A New Decade of ME Research: The 11th Invest in ME International ME Conference 2016
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Dr. Bateman answers IOM questions from the community: Part 1

Discussion in 'Phoenix Rising Articles' started by ClarkEllis, Mar 31, 2015.

  1. jimells

    jimells Senior Member

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    I'm sure glad I'm not writing medical billing software any more. The changeover to an entirely new coding scheme is going to be a cluster-you-know-what.
     
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  2. SOC

    SOC Senior Member

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    When I look that up it says that code is for Post Viral Fatigue Syndrome and discusses "CFS" at some length. It says it excludes CFS NOS, but the CFS NOS code contains the same Clinical Information about CFS as the Post Viral Fatigue Syndrome code (G93.3), which makes no sense in my mind. If the two (PVS and CFS NOS) exclude each other, why do they have exactly the same wording in the Clinical Information sections. o_O

    How is any of that a code for ME?
     
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  3. Nielk

    Nielk

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    This blog explains it - http://twenty-years-and-counting.blogspot.com/2015_02_01_archive.html
     
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  4. halcyon

    halcyon Senior Member

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    It's the same in the WHO ICD, G93.3 is PVFS, and benign myalgic encephalomyelitis is indexed to it. There is no distinct CFS code in the WHO ICD as far as I know, it just links R53 (malaise and fatigue) to either G93.3 (ME) or F48.0 (neurasthenia), among other causes of fatigue. G93.3 doesn't list any exclusions, but F48.0 excludes ME. It was a US ICD-10-CM thing to wedge CFS in there and code it as a distinct disease.
     
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  5. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

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    There is no clinical descriptive text for either PVFS (G93.3), BME (inclusion term to G93.3) or CFS NOS (R53.82) within ICD-10-CM (or within the WHO's ICD-10).

    The reference given in the IOM prepublication version of the Report was for a commercial data scraping site which aggregates content from a variety of sources, including non ICD sources, not the official ICD-10-CM Release for FY 2015, which can be downloaded from the CDC's ICD-10-CM page.
     
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  6. Nielk

    Nielk

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    Indeed when I looked up the IOM criteria's clinicians' guide, it states:

    Yet, the IOM criteria are billed to be a set of criteria with a diagnosis to be made; not an diagnosis by exclusion like the other criteria.

    When I look at the CCC Primer, it states:

    It goes on to list a table of possible exclusionary diagnosis.http://www.iacfsme.org/portals/0/pdf/primerfinal3.pdf p. 16

    So, is the only difference that the CCC actually lists a table of possible diagnosis and the IOM leaves it up to the individual clinicians to figure it out? Why do they bill it then as not an exclusionary diagnosis? I see no difference in this between the CCC and IOM except that the CCC includes a chart.
     
  7. SOC

    SOC Senior Member

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    Okay, so let me see if I have this right.... ME is not actually listed as a codable condition in either the WHO ICD or the US ICD-10-CM, but Benign (hah!) Myalgic Encephalomyelitis is indexed (along with Iceland Disease and Akureyri Disease) as an alternative name to Post Viral Fatigue Syndrome in both? So ME = PVFS?
     
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  8. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

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    In the WHO's ICD-10, BME is the inclusion term to G93.3 PVFS within Volume 1: The Tabular List.

    In WHO's ICD-10, CFS is included only in Volume 3: The Alphabetical Index, and indexed to G93.3.

    For the U.S. specific, ICD-10-CM, the original (2003) proposal was for PVFS, BME and a Chronic fatigue syndrome, postviral under G93.3

    like this:

    How the Draft ICD-10-CM had stood in 2003 (PVFS, BME and CFS, postviral under G93.3. CFS, NOS at R53.82)

    https://twitter.com/dxrevisionwatch/status/571779906511761408

    Around 2004, the "Chronic fatigue syndrome, postviral" was removed from under G93.3, leaving "Chronic fatigue syndrome NOS" orphaned in the R codes, under R53.82.

    When the 2007 Release of ICD-10-CM was posted, the proposal looked like this:

    How the Draft ICD-10-CM was changed for the 2007 release: PVFS and BME at G93.3. CFS NOS at R53.82:

    https://twitter.com/dxrevisionwatch/status/571781001183154176
     
    Last edited: Apr 1, 2015
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  9. halcyon

    halcyon Senior Member

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    That's how it is in the WHO ICD-10, yes. It wasn't always this way, see here.
     
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  10. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

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    In the WHO's ICD-10, BME is coded to G93.3 PVFS in the Tabular List (as the Inclusion term to PVFS).

    In indexing Chronic fatigue syndrome to G93.3, ICD-10 does not specify whether it views the term as a synonym, sub-entity or “best coding guess” to Postviral fatigue syndrome or to Benign myalgic encephalomyelitis. Nor does ICD-10 specify how it views the relationship between Postviral fatigue syndrome and Benign myalgic encephalomyelitis.

    In the U.S.'s ICD-10-CM, BME is also coded to G93.3 PVFS in the Tabular List (as the Inclusion term to PVFS).
     
  11. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

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    For a history of the coding of PVFS, ME and CFS in ICD to March 2001, see the CDC 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, CDC archive document, March 2001.

    https://dxrevisionwatch.files.wordpress.com/2009/12/icd_code-cdc-march-2001.pdf
     
    Last edited: Apr 1, 2015
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  12. caledonia

    caledonia

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    1) ME/CFS = SEID
    2) SEID = partially describes (not replaces) both ME and CFS

    It replaces Fukuda with PEM. It leaves out Fukuda without PEM.

    It leaves out ME with good sleep. A person could have an ME and SEID diagnosis. A person could have a CFS diagnosis. A person could have a SEID diagnosis. A person could have an ME diagnosis. A person cannot have an ME and CFS diagnosis. A person cannot have a SEID and CFS diagnosis.

    A diagram would be helpful here to help visualize this. I will attempt one.

    ICD codes (US ICD-10-CM) - the most logical thing would seem to be give SEID a third code.

    CFS remains, but SEID would weed out non PEM patients
    ME remains under G93.3 and is mutually exclusive from CFS (but not from SEID)
    SEID gets a code, which is not fatigue or neurasthenia

    This means SEID can't have the same code as CFS or be in the same category
    I don't think SEID could go under G93.3 (to replace ME, as it leaves out ME patients with good sleep). G93.3 could be addended to say that a person could have both ME and SEID at the same time.
    SEID could get a third code, I would guess in G (diseases of the nervous system). (multiple sclerosis and ME are both in G).
     

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  13. Nielk

    Nielk

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    I am surprised by this statement since Dr. Bateman was an author of the 2003 CCC as well as the 2011 ICC.
     
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  14. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

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    Given that CDC strives to retain legacy ICD codes in order to avoid data loss from previous editions, it would not surprise me if Donna Pickett (CDC) were to advance the need to retain a CFS NOS in the R codes for ICD-10-CM, irrespective of whatever chapter and parent class might be proposed for SEID, and irrespective of whether a unique new code would be created for SEID or if SEID were inserted as an inclusion term under an existing code.


    There is the option within ICD-10-CM for creating additional discrete codes under an existing parent class, or renaming the parent class and adding additional codes, for example:

    G93.3 [Add new parent class]

    G93.31 Postviral fatigue syndrome
    G93.32 Benign myalgic encephalomyelitis
    G93.33 Systemic exertion intolerance disease
    Excludes1 Chronic fatigue syndrome NOS (R53.82)


    Note that I am not advocating for such an arrangement but offer it as a hypothetical proposal.

    (For the benefit of readers unfamiliar with the two types of ICD-10-CM Excludes)

    Source: ICD-10-CM Release FY 2015 Tabular List

    "Excludes Notes

    The ICD-10-CM has two types of excludes notes. Each note has a different definition for use but they are both similar in that they indicate that codes excluded from each other are independent of each other.

    Excludes1

    A type 1 Excludes note is a pure excludes. It means 'NOT CODED HERE!' An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

    Excludes2

    A type 2 excludes note represents 'Not included here'. An excludes2 note indicates that the condition excluded is not part of the condition it is excluded from but a patient may have both conditions at the same time. When an Excludes2 note appears under a code it is acceptable to use both the code and the excluded code together."
     
  15. Kati

    Kati Patient in training

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    Despite the CCC being shared in thousands of dr's offices (at least in Canada) and the MEICC being published in a prominent journL, these 2 never caught up in the larger medicine field. It's pretty sad but Dr Bateman felt it was time to move forward and embrace the opportunity to work with the most reputable IOM to propel the field forward. ( I am not speaking for her, I believe she has said that herself)
     
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  16. halcyon

    halcyon Senior Member

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    To me it's not logical at all unless you can prove that SEID is a third distinct disease from both ME and CFS. As I understand it, the same disease is not supposed to appear in the ICD under mutliple rubrics. This is why we want to know what disease the IOM report is talking about. In my opinion it's already dubious that the ICD-10-CM contains both ME and CFS as two distinct, exclusionary diseases. Where is the evidence for this? CFS has always been poorly described ME that likely picks up both people with ME as well as other sick people.

    If the SEID criteria picks up only people with ME, then it should be indexed to G93.3 (BME/PVFS). If it only picks up people with CFS, then it should be indexed to R53.82 (or R53.82 could be renamed to remove the stigmatic name). If it picks up people with both then we really need to stop and ask ourselves what the hell is going on. The same criteria should not describe three different diseases, if in fact they are three distinct diseases, which is what is implied by leaving ME and CFS at different codes and creating a third for SEID.
     
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  17. usedtobeperkytina

    usedtobeperkytina Senior Member

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    I'm sorry if I wasn't clear. I didn't mean a person with our disease can't be denied. I meant to say what objective medical impairment is included in the Soc. Sec. guidelines for this disease is not dependent on disease criteria. EBV titers (as you referred to) is an OMI that, if it's high enough, can be used for this disease. But I don't know of any criteria that requires a certain EBV titer to be diagnosed. Same with abnormal MRI, which can be used as an OMI for Soc. Sec. disability but is not required, to my knowledge, in any Me/CFS criteria.
     
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  18. usedtobeperkytina

    usedtobeperkytina Senior Member

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    Yes, we do. G93.3 under PVFS is Benign ME.
     
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  19. usedtobeperkytina

    usedtobeperkytina Senior Member

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    Agreed. And so what to do with and where to out SEID means we need more clarity on the intent of the IoM committee or from a science-based decision from someone else in authority, but whom?

    By the way, if the SEID recommendations are followed, it would not be in the R53 code under "Fatigue." But, considering it's multisystem nature, sure would be nice to have had some science-based guidance on where it should go. And by the way, someone must make a proposal to the US government NCHS for any addition or change to happen.
     
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  20. usedtobeperkytina

    usedtobeperkytina Senior Member

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    Well, this is speculation, but I can see where the chairman, Dr. Clayton, would have reigned in any discussion or debate on topics outside the scope. It's hard enough to get a 15-person consensus on the particular questions out to them. Getting the group to stay on task is very common to get to the goal in the time allowed. Also, remember, the P2P was supposed to be handling the research definition aspect.
     

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