
“postviral fatigue syndrome” as an Exclusion with References

G93.3 -> Gj92 Chronic fatigue syndrome

that Chapter 18 XVIII Details for R53 Malaise and Fatigue specifies
“fatigue syndrome postviral” [sic] as an Exclusion with References

F48.0 -> F48.0 Neurasthenia,
G93.3 -> Gj92 Chronic fatigue syndrome

but that in the absence of further information, it is currently unclear what the proposed hierarchical status of Postviral fatigue syndrome and Benign myalgic encephalomyelitis will be in relation to Chronic fatigue syndrome, and in relation to each other.

I shall continue to monitor the iCAT production server closely and report on any changes to proposals for Category listings and on the progress of the population of content.

 

[1] Key documents:

a) ICD-11 Revision Project Plan – Draft 2.0 (v March 10) [PDF format]
Describes the ICD revision process as an overall project plan in terms of goals, key streams of work, activities, products, and key participants.

b) Content Model Specifications and User Guide (v April 10)
Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.

c) Alpha Drafting Workflow (v 06.10.09)
Sets out lines of responsibility between the various contributors for the alpha drafting phase.

d) Further documents eg Style Guide, ICD-11 Conventions:
ICD Revision Google site