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Dx Revision Watch: Update on the US specific ICD-10-CM

Discussion in 'General ME/CFS News' started by mango, Jun 30, 2016.

  1. mango

    mango Senior Member

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    https://twitter.com/dxrevisionwatch/
    https://twitter.com/dxrevisionwatch/
     
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  2. A.B.

    A.B. Senior Member

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    Somatic symptom disorder is a very dangerous diagnosis

    The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill
    by Allen Francis

    http://www.bmj.com/content/346/bmj.f1580

    and once the patient (with an underlying organic disease) has a psychosomatic label they will have a hard time finding a doctor that takes them seriously and could correctly diagnose them.

    What for? A power grab by psychiatry that fears losing influence? A trojan horse diagnosis inserted by insurance companies so they can apply mental health exclusion to as many patients as possible?

    It's good to see that there is some resistance from within psychiatry to this diagnosis, but I wish the opposition was stronger.
     
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  3. eastcoast12

    eastcoast12 Senior Member

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    Some of the comments are are really good. If you guys have the time check them out. There's some really well thought detailed responses not only against the new definition, but about the whole basis of somatic/conversion/functional disorders. Shockingly (I guess it shouldn't be but we're all used to evil psychs) a lot of the responses are from people in the psych field.

    If you scroll all the way down you'll see some links to other studys. 2 are about abnormal illness beliefs in relation to cfs. I'll let you guys read them (only read the results and conclusions) but I think you'll all day a bit surprised
     
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  4. Large Donner

    Large Donner Senior Member

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    Isnt this very bad? Its placing chronic fatigue alongside Chronic Fatigue Syndrome and separating CFS from ME but no one gets the diagnostic label ME in the US. Also most doctors have never even heard of ME or know whats tests to run for it.

    Or is this just the same as it was before in the US ICD?
     
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  5. Esther12

    Esther12 Senior Member

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    I always get lost in this stuff.
     
  6. halcyon

    halcyon Senior Member

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    I don't see why it's bad. ME and CFS have always been separate in the US ICD 9 and 10. Why would we want to conflate chronic fatigue (or CFS) with ME?
     
  7. eastcoast12

    eastcoast12 Senior Member

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    I don't understand what the difference is. The two terms are used interchangeably so often. What is the difference?
     
  8. halcyon

    halcyon Senior Member

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    One could probably write enough on this topic to fill an entire book. Simply put, the symptoms historically ascribed to ME don't fully overlap with the symptoms historically ascribed to CFS. When you apply the criteria for both to a cohort they will each select different groups of patients. The unanswered question is does this mean that the patients in these different groups have a different underlying cause to their disease or just a different range of symptoms being caused by the same underlying disease.
     
  9. Large Donner

    Large Donner Senior Member

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    Thats why it is bad isn't it? Isn't chronic fatigue being conflated here with CFS under the same code:

    Were not CF and CFS seperated before in the US ICD?

    No one gets the diagnostic label of ME in the US is my understanding, isnt it the case that CFS was somewhat safer a term than CF and previously separated?
     
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  10. halcyon

    halcyon Senior Member

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    There is no 'chronic fatigue' listing in the 2011 ICD-9-CM. 780.7 is 'malaise and fatigue' and under that 780.71 is 'chronic fatigue syndrome'. So yeah, you could argue that the ICD-10-CM is worse in this way, but how much effort do we want to spend fighting for the CFS name?

    There is no technical reason standing in the way of it being used though. ME was in the ICD-9-CM as well. Doctors just have to use it.
     
  11. eastcoast12

    eastcoast12 Senior Member

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    I'm a bit confused. Like donner said, ME isn't really used in the US. I was diagnosed twice by 2 different docs both who have been in the field for a while. One told me cfs while the other wrote on a referral for an eye doc cfids/me. Before that I saw a bunch of other specialist a few told me its most likely cfs.
    Any chance you can be a little more specific about the differences?
     
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  12. halcyon

    halcyon Senior Member

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    I don't really understand what people mean when they say this. Again, ME has been in the US ICD 9 and 10 for many many years. I am in the US and I use ME. HHS and NIH have started using ME/CFS. If you mean that doctors don't write G93.3 (or 323.9 previously) on forms then yes that is probably mostly true, but that's purely out of ignorance and can be changed with education. We have peer reviewed published ME criteria, we have the diagnostic code, we just need to use them.

    It depends on which ME or CFS definitions you compare. The most glaring is that Holmes 1988 and Fukuda 1994 criteria don't require post exertional malaise as a symptom, while the CCC, ICC, and Ramsay's description do require specific post exertional effects. Chronic fatigue is a required symptom of Holmes 1988, Fukuda 1994, and CCC but not ICC or Ramsay's description.
     
    Last edited: Jul 1, 2016
  13. duncan

    duncan Senior Member

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    I have heard of individuals getting an ME diagnosis in the US, but I believe those are exceptions. Most doctors will only use CFS. Indeed, this (CFS) is what the the old CFIDS Association or whatever advised Social Security on back in '98 or '99. ME didn't enter the equation.

    It may be easier to get an ME diagnosis in the US now that ME/CFS is acceptable, but it is still at best unusual. Bottom line in the United States, the govt has permitted ME to be supplanted by CFS, and that policy has been successful across the 50 states since at least the early 90's.

    The best you can expect - usually - from clinicians in the US is that CFS is NOT chronic fatigue, and that is asking alot. As for ME, the majority will not have heard of it. The most you can hope for is that a handful will know ME is CFS for many e.g., when one applies the ICC definition to CFS...But how rare is that doctor? It's rarer still he will use ME as a diagnosis and not default to CFS.

    I can recall just a few years back going on the CDC's website and using its search function and not finding anything on ME, and only the usual rubbish about CFS. It was as if ME didn't exist in the United States.

    Ever try selling a doctor on CFS not being synonymous with chronic fatigue? Well, imagine trying to change some of these rubes' minds that ME is a real thing, when they already think you are delusional for thinking CFS is a real thing. That kind of sums up the situation in most of the US.
     
    Last edited: Jul 1, 2016
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  14. Large Donner

    Large Donner Senior Member

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    The main point is that most Americans on this Forum will have a CFS label currently and it will be longstanding in their medical notes and now that is conflated with chronic fatigue and not only that but it also means that the ICD in the US has decided that CFS is CF.
     
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  15. osisposis

    osisposis Senior Member

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    so, if diagnosed with malaise and fatique, R53-81 and R53.83, is that what is being used for ME/CFS so far in the USA?
     
  16. halcyon

    halcyon Senior Member

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    Seems to depend on the doctor. My PCP uses 780.71/R53.82. When I went to Stanford CFS clinic they used 780.79 (Other malaise and fatigue). Dr. Chia used 079.99 (Unspecified viral infection).
     
  17. osisposis

    osisposis Senior Member

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  18. Dx Revision Watch

    Dx Revision Watch Owner of Dx Revision Watch

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    This has been the case since the 2007 draft Release for ICD-10-CM.

    The 2003 Release had proposed three terms (PVFS, BME, Chronic fatigue syndrome, postviral) under G93.3, with a "Chronic fatigue syndrome NOS*" under R53.82 - like this:

    *NOS = "Not otherwise specified"


    [​IMG]

    When the 2007 draft was released, "Chronic fatigue syndrome, postviral" was deleted as the second inclusion term under

    G93.3 Postviral fatigue syndrome

    Benign myalgic encephalomyelitis​


    leaving "Chronic fatigue syndrome NOS" under R53.82. This was implemented in October 2015, when ICD-10-CM replaced ICD-9.


    [​IMG]
     
    Last edited: Jul 19, 2016
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  19. osisposis

    osisposis Senior Member

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    so sence I was made ill from a water damaged /moldy home, I guess the R53.81 and R53.83 would be right, ?!?, oh my goodness, nothing like having a damaged brain and having to deal with all this crap , fell like I'll be dead before this mess ever gets straightened out.
     
  20. Dx Revision Watch

    Dx Revision Watch Owner of Dx Revision Watch

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    Last edited: Jul 19, 2016
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