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IOM and WHO-ICD - change suggested only for the US version?

Anne

Senior Member
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295
Apologies if this has already been discussed (I couldn't find it through a quick search):

The IOM report suggests a new WHO-ICD code for SEID. Am I right in assuming that this only pertains to the US adaption of ICD-10?

As I understand it, there is a central WHO-ICD, which keeps getting updated (ICD-10, ICD-11, etc). But then some countries have their own adaptions. The US is in the process of adapting ICD-10, right? (most countries have had their versions of ICD-10 in place for a few years) And the IOM suggestion is for this US ICD-10?

So there is no suggestion for the "central" WHO updating process, where (if I'm not mistaken), the ICD-11 is currently being processed?

Meaning: a new code in the US adaption of ICD-10 won't mean anything for the rest of the world?

Or?

Susy C, are you here? Also calling @charles shepherd
 
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All countries do not create their own versions of the WHO-ICD.

'ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994. ICD is currently under revision, through an ongoing Revision Process, and the release date for ICD-11 is 2017.'
http://www.who.int/classifications/icd/en/

I am not able to explain ICD10 CM, which is US specific.

.
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Yes, I'm here.

I've got family health problems piling up, so to save time, I'm reposting (over three posts) pretty much what I've posted, today, in the comments to Valerie Eliot Smith's blog post:

The IOM: Death by Acronym and Epic Media Fail

https://valerieeliotsmith.wordpress...d-epic-media-fail/comment-page-1/#comment-441


Over a hundred countries use ICD-10 (the WHO's 1994 edition). They will transition to ICD-11 at their own pace and it may take several years for some countries, especially low resources countries, to shift from ICD-10 to ICD-11.

A handful of countries have been authorized by WHO to develop their own "clinical modification" of ICD-10, including the U.S. (its ICD-10-CM does not implement until October 2015); Australia (ICD-10-AM); Germany (ICD-10-GM) and Canada (ICD-10-CA). A few other countries also use the Australian modification.


The IOM report’s authors have got themselves into a tangle over ICD coding. There is no excuse for them having published unreliable information around ICD and I trust this is going to be corrected for the final version. (I have asked Dr Bateman, via Twitter, if the information given on ICD is going to be reviewed and amended, but have received no response.)


The report states on Page 31:


‘A new code should be assigned to this disorder in the International Classification of Diseases, Tenth Edition (ICD-10), that is not linked to “chronic fatigue” or “neurasthenia.”’

and on Page 50:

“In the World Health Organization’s International Classification of Diseases, Tenth Revision, which will be implemented in October 2015, the clinical descriptions of ME and CFS are identical, yet ME is classified as a disorder of the neurologic system (ICD G93.3), while CFS is considered a synonym for chronic fatigue, which is classified under “signs, symptoms, and abnormal clinical and laboratory findings, not elsewhere classified” (ICDR53.82).1


and gives the source reference:

1 The World Health Organization’s International Classification of Diseases, Tenth Revision, can be accessed at http://www.icd10data.com/ICD10CM/Codes (accessed January 13, 2015).



To disentangle:

Clarification 1:


The version of ICD-10 that is scheduled for implementation in October 2015 is the U.S. specific, “clinical modification” of the WHO’s ICD-10, known as ICD-10-CM (for diagnosis codes) and ICD-10-PCS (for procedure codes).

This adaptation of ICD-10, for U.S. use only, is the responsibility of the National Center for Health Statistics (NCHS) and Centers for Medicare and Medicaid Services (CMS).

It is not the responsibility of WHO or WHO-FIC.

The code sets for ICD-10-CM/PCS are currently subject to a partial code freeze during which only limited updates and revisions can be made, for example, to include new viruses.

The ICD-10-CM Coordination and Maintenance Committee is jointly chaired by NCHS (Donna Pickett, CDC) and CMS and is responsible for considering updates and revisions prior to, and post implementation.

Any code requests that do not meet the criteria for consideration during a partial code freeze will be evaluated for implementation within ICD-10-CM/PCS on and after October 1, 2016, once the partial freeze has lifted.

This is a public process and meetings to discuss corrections, revisions and updates to ICD-10-CM/PCS are held in public, twice yearly, (usually March and September) followed by public comment periods.

Submissions for modifications to existing codes or for new additions come from federal agencies, the APA, clinicians, medical professional bodies, the coding industry, patient interest groups and individuals.

Information about the ICD-10-CM revision process and making submissions cam be found here: http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

So any potential inclusion of SEID within the U.S. specific ICD-10-CM, either as a discrete new code, or as an inclusion term to an existing ICD-10-CM code or as a replacement for existing codes would be the purview of the ICD-10-CM Coordination and Maintenance Committee and not the WHO, Geneva.


WHO’s ICD-10

The WHO’s ICD-10 is also subject to an annual revision and update process. This is the responsibility of the WHO-FIC Update and Revision Committee (URC).

The URC update and revision process is expected to continue to update ICD-10 for several years, until most WHO Member States have transitioned to ICD-11.But WHO has said it won't support ICD-10 indefinitely.

In my view, given how conservative the URC is and with ICD-11 currently scheduled for completion in 2017/18, I doubt that URC would consider including SEID within the WHO’s ICD-10, if HHS or other U.S. agency were to put this forward for consideration by the URC via the North American WHO-FIC Collaborating Center or via the Collaborating Centers for Classifications, Terminologies and Standards at Stanford or Mayo.

Suzy Chapman for Dx Revision Watch
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Clarification 2:

The IOM report refers to “WHO ICD Tenth Revision” coding of ME at G93.3 (under Diseases of the nervous system chapter) with CFS at R53.82 (Symptoms, signs chapter).

It is important to note that this chapter placement and coding is specific to the U.S.’s forthcoming ICD-10-CM. It does not apply to the WHO’s ICD-10.

In the WHO’s ICD-10 (adopted by Member States from 1994), PVFS is the ICD “Title term” and is coded under the G93 parent class, at G93.3.

(B)ME is the inclusion term under PVFS, and assigned to the G93.3 code.

CFS has never been included within ICD-10 Volume 1: The Tabular List, and remains indexed only to G93.3, within Volume 3: The Alphabetical Index.

The WHO’s ICD-10 Version: 2015 can be viewed online here:

http://apps.who.int/classifications/icd10/browse/2015/en


icd102015.png


Screenshot shows Chronic fatigue syndrome indexed to G93.3 (Index term designated by orange symbol).



ICD-11


ICD-11 is being developed by an international Revision Steering Group (RSG) that reports to WHO. Reporting to the RSG are numerous international working groups (known as Topic Advisory Groups) and subworking groups. The working groups’ recommendations are advisory and final decisions (after peer review and in some cases, field testing) lie with the RSG and WHO classification experts.

The Beta draft for ICD-11 is an ongoing process and proposals are still coming in and being evaluated and in some cases, field tested, across all chapters. But the draft will need to have been finalized and put out for public review by mid 2016 to early 2017, if the RSG is going to have ICD-11 ready for World Health Assembly (WHA) approval by May 2017.

The three ICD-10 legacy terms, PVFS, (B)ME and CFS have been absent from the Beta draft since early 2013.

At that point, the Beta draft had CFS as the Title term with (B)ME specified as the Inclusion term to CFS.

At that point, PVFS was listed under Synonyms to CFS, along with a dozen or so other terms* that had been scraped from various terminology systems and from other sources - a list which had also included the yet to be implemented, ICD-10-CM Chapter 18 R coded terms, “Chronic fatigue, unspecified” and “Chronic fatigue syndrome NOS”.

*This list of terms under Synonyms had not included "Myalgic Encephalopathy" - which may reflect the search methods used to generate lists of Synonyms when populating the initial content for the Beta draft and the terminology available within the sources from which lists of alternative or historical terms have been derived, rather than a human decision on the part of TAG Neurology to omit "Myalgic Encephalopathy" from the list.

NB: "Myalgic Encephalopathy" is listed under synonyms to CFS in the UK browser for SNOMED CT http://browser.ihtsdotools.org/



WHO has said in response to various enquirers, including the Scottish Health Directorate, a joint enquiry by several UK patient orgs, and in written response to my own enquiries, that the placement of ME and related conditions within ICD-11 is still unresolved and that more time and input from the relevant working groups is required.


WHO has confirmed three times now that there has been no proposal and no intention to include ME or other conditions such as fibromyalgia or chronic fatigue syndrome in the ICD-11 classification of mental disorders.

I have also been told, in writing, by ICD’s Dr G Reed*: “That the easiest way to make this absolutely clear will be through the use of exclusion terms.” However, Dr Reed would be unable to ask that exclusion terms are added to relevant Mental and behavioural disorders categories (e.g. Bodily distress disorder) until the conditions that are being excluded have been restored in the classification. That at such time, he would be happy to request exclusions.

*Personal communication, July 24, 2014

Suzy Chapman for Dx Revision Watch
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Clarification 3:

The IOM report gives a link for ICD Tenth Revision.

The link the authors have provided is for a U.S. commercial site that aggregates coding data from a variety of sources. It also scrapes disease and disorder descriptions from a variety of sources, including non ICD sources.

The correct link for the U.S. specific ICD-10-CM (FY 2015 Release) should have been given as:

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

from which zip files and PDFs for the latest ICD-10-CM (FY 2015 Release) can be downloaded.

The correct link for the WHO’s ICD-10 Version 2015 is:

http://apps.who.int/classifications/icd10/browse/2015/en


where the 2015 electronic version of ICD-10 Volume 1 can be accessed for free.

It is important to note that for the WHO’s ICD-10, there are NO definitions, disease descriptions or other descriptive content included for PVFS, (B)ME or CFS.

Similarly, within ICD-10-CM, there are NO definitions, disease descriptions or other descriptive content included for PVFS, (B)ME or for the Chapter 18 R coded, Chronic fatigue, unspecified or Chronic fatigue syndrome NOS.

So the authors’ statement, “In the World Health Organization’s International Classification of Diseases, Tenth Revision, which will be implemented in October 2015, the clinical descriptions of ME and CFS are identical (…)”

is erroneous, since there is NO descriptive content within either classification for any of these terms.


However, for ICD-11, all ICD Title terms will be assigned short and long definitions for the print and electronic versions and assigned other descriptive parameters. And if CFS and (B)ME were coded under separate codes, then both terms would require definitions.

Suzy Chapman for Dx Revision Watch
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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A couple of additional points:

Canada, Germany and Australia, which have country specific “clinical modifications” of the WHO’s ICD-10, are responsible for their own update and revision cycles and will also decide when to start developing and implementing their adaptations of ICD-11 (a process which can't be started until after the ICD-11 code sets have been ratified by WHA).

In the Canadian modification and the German modification:

https://www.dimdi.de/static/de/klas.../onlinefassungen/htmlgm2015/block-g90-g99.htm


G93.3 Chronisches Müdigkeitssyndrom

Benigne myalgische Enzephalomyelitis
Chronisches Müdigkeitssyndrom bei Immundysfunktion
Postvirales Müdigkeitssyndrom


the three terms, PVFS, (B)ME, CFS, are already included in the Tabular List, under Chapter 6 Diseases of the nervous system, at G93.3, though the German modification has a different hierarchy.


ICD-11 and multiple parents

For ICD-11, the ICD-10 concept of discrete chapter location has been dispensed with.

ICD-11 permits multiple parentage, which means that disease and disorder terms can be listed under a “primary parent” and a “secondary parent” across two or more chapters.

In the Foundation Component, disorders which straddle more than one chapter, for example, skin neoplasms, or eye diseases in diabetes can be accessed under two or more relevant chapters, though the code remains the same as the code assigned under the “primary parent.”


In 2010, ICD Revision published a Discussion Document on the potential for incorporating a new chapter into ICD-11 for Multisystem diseases [1]. But this was later rejected.

In 2013, consideration was being given, instead, for generating a multisystem diseases linearization – as a virtual chapter – compiled from the Foundation Component that lists all ICD disorders and diseases, but it was envisaged there would be no separate Multisystem diseases chapter within the print version.

It isn’t known whether a decision has been reached yet, but there is currently no ability to generate a multisystem diseases linearization from the Foundation Component, at least not within the public version of the Beta drafting platform.

How to represent multisystem diseases within ICD-11 (and the potential for an ICD category term to be assigned to multiple parents across two or more chapters) could have implications for classification of one or more of the three ICD-10 G93.3 legacy terms.


Suzy Chapman for Dx Revision Watch

1. http://dxrevisionwatch.files.wordpress.com/2010/1/considerations20on20multisystem_diseases_201008181.doc
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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This comment has undergone substantial editing since initial posting.

The NCHS/CMS ICD-10-CM update and revision mechanism is a public process.

Requests for additions or modifications to ICD-10-CM/PCS are tabled in meeting Agendas (or Topic Packets as they are known). The public can register to attend meetings in person, or participate via phone link. Meetings are web-cast live and videos of both days’ proceedings are posted, followed by the posting of a meeting summary and public comment period (of between 3 to 8 weeks) through which comments and objections to requests for modifications presented at the most recent meeting can be submitted.

But the WHO-FIC’s ICD-10 Update and Revision process is not a public process.

It would not be easy to monitor the progress of any potential request submitted to the WHO-FIC Update and Revision Committee via the North American WHO-FIC Collaborating Center or Collaborating Centers for Classifications, Terminologies and Standards (or any other countries' WHO-FIC Network Collaborating Centres) unless the agencies steering any request and its progress placed information in the public domain.

If a request for inclusion in WHO's ICD-10 were to be made by the agencies with a stake in the IOM's recommendations, via the U.S. Collaborating Centers, I think it unlikely that any request would be submitted until after SEID had been adopted, approved for insertion into ICD-10-CM and preparations for its dissemination and implementation within the U.S. were well advanced.

By then, we could be looking at 2016+ if not longer. (I haven't noted any projected timeline within the Report's recommendations.)

I would envisage the URC rejecting any proposal for adding SEID to WHO's ICD-10 in preference to consideration for inclusion within the ICD-11 Beta draft (either coded for or included under the list of Synonym terms) or for consideration for inclusion within the next annual update of ICD-11, if the ICD-11 version for 2017 had already been ratified by WHA and released.
The update cycle for ICD-10 has been:

Tabular list: Every three years for major changes, annually for minor changes.
Index: Annually for changes that do not impact on the structure of the tabular list.

What constitutes a Major or Minor change is set out on Page 3 of this document.


However, it may be that the U.S. agencies with a stake in SEID do not see their remit extending to the colonization of classification systems beyond the U.S. Though they may conceivably apply for inclusion of the SEID term within the U.S. extension of SNOMED CT and the U.S. SNOMED CT code to ICD-10-CM code cross-walk.


CDC's Donna Pickett* co-chairs the NCHS/CMS Coordination and Maintenance Committee meetings. In 2010-11, when U.S. advocates submitted proposals via the C & M meetings for shifting CFS out of the Chapter 18 R codes and back under Chapter 6 under G93.3, where it had originally been proposed to be located, Ms Pickett put up considerable barriers to change. Committee elected to stick with the status quo.

Given Ms Pickett's opposition to these proposals for changing the location of CFS, several years ago, it will be interesting to see how she deals with any future submission on behalf of IOM contract stakeholders for the insertion of SEID into ICD-10-CM.

*WHO Collaborating Centre for WHO-FIC in North America; Voting Member, WHO-FIC Update and Revision Committee (URC).


ICD-11


As far as ICD-11 is concerned, stakeholders need to register with the Beta draft for enhanced interaction with the drafting platform, for access to additional resources and in order to submit proposals for addition of new entities or suggest content changes to existing entities, via the Proposal Mechanism. New proposals to the evolving Beta draft are generated internally by the Topic Advisory Groups and externally by medical professional bodies, clinicians, researchers, allied medical professionals and other interested stakeholders.

Proposals are then subject to review by the chairs and managing editors of the appropriate Topic Advisory Groups (TAGs), sometimes to external review, and by the RSG. Proposals that are approved, provisionally, are then entered into the Beta draft and marked as “Implemented” in the Proposal Mechanism.

One can follow the status of proposals via the Proposal Mechanism. But one cannot view the TAGs’ rationales or Discussion Notes (ie the decision making process) that results in the Approval or Rejection of a specific proposal. These Discussion Notes are only available to those with editing access to the more complex iCAT authoring platform that the ICD working groups are using to develop the draft on, which looks like this:

icat-editing-platform-3.png


If you look closely, you'll see that at the point at which this screencast was posted by a member of the iCAT editors Google Group the dropdown for "Multisystem diseases" had a strike-through.


For comparison between the public Beta draft and the complexity of the iCAT, view this 2 minute iCAT screencast animation (with audio), intended as a demo for ICD Revision editors. The animation is an .ogv file format which should run in recent releases of Firefox but may not load in other browsers.


Proposals for new entities to the public version of the Beta draft need to be supported with rationales and references. In theory, any registered stakeholder could propose the addition of the SEID term and construct to ICD-11, supported by rationales and references. A proposal would not have to come from HHS, IOM, per se, or from any other stakeholder agency.

(Or, when ICD-11 does restore the three ICD-10 legacy terms to the draft, for SEID to be proposed as a specified Inclusion term to whichever ICD-10 legacy term may be designated as the ICD-11 "Title term," or listed under Synonyms to a Title term, if not proposed to be inserted under a discrete new code or if not proposed to replace or subsume one or more of the legacy ICD-10 terms.)

Once ICD-11 has been disseminated, it will be subject to an annual update and revision process, though it is expected that proposals will be considered as soon as they arrive and if approved, added to an annual updated release (as ICD-11 2018, ICD-11 2019 and so on).

Suzy Chapman for Dx Revision Watch
 
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Anne

Senior Member
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295
So, if this brain fogged person got it right:

The IOM suggestion is not aimed at the "central" WHO updating process, where the ICD-11 is currently being processed?

And it's not clear whether the IOM suggestion will have any impact on the US ICD-10 adaption either?
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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So, if this brain fogged person got it right:

The IOM suggestion is not aimed at the "central" WHO updating process, where the ICD-11 is currently being processed?

And it's not clear whether the IOM suggestion will have any impact on the US ICD-10 adaption either?


On Page 31, the report states:

'A new code should be assigned to this disorder in the International Classification of Diseases, Tenth Edition (ICD-10), that is not linked to “chronic fatigue” or “neurasthenia.”’'

Since the WHO's ICD-10 is known as "ICD-10" and the U.S. adaptation is known as "ICD-10-CM," on the surface, this would appear to be referring to the WHO's ICD-10.

However, people in the U.S. coding industry, U.S. clinicians and federal agencies will often refer to "ICD-10-CM" as "ICD-10."


The report later states (on Page 50):

“In the World Health Organization’s International Classification of Diseases, Tenth Revision, which will be implemented in October 2015, the clinical descriptions of ME and CFS are identical, yet ME is classified as a disorder of the neurologic system (ICD G93.3), while CFS is considered a synonym for chronic fatigue, which is classified under “signs, symptoms, and abnormal clinical and laboratory findings, not elsewhere classified” (ICDR53.82).1

and gives the source reference:

1 The World Health Organization’s International Classification of Diseases, Tenth Revision, can be accessed at http://www.icd10data.com/ICD10CM/Codes (accessed January 13, 2015).


Since it is the U.S.'s ICD-10-CM that is scheduled for implementation in October 2015, the report appears to be referring to the ICD-10-CM. Additionally, the code referred to (CFS NOS under Symptoms, signs chapter under R53.82) is specific to ICD-10-CM.

But the reference given for "The World Health Organization’s International Classification of Diseases, Tenth Revision" is not for WHO ICD-10 codes but for a commercial site for ICD-10-CM codes.

So the information provided in the report is a dog's breakfast and it needs redrafting.

And the link provided does not even point to the CDC page for the official ICD-10-CM Release for FY2015. Which is why the authors need to review and amend that section, for better clarity of intention.

I imagine (but this has not been confirmed) that the authors intention is to propose addition of SEID into the forthcoming ICD-10-CM, which would need to be submitted via the ICD-10-CM Coordination and Maintenance Committee, jointly chaired by NCHS (Donna Pickett) and CMS.

Irrespective of the development of WHO's ICD-11, the ICD-10 will continue to be updated for several years. This ICD-10 update process is the responsibility of the WHO-FIC Update and Revision Committee (URC) - not the Revision Steering Group tasked with oversight of the development of ICD-11.

Anne has said:

And it's not clear whether the IOM suggestion will have any impact on the US ICD-10 adaption either?

If it is the intention of HSS or IOM or any other agency involved in this contract to have SEID added to the forthcoming ICD-10-CM (either as a new code or as an inclusion term to an existing code) then they will need to submit their proposal via the C & M Committee meetings for consideration by the Director of NCHS and for public scrutiny and comment.

They could, conceivably, submit a request for consideration by the C & M Committee at the September 2015 meeting or at the March 2016 meeting. But they might need to wait until the IOM recommendations are further advanced.

(The date for submissions for the March 2015 meeting was reached in January, but the full agenda won't be available until the day before the March meeting, so I can't check until then whether a request has already gone in and been tabled in the agenda for the March meeting.)

So achieving addition of SEID into ICD-10-CM, ICD-10 or ICD-11 would require submitting proposals for consideration by two different bodies, and in the case of ICD-11, through the ICD-11 Revision Proposals Mechanism, which is a separate body to the WHO-FIC URC.

If the WHO-FIC URC were to approve the addition of SEID into ICD-10 (which in my view, I doubt they would) that would not automatically add SEID to ICD-10-CM, since NCHS/CMS is responsible for the ICD-10-CM update and revision cycle and for approving modifications to the code sets.

Suzy



.
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Here are some important dates for upcoming NCHS/CMS ICD-10-CM Coordination and Maintenance meetings, taken from the Topic Packet (Full agenda) for the September 23-24, 2014 meeting:


http://www.cdc.gov/nchs/data/icd/Topic_Packet_09_23_2012.pdf


Next Meeting

March 18-19, 2015


The Deadline for new proposals has already been reached (January 16, 2015).


April 17, 2015 Deadline for receipt of public comments on proposed code revisions discussed at the March 18–19, 2015 ICD-10 Coordination and Maintenance Committee meetings for implementation on October 1, 2015.



September Meeting

July 17, 2015 Deadline for requestors: Those members of the public requesting that topics be discussed at the September 22–23, 2015 ICD-10 Coordination and Maintenance Committee meeting must have their requests submitted to CMS for procedures and NCHS for diagnoses.


August 2015 (TBA) Tentative agenda for the Diagnosis part of the September 22 –23, 2015 ICD-10 Coordination and Maintenance Committee meeting will be posted on the NCHS webpage at - http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

September 22 –23, 2015 ICD-10 Coordination and Maintenance Committee


October 16, 2015 Deadline for receipt of public comments on proposed code revisions discussed at the September 22-23, 2015 ICD-10 Coordination and Maintenance Committee meetings for implementation on April 1, 2016.


November 13, 2015 Deadline for receipt of public comments on proposed code revisions discussed at the September 22-23, 2015 ICD-10 Coordination and Maintenance Committee meetings for implementation on October 1, 2016.

----------


Any developments re the IOM and future C & M meetings will be reported via Twitter and via my site, and I'll post here as well. Likewise, any proposal (from any quarter) to add SEID to the ICD-11 Beta draft via the Beta Proposal Mechanism.
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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What a tangle...

Yes, if the authors were not confident to write accurately in relation to ICD-10 and ICD-10-CM coding or to provide official links, they should have consulted before publishing.

Because of the potential for confusion, I'd recommend that whenever anyone is referring to the U.S.'s ICD-10-CM adaptation, they use "ICD-10-CM" and not "ICD-10" - because for the rest of the world, ICD-10 will imply the WHO's 1994 version.
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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... and then there is the SNOMED CT healthcare terminology system which ICD-11 is planned to be integrable with.

There are international versions of SNOMED CT but the U.S. has developed a U.S. specific SNOMED CT and a cross-walk from SNOMED CT codes to the forthcoming ICD-10-CM codes.

SNOMED CT and NHS


SNOMED CT international browsers
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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That was an excellent blog posting by Jennie Spotila but maybe it deserves its own thread?
( if it doesn't have one already )

It seems to be a different topic -- but maybe I'm missing something?


It raises questions about what HHS does next, but also asks:

Will the National Center for Health Statistics create a new diagnostic code for SEID? Who will be charged with writing that proposal and seeing it through?


which has relevance to this thread.