Updates on ICD-11 and other classification and terminology systems

[Dx Revision Watch]

A Frozen release of the Beta draft was made on May 18 for quality assurance processes. This has not been posted on the Beta platform's Frozen Release page but can be found here:

https://icd.who.int/browse11_2018-05-18/l-m/en

I do not think this is the Beta freeze referred to by WHO's Dr John Grove scheduled for the end of May, in preparation for release of an initial version of ICD-11 in June.

No date for the June release has been announced yet by WHO.

 

[Dx Revision Watch]

https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00151/full

ORIGINAL RESEARCH ARTICLE
Front. Psychiatry, 14 May 2018 | https://doi.org/10.3389/fpsyt.2018.00151

A European Research Agenda for Somatic Symptom Disorders, Bodily Distress Disorders, and Functional Disorders: Results of an Estimate-Talk-Estimate Delphi Expert Study

Extract:

"The former DSM-IV somatoform disorder section mostly focused on the criterion that physical symptoms should medically unexplained (17), which left diagnostic and treatment difficulties unresolved (18–20). This changed with the introduction of the DSM-5 Somatic Symptom Disorders (SSD) in 2013. In DSM-5 the nature of the physical symptoms, i.e., being medically unexplained or not, is no longer a criterion. Instead, DSM-5 focuses on the way a patient emotionally, cognitively and behaviorally copes with the physical symptoms (21). According to the SSD classification, patients suffering from chronic medical conditions can also be diagnosed and receive treatment. This in its own right poses new diagnostic and treatment challenges (22, 23).

The proposed ICD-11 beta draft classification of Bodily Distress Disorders (BDD) (24, 25) may differ from SSD (19). This has led to controversy and a proposal to delete BDD from the ICD-11 beta version (26) as it seems hard to discern from Bodily Distress Syndromes (27) that captures many of functional and somatoform disorders (28) and shows similarities with the ICD-10 classification of somatoform autonomous dysfunction (29). Similarly to functional disorders (FD), BDD mainly focuses on medically unexplained physical symptoms for its classification, rather than on their psychological conundrums (30). In order to cover the multitude of aspects described above, in this study, we will use the combined term of Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD), as was done in an earlier study of the EURONET-SOMA network (31)..."


The highlighted passage presents an incorrect interpretation of the ICD-11 core edition's conceptualization and characterization of Bodily distress disorder.

One of the reasons for proposing deletion of BDD from ICD-11 is the similarity between the name proposed for the ICD-11 core version construct (Bodily distress disorder) and the name of the differently conceptualized, Fink et al (2010) construct (Bodily distress syndrome).

There is a history of these two names being used interchangeably for the Fink et al (2010) construct and this has been the case since at least 2007. Five or six examples of researchers and practitioners using these two terms indiscriminately are provided in my rationale as evidence.

As set out in progress and position papers published by the S3DWG work group and reiterated in my rationale, the focus of the ICD-11 core version's conceptualization of BDD is emotional, cognitive and behavioral responses. The nature of the physical symptoms, i.e., being medically unexplained or not, is no longer a criterion. Like the SSD classification, patients suffering from chronic medical conditions can also be diagnosed with BDD: "If another health condition is causing or contributing to the symptoms, the degree of attention is clearly excessive in relation to its nature and progression."

Somatic symptom disorder is listed under Synonyms to BDD and Fink, himself, acknowledges that ICD-11's BDD is close to DSM-5's SSD [1].

Evidently the authors are insufficiently familiar with the papers of the S3DWG work group and the characterization of ICD-11's Bodily distress disorder and its three severity specifiers: Mild bodily distress disorder, Moderate bodily distress disorder, and Severe bodily distress disorder.

Ironically, the paper referenced at (30) is

Rief W, Isaac M. The future of somatoform disorders: somatic symptom disorder, bodily distress disorder or functional syndromes? Curr Opin Psychiatry (2014) 27:315–9. doi: 10.1097/YCO.0000000000000089

in which, Rief and Isaac have used the term "Bodily distress disorder" throughout their paper when what they are discussing is the Fink et al (2007, 2010) BDS construct.

Which rather nicely proves my point.



1 Syndromes of bodily distress or functional somatic syndromes - Where are we heading. Lecture on the occasion of receiving the Alison Creed award 2017. Fink, Per Journal of Psychosomatic Research, Volume 97, 127 - 130

 

[Dx Revision Watch]

Some months ago, in another thread, I posted the paper:

Syndromes of bodily distress or functional somatic syndromes - Where are we heading. Lecture on the occasion of receiving the Alison Creed award 2017. Fink, Per. Journal of Psychosomatic Research, Volume 97,127 - 130

At the time, the paper wasn't behind a paywall, but now only the first page is viewable at:
https://www.jpsychores.com/article/S0022-3999(17)30445-2/fulltext


The slides that accompanied this lecture have now turned up and can be downloaded from:

http://www.eapm2017.com/images/site/abstracts/PLENARY_Prof_FINK.pdf

and I have also attached a copy to this post.


Here are a few of the slides:

ICD-11 PC (aka ICD-11 PHC) proposed Bodily Stress Syndrome compared with ICD-11 core edition's Bodily distress disorder

All slides here and attached:

http://www.eapm2017.com/images/site/abstracts/PLENARY_Prof_FINK.pdf


Edited to add additional information:

Since February 2012, the construct selected to replace most of the ICD-10 F45.x Somatoform disorders and F48.0 Neurasthenia for the ICD-11 core edition has been Bodily distress disorder (with Somatic symptom disorder under Synonyms to BDD).

In July 2017, Concept: SCTID: 723916001 Bodily distress disorder (disorder) was added to SNOMED CT International Edition by the team working on the SNOMED CT and ICD-11 MMS Mapping Project, as an exact match for ICD-11 core edition term, Bodily distress disorder.

Somatic symptom disorder is not currently included in any edition of SNOMED CT.
Bodily distress syndrome (Fink et al 2007, 2010) is not currently included in any edition of SNOMED CT.


Note: The ICD-11 Beta draft displays brief Description texts for: 6C20 Bodily distress disorder and its three Severity specifiers: 6C20.0 Mild bodily distress disorder; 6C20.1 Moderate bodily distress disorder; 6C20.2 Severe bodily distress disorder.

The companion publication, ICD-11 Clinical descriptions and diagnostic guidelines for Mental and Behavioural Disorders (the equivalent of the ICD-10 "Blue Book") is in the process of being drafted. This publication expands on the disorder descriptions in the Foundation and MMS Linearization and includes: "Essential (Required) Features, Boundaries with Other Disorders and Normality, and Additional Features sections. Additional sections (e.g., Culture-Related Features)".

The drafts for this companion publication have been made available to clinical professionals for review and comment via the The Global Clinical Practice Network: https://gcp.network/en/icd-11-guidelines

The draft of this publication is not available to public stakeholders and I have not been able to review the expanded draft texts for the category Bodily distress disorder and its three coded for Severity specifiers.

It is currently unclear whether the ICD-11 Clinical descriptions and diagnostic guidelines for Mental and Behavioural Disorders has been finalized and will be ready to publish at the point at which the ICD-11 MMS is released, in June, or whether publication will be delayed until later this year, or next year.

 

[Countrygirl]

I will read the above when a little stronger I think...............dreadful rubbish ..................what is this about not doing as we are told!!! ??? The sooner these people end up in court the better or at least in front of a psychiatrist to determine their multiple personality disorders. Per Fink must be in a category of his own.

 

[Dx Revision Watch]

June 2018 paper:

Ziebold C, Goldberg DP, Reed GM et al (2018). Dimensional analysis of depressive, anxious and somatic symptoms presented by primary care patients and their relationship with ICD-11 PHC proposed diagnoses. Psychological Medicine 1–8. https://doi.org/10.1017/S0033291718001381

Open Access PDF

Received: 13 January 2018
Revised: 27 March 2018
Accepted: 25 April 2018


This June 2018 study used data from the ICD-11 PHC field trials for the proposed ICD-11 PHC constructs 1) Anxious Depression; and 2) Bodily stress syndrome (BSS).

The 2013 Master Field Trial Protocol had used:

"...at least three persistent somatic, medically unexplained symptoms in the adult patient, or views the patient as highly preoccupied with persistent but unfounded worry about potential health problems. Either condition must cause distress to the patient, and must negatively affect the patient’s functioning (e.g., social functioning, abilities of daily living, work performance)."

"Patients with conditions such as fibromyalgia, irritable bowel syndrome and effort syndrome [sic] ARE eligible for this part of the study, as are patients without any such label for their symptoms."


Ed: Note that in the papers published on behalf of the external PCCG work group that has been making recommendations for the revision of the ICD-10 PHC, there have been no specific exclusions for FM, IBS or CFS under the various iterations of proposed BSS diagnostic guidelines. Nor have these been listed under "Differential diagnoses". Note also, that in the early emerging proposals editorials, use of the term, BDS, was being proposed with criteria adapted from Fink et al (2010) BDS. Later the term, BSS, was proposed and the proposed criteria further modified for the 2013 field trials.

--------------

Open Access PDF

"The purpose of this study was to investigate whether the depressive, anxiety and somatic symptoms proposed for BSS and AD in the ICD-11 PHC could be used in PHC as reliable indicators of these disorders. With this aim, we tested the fit and reliability of dimensional models of ICD-11 PHC depressive, anxious and somatic symptoms presented by participants of the ICD-11 PHC field studies."

"Participants

"PCPs were instructed by local investigators to refer adult patients (older than 18 years) seen in a routine PHC practice for participation in the study. The inclusion criterion for part 2 was the presence of at least three somatic symptoms not accounted for by a known physical pathology, as rated by the PCP on a checklist that included 29 somatic symptoms under study for the proposed ICD-11 PHC diagnosis of BSS. PCPs could write in additional symptoms not listed, which also counted toward the minimum of three. (See section on Measures, below.)

"Additionally, current diagnostic constructs for somatoform disorder, somatization disorder and medically unexplained symptoms have generated controversy regarding their clinical utility and validity. Arguments against these constructs include the following: (a) a lack of construct and predictive validity; (b) poor discriminant validity due to high comorbidity with mood and anxiety disorders and their overlap with functional somatic syndromes (irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia); (c) particularly in the case of medically unexplained symptoms, the fact that the construct is based on the exclusion of medical etiologies rather than on positive biopsychosocial features; and (d) these constructs do not facilitate a positive therapeutic dialogue between clinicians and patients because they are unhelpful in describing symptoms and their causes and imply that patients exaggerate or imagine their symptoms (Kroenke,
2007; Kroenke et al., 2007; Tófoli et al., 2011).

"BSS is a disorder proposed for the ICD-11 PHC to replace the ‘Medically Unexplained Symptoms’* diagnosis in the previous version of the classifications for PHC (ICD-10 PHC) (Lam et al., 2013). The change is based in part on studies carried out by Fink et al. (2007), who examined the latent structure of somatic symptoms not explained by known physical pathology. BSS provides a single overall category for different ‘functional’ and somatoform disorders that could be exacerbated by stress rather than being distinct diseases of non-cerebral pathology. For the ICD-11 PHC, the BSS defines the presentation of three or more somatic symptoms that are associated with distress and/or interference with daily functioning and are not explained by a known physical pathology (Goldberg et al., 2016)."


*Ed: F45 Unexplained somatic complaints in the 1996 publication, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. 1996 (aka ICD-10-PHC, ICD-10 PHC, ICD-10-PC, ICD-10 PC).


Ed: Notes:

The ICD-10 PHC is not a WHO mandatory classification system. The publication was designed as a clinical tool written in simpler language to assist non-mental health specialists, especially primary care practitioners and non medically trained health workers, in diagnosis and management of 25 common mental disorders. It was also intended for use in education, training, low resource settings and in low- to middle-income countries. It provided a model for national adaptation and allowed for other changes as appropriate. It was intended to be consistent with the core ICD-10 classification (ie. each of the 25 diagnostic categories had a corresponding or roughly corresponding category in the ICD-10 Tabular List).

The draft descriptive texts, characterizations and criteria for the proposed ICD-11 PHC are not available for public scrutiny. Therefore the draft proposals for the ICD-11 PHC, as they currently stand, are not available.

In April, before the Countess of Mar terminated our collaboration, I advised that it was essential that any discussions or strategies around proposals for the ICD-11 PHC are conducted in the context of the WHO's projected timeline for the publication's completion and release; are based on the most recently proposed criteria and benefit from the context of the most recently drafted full disorder description texts, rather than rely on papers from early 2017, or earlier, and without the full draft description and management guidelines content.

I also advised that it should be established whether any public stakeholder review of the ICD-11 PHC draft content is planned. If not (and there has never been any intention to the best of my knowledge to make the draft available for public scrutiny) whether a formal public review mechanism or alternative channel for submission of stakeholder input might realistically be negotiated for. A letter requesting specific clarifications from WHO/ICD Revision was drafted, in April, for the use of the Countess of Mar.

 

[Dx Revision Watch]

This is the fourth in a series of posts about SNOMED CT:

Post #4 Change of Parent for Chronic fatigue syndrome and its Synonym terms

Post #1 Introduction to SNOMED CT clinical terminology system
Post #2 Concept terms of interest to us
Post #3 Inclusion of ICD-11's Bodily distress disorder
Post #5 Confirmation of change of Parent for CFS and its Synonym terms (to be posted on July 31, 2018)


Change of Parent for SNOMED CT Concept: SCTID: 52702003 Chronic fatigue syndrome (disorder)

As set out in Post #1 of this series, the SNOMED CT terminology system is structured differently to ICD-10 and ICD-11. SNOMED CT doesn't use a chapter system. Instead, disease and disorder Concept terms are arranged hierarchically under a series of Parent terms which provide "Relationships" for the Concept term.

SNOMED CT is made available under license. But a public browser for the International Edition and a number of the country editions can be viewed here:

http://browser.ihtsdotools.org/

The SNOMED CT UK Edition is managed by NHS Digital, as the designated SNOMED CT UK National Release Centre. A public browser can be viewed here:

https://termbrowser.nhs.uk/


Since April 2018, SNOMED CT UK Edition has been the mandatory clinical terminology for use in NHS primary care, replacing the Read Code (CTV3) terminology, which is now retired.

Secondary Care, Acute Care, Mental Health, Community systems, Dentistry and other systems used in the direct management of care of an individual are scheduled to adopt SNOMED CT as the mandatory clinical terminology before 1 April 2020.


History of CFS, ME in SNOMED CT:

In SNOMED CT, the Concept term is Chronic fatigue syndrome (Concept SCTID: 52702003).


Prior to July 2015, Chronic fatigue syndrome and its Synonym terms had been assigned under two Parents:

Multisystem disorder
Mental disorder

Following discussions in 2015 between the Countess of Mar, NHS Digital (then HSCIC) and SNOMED International, it was agreed that the Mental disorder Parent would be removed from CFS and that this would be actioned for the July 2015 release of the International Edition.

At the same time, a change was made for the listing of Postviral fatigue syndrome (a change which had not been requested by the Countess of Mar).

Postviral fatigue syndrome had been listed under Children to CFS. But PVFS was assigned a new SCTID code of its own and moved under new Parent: Post-viral disorder, under Parent: Post-infectious disorder.


The Multisystem disorder Parent was retired for the January 2018 release:

In 2017, SNOMED International terminology managers decided that the Concept: Multisystem disorder was not sufficiently specific for the purposes of their terminology and that the term should be retired from use across the entire system.

Concept SCTID: 281867008 Multisystem disorder (disorder) had 90 Children Concepts located under it, including CFS.

So its retirement for the January 2018 release had implications for all of these terms - not just for CFS.

When the Multisystem disorder Parent was retired, many of these 90 terms were relocated under more specific Parents. A few of these terms, including CFS, were not re-assigned under a new Parent.

(A small number of these 90 terms have been retired from the system altogether because they were historical terms, or duplicates, or were considered to be ambiguous terms that were unsuitable for inclusion.)

The removal of the Multisystem disorder Parent left CFS without a body system or aetiology Parent. Now, its only Parents were:

Parents

Clinical finding (finding)

• Disease (disorder)

This was not ideal. But it presented a good opportunity to request that a more specific Parent should be assigned to CFS.

A formal request and a rationale text for adding the Parent: Disorder of nervous system to CFS was drafted by me and submitted via Forward-ME to the UK National Release Centre.

A couple of weeks later, we were advised that this request for a change had been entered into the International Edition's peer review process and had been approved. The change is scheduled to be actioned for the July 31, 2018 release.

This change would then be incorporated into the next release of the UK Edition (October 01, 2018) and in all the country editions, as they publish their new releases (from September 01 onwards, on a staggered schedule).

If this change goes forward without any unforeseen delays, then for the July 2018 release, CFS should display like this in SNOMED CT:

Parents

> Disorder of body system (disorder)

> Disorder of nervous system (disorder)


Chronic fatigue syndrome (disorder) SCTID: 52702003

52702003 | Chronic fatigue syndrome (disorder) |

Myalgic encephalitis
Myalgic encephalopathy
Iceland disease
Benign myalgic encephalomyelitis
Chronic fatigue syndrome
Myalgic encephalomyelitis syndrome
ME - Myalgic encephalomyelitis
Myalgic encephalomyelitis
CFS - Chronic fatigue syndrome
Chronic fatigue syndrome (disorder)

Children

There are no Children under CFS in the International Edition. But the UK Edition includes three severity specifier options: Mild CFS; Moderate CFS; Severe CFS. These are marked with the Union Flag symbol to indicate that inclusion of these three additional severity terms is specific to the UK Edition.

(I intend to establish in what year the three severity specifiers were added to the UK Edition; who submitted the request for their addition; whether they are optional; and by what means clinicians are to determine which of the three severities to specify.)

For SNOMED CT, SCTID: 52702003 Chronic fatigue syndrome (disorder) was already cross mapped to ICD-10 G93.3. This additional Parent would consolidate that relationship.


Caveat:

This request for addition of Parent: Disorder of nervous system (disorder) has been accepted but the draft content for the July 31, 2018 release has not yet been finalized. The July 31, 2018 Release has now reached the BETA Release stage.

Member organizations are able to download the Beta release files to perform a technical evaluation of the core files before the next International Edition release package is distributed to Members on June 30, 2018 (ie a full month before the July release is implemented).

I will update in Post #5 Confirmation of change of Parent for CFS and its Synonym terms when the content of the July 2018 Release has been finalized and when the July Release is available on the public browser.

I'll also confirm that the three severity specifiers for BDD have been incorporated into the July Release (See Post #3).

 

[Dx Revision Watch]

The World Health Organization (WHO) has released an initial version of ICD-11 overnight.

A press conference was scheduled for June 14th:

WHO Press Conference
14 June 2018 15:00 - 15:45

Release of ICD-11 – the 11th revision of the International Classification of Disease – Monday, 18 June 2018.
ICD is a global health information standard that is translated into 43 languages and used in more than 120 countries in its 10th revision (ICD-10). The last revision of this standard has occurred 28 years ago.This new ICD 11th revision has developed into a modern electronic tool that fulfils all needs for accurately recording diseases and causes of death. Its content has been updated with the most current scientific knowledge and will provide much better information on how to prevent or treat injury and disease.

• Dr Shekhar Saxena, Director, Department for Mental Health and Substance Abuse, WHO

• Dr Robert Jakob, Team Lead, Classifications, Terminologies and Standards, WHO

Press release:

The embargo on a WHO press release is understood to lift on Monday, June 18th. I will update this post with the link for the press release when this becomes available.


A dedicated website for ICD-11 has been launched overnight:

https://icd.who.int

As of June 15, the ICD-11 Beta Draft platform is renamed to ICD-11 Maintenance Platform

https://icd.who.int/dev11/f/en#/

The Maintenance Platform remains orange.

(If you had a registration for the Beta Draft platform this will still work for the Maintenance Platform.)

Welcome to the ICD-11 Maintenance Platform

IMPORTANT! The content made availabe [sic] here is not a released version of the ICD-11. It is a work in progress in between released versions

• The audience for this site is the maintainers, contributors and translators of the classification
• The classification seen on this is not the released version of the classification. The content in this platform may change on an ongoing basis
• For the latest release of the classification please see ICD-11 Browser (blue)

(The Maintenance Platform continues to display both the Foundation and the ICD-11 (Mortality and Morbidity Statistics). It continues to display Descriptions for some but not all categories, Inclusion terms, Synonym terms, Index terms, Equivalent ICD-10 term etc.)


The initial release of ICD-11 is on a new, dark blue platform:

ICD-11 Browser:

https://icd.who.int/browse11/l-m/en

ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 version

Version for preparing implementation

Release Notes

• The code structure for the ICD-11 MMS is stable.

• Updating mechanism is in place, based on the proposals submitted on the maintenance platform

ICD-11 Coding Tool Mortality and Morbidity Statistics (MMS) 2018:

https://icd.who.int/ct11_2018/icd11_mms/en/release#/


ICD-11 Reference Guide:

https://icd.who.int/browse11/content/refguide.ICD11_en/html/index.html

Edited to add: It looks as though a PDF version of the ICD-11 Reference Guide will follow.


ICD Video:

https://www.youtube.com/embed/tZFcoYfnwiM


(The Implementation package doesn't appear to be accessible yet.)

Implementation package:

Training materials, implementation guidance, transition tables, translation tools, information about governance and maintenance, and different formats of ICD-11 for incorporation into existing health-reporting systems (paper, offline and online).



ICD Home Page:

http://www.who.int/classifications/icd/en/



What hasn't been released?

1) The ICD-11 Clinical descriptions and diagnostic guidelines for Mental and Behavioural Disorders (the equivalent to the ICD-10 "Blue Book") does not appear to be released.

This is the companion publication to ICD-11 Chapter 06: Mental, behavioural and neurodevelopmental disorders. It provides expanded clinical descriptions, differential diagnoses, diagnostic guidelines and codes for the categories in Chapter 06 of the Foundation and MMS Linearization, including: "Essential (Required) Features, Boundaries with Other Disorders and Normality, and Additional Features sections. Additional sections (e.g., Culture-Related Features)".

2) Any other specialty guidelines that had originally been projected, eg Neurological disorders; Paediatrics.

3) As anticipated, ICD-11 PC (aka ICD-11 PHC), the revision of the 1996 publication: Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. 1996 (aka "ICD-10-PHC") does not appear to have been completed.

-----------

I will update this thread as more materials become available.

 

[Dx Revision Watch]

As published June 2018:

ICD-11 for Mortality and Morbidity Statistics (2018)

https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/569175314

Notes:

Because additional chapters have been added for ICD-11 and the chapter order reorganized, ICD-10's Chapter VI is now Chapter 08.

The new coding structure takes its initial character from the chapter number, so the code for Postviral fatigue syndrome and its two specified Inclusion terms starts with 8 and the new code for Postviral fatigue syndrome is 8E49.

Note that this release of the MMS does not display Synonym terms, so only the two specified Inclusion terms display under PVFS.

 

[Dx Revision Watch]

As published June 2018:

ICD-11 for Mortality and Morbidity Statistics (2018)

https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/767044268


Foundation Id : http://id.who.int/icd/entity/767044268

6C20 Bodily distress disorder

All ancestors up to top

• 06 Mental, behavioural or neurodevelopmental disorders
• Disorders of bodily distress or bodily experience
• 6C20 Bodily distress disorder

BDD Severity specifier texts:

Foundation Id : http://id.who.int/icd/entity/1472866636

6C20.0 Mild bodily distress disorder

All ancestors up to top

• 06 Mental, behavioural or neurodevelopmental disorders
• Disorders of bodily distress or bodily experience
• 6C20 Bodily distress disorder
• 6C20.0 Mild bodily distress disorder

Description
All definitional requirements of bodily distress disorder are present. There is excessive attention to distressing symptoms and their consequences, which may result in frequent medical visits, but the person is not preoccupied with the symptoms (e.g., the individual spends less than an hour per day focusing on them). Although the individual expresses distress about the symptoms and they may have some impact on his or her life (e.g., strain in relationships, less effective academic or occupational functioning, abandonment of specific leisure activities), there is no substantial impairment in the person’s personal, family, social, educational, occupational, or other important areas of functioning.

-------------------------------

Foundation Id : http://id.who.int/icd/entity/1967782703

6C20.1 Moderate bodily distress disorder

All ancestors up to top

• 06 Mental, behavioural or neurodevelopmental disorders
• Disorders of bodily distress or bodily experience
• 6C20 Bodily distress disorder
• 6C20.1 Moderate bodily distress disorder

Description
All definitional requirements of bodily distress disorder are present. There is persistent preoccupation with the distressing symptoms and their consequences (e.g., the individual spends more than an hour a day thinking about them), typically associated with frequent medical visits. The person devotes much of his or her energy to focusing on the symptoms and their consequences. The symptoms and associated distress and preoccupation cause moderate impairment in personal, family, social, educational, occupational, or other important areas of functioning (e.g., relationship conflict, performance problems at work, abandonment of a range of social and leisure activities).

-------------------------------

Foundation Id : http://id.who.int/icd/entity/1121638993

6C20.2 Severe bodily distress disorder

All ancestors up to top

• 06 Mental, behavioural or neurodevelopmental disorders
• Disorders of bodily distress or bodily experience
• 6C20 Bodily distress disorder
• 6C20.2 Severe bodily distress disorder

Description
All definitional requirements of Bodily distress disorder are present. There is pervasive and persistent preoccupation with the symptoms and their consequences to the extent that these may become the focal point of the person’s life, typically resulting in extensive interactions with the health care system. The symptoms and associated distress and preoccupation cause serious impairment in personal, family, social, educational, occupational, or other important areas of functioning (e.g., unable to work, alienation of friends and family, abandonment of nearly all social and leisure activities). The person’s interests may become so narrow so as to focus almost exclusively on his or her bodily symptoms and their negative consequences.

-------------------------------


Notes:

This release of the MMS does not display Synonym terms.

Two proposals requesting addition of Exclusions for PVFS; (B)ME; CFS under Bodily distress disorder remain unprocessed.

 

[Dx Revision Watch]

ICD-11 for Mortality and Morbidity Statistics (2018)


User Guide:

https://icd.who.int/browse11/Help/Get/Caveat/en

From the User Guide page

Release Notes

Initial release of ICD-11 MMS...

• The code structure for the ICD-11 MMS is stable.
• The classification will be updated yearly.
  Initially we are expecting more changes in the Extension Codes chapter.
• There will be improvements on the user guidance

Edited to insert:

From the Reference Guide:

https://icd.who.int/browse11/content/refguide.ICD11_en/html/index.html#1.7.1Updateprocesses|icd11-update-process|c1-6-1

1.6.1 ICD–11 Update Process

Official releases of the ICD-11 MMS classification are produced annually for international use in mortality and morbidity (blue browser).

The ICD-11 Foundation Component is continuously updated. A standardised process has been established to ensure that the proposed updates are collected, routed, reviewed, and duly considered before being implemented. The updating is carried out at different levels with different frequencies. Updates that impact on the 4 and 5 digit structures will be published every 5 years. Updates at a more detailed level can be published more frequently. Additions to the index can be done on an ongoing basis. Mortality and morbidity rules that have serious impact on statistics will be updated in long term cycles of 10 years.

-------------------

Reference Guide

3.7 Annex - ICD-11 Updating and Maintenance

https://icd.who.int/browse11/conten...ce|annex-icd-11-updating-and-maintenance|c3-7

This section of the Reference Guide describes the workflow for updating ICD-11.

 

[Dx Revision Watch]

If you had registered for increased interaction with the ICD-11 Beta development platform, you'll have continued access to the ICD-11 Maintenance Platform. If not registered, you can register here:

https://icd.who.int/dev11/Account/Register


The two platforms:

(Blue) ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 Version:
https://icd.who.int/browse11/l-m/en

(Orange) Maintenance Platform:
https://icd.who.int/dev11/l-m/en#/

You won't see existing unprocessed proposals or responses to those proposals, or be able to view new proposals submitted since the release of the ICD-11 MMS, unless you are registered with the orange platform.

 

[Dx Revision Watch]

(NB: WHO may not post the news release until around 12 noon Geneva time. Will post the news release, once available, in a separate post.)

The World Health Organization officially released an initial version of ICD-11 MMS today, Monday 18 June.

A press conference was held on Thursday, 14 June at UNOG (United Nations Office in Geneva)

WHO Press Conference
14 June 2018 15:00 - 15:45

Release of ICD-11 – the 11th revision of the International Classification of Disease – Monday, 18 June 2018.

ICD is a global health information standard that is translated into 43 languages and used in more than 120 countries in its 10th revision (ICD-10). The last revision of this standard has occurred 28 years ago.This new ICD 11th revision has developed into a modern electronic tool that fulfils all needs for accurately recording diseases and causes of death. Its content has been updated with the most current scientific knowledge and will provide much better information on how to prevent or treat injury and disease.

• Dr Shekhar Saxena, Director, Department for Mental Health and Substance Abuse, WHO

• Dr Robert Jakob, Team Lead, Classifications, Terminologies and Standards, WHO

--------------------------------

News release:

http://www.who.int/news-room/detail...rnational-classification-of-diseases-(icd-11)

17 June 2018 News Release

18 June 2018 ¦ Geneva: The World Health Organization (WHO) is today releasing its new International Classification of Diseases (ICD-11).

--------------------------------

YouTube Videos released today:

[June 18, 2018 Video]

World Health Organization Release of International Classification of Diseases. ICD-11
https://www.youtube.com/watch?v=-iNwUnGD7sY

[June 18, 2018 Video]

WHO: Revision of ICD-11 – questions and answers (Q&A) Dr Robert Jakob, team leader for Classifications Terminologies and Standards at the World Health Organization discusses the revision of the new ICD-11.
https://www.youtube.com/watch?v=_pE_Mai4A9U



WHO Updated ICD-11 page:
http://www.who.int/classifications/icd/en/



Dedicated website for ICD-11:

https://icd.who.int



The two browser platforms:

(Blue) ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 Version:

https://icd.who.int/browse11/l-m/en


(Orange) Maintenance Platform:

https://icd.who.int/dev11/l-m/en#/


Reference Guide:

https://icd.who.int/dev11/content/refguide.ICD11_en/html/index.html

 

[Dx Revision Watch]

(My emphasis)

NEWS RELEASE:

http://www.who.int/news-room/detail...rnational-classification-of-diseases-(icd-11)

WHO releases new International Classification of Diseases (ICD 11)

17 June 2018
News Release

Geneva

18 June 2018 ¦ Geneva: The World Health Organization (WHO) is today releasing its new International Classification of Diseases (ICD-11).

The ICD is the foundation for identifying health trends and statistics worldwide, and contains around 55 000 unique codes for injuries, diseases and causes of death. It provides a common language that allows health professionals to share health information across the globe.

“The ICD is a product that WHO is truly proud of," says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “It enables us to understand so much about what makes people get sick and die, and to take action to prevent suffering and save lives."

ICD-11, which has been over a decade in the making, provides significant improvements on previous versions. For the first time, it is completely electronic and has a much more user-friendly format. And there has been unprecedented involvement of health care workers who have joined collaborative meetings and submitted proposals. The ICD team in WHO headquarters has received over 10 000 proposals for revisions.

ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come into effect on 1 January 2022. This release is an advance preview that will allow countries to plan how to use the new version, prepare translations, and train health professionals all over the country.

The ICD is also used by health insurers whose reimbursements depend on ICD coding; national health programme managers; data collection specialists; and others who track progress in global health and determine the allocation of health resources.

The new ICD-11 also reflects progress in medicine and advances in scientific understanding. For example, the codes relating to antimicrobial resistance are more closely in line with the Global

Antimicrobial Resistance Surveillance System (GLASS). ICD-11 is also able to better capture data regarding safety in healthcare, which means that unnecessary events that may harm health – such as unsafe workflows in hospitals - can be identified and reduced.

The new ICD also includes new chapters, one on traditional medicine: although millions of people use traditional medicine worldwide, it has never been classified in this system. Another new chapter on sexual health brings together conditions that were previously categorized in other ways (e.g. gender incongruence was listed under mental health conditions) or described differently. Gaming disorder has been added to the section on addictive disorders.

“A key principle in this revision was to simplify the coding structure and electronic tooling – this will allow health care professionals to more easily and completely record conditions,” says Dr Robert Jakob, Team Leader, Classifications Terminologies and Standards, WHO.

Dr Lubna Alansari, WHO’s Assistant Director-General for Health Metrics and Measurement, says: “ICD is a cornerstone of health information and ICD-11 will deliver an up-to-date view of the patterns of disease.”

Editors’ note:
ICD-11 is linked to the WHO non-proprietary names of pharmaceutical products, and it can be used for cancer registration. ICD-11 has been designed to be used in multiple languages: a central translation platform ensures that its features and outputs are available in all translated languages. Transition tables from and to ICD-10 support migration to ICD-11. WHO will support countries as they move towards implementation of the new ICD-11.

 

[Dx Revision Watch]

http://www.who.int/health-topics/international-classification-of-diseases

ICD-11:

Classifying disease to map the way we live and die

(...)

Ready for the 21st century

On 18 June 2018, 18 years after the launch of ICD-10, WHO released a version of ICD-11 to allow Member States time to plan implementation. This is anticipating the presentation of ICD-11 to the World Health Assembly in 2019 for adoption by countries...

The version given to the World Health Assembly in 2019 will go into effect on 1 January 2022. However, given the vast technical and technological adaptation and training required to move to a new system – thousands of coders from small primary health care clinics to large hospitals will need retraining – the switch from using ICD-10 to ICD-11 is unlikely to happen overnight.

While there will be a few early adopters, not many countries are likely to adapt that quickly – some countries are still using ICD-9, and a few are even using ICD-8. ICD-10 which was released in 1990 was first implemented by Thailand in 1994; the USA only switched to it in 2015...

What shelf life will ICD-11 have?

The reason for revising the code every decade or so is this: countries can apply to develop their own adaptations. They are not allowed to change the basic code, but they can add detail – essentially producing more granular versions tailored to their health systems and circumstances.

Countries that create bespoke versions can then sell those to other countries, training them in its use. Practitioners of specialities such as dermatology or mental health may want to produce their own adaptations too.

As WHO tweaks the ICD through the years to take into account new understandings of medicine, countries are expected to follow suit. Many do not, however.

Every year, WHO takes slightly incompatible data from countries and makes them comparable.

Over the years though, version control slips too far and several slightly varying versions appear all over the world. Thus, a new version becomes necessary to reset the system.

ICD-11, however, has been produced electronically and therefore should act more as a living document to which everyone access the latest version. Its agility should ensure considerable longevity.​

---------------------------------------------

Canada uses a clinical modification (CM) of ICD-10 (ICD-10-CA) and has published no projected timeline for development, testing and implementation of a CM of ICD-11.

Germany uses a clinical modification of ICD-10 (ICD-10-GM) which is developed and managed by DIMDI. DIMDI recently posted that it has not yet determined any date by which it projects a CM of ICD-11 will have been adapted for use in Germany.

The U.S. specific ICD-10-CM is developed and maintained by NCHS/CDC. CDC's Donna Pickett has stated it could be 2027 before the U.S. is ready to begin rule making for implementation of a clinical modification of ICD-11. An ICD-11-PCS for procedural codes would also need be developed.

Australia uses ICD-10-AM (which is also used in Ireland). I envisage that Australia may potentially be among the early implementers. Australian classification and terminology agencies have 6 reps on the 22 member Joint Task Force and have been closely involved in the ICD-11 development process since its launch in 2007/2008.

There are a number of other countries that use country specific adaptations of ICD-10, who won't be using ICD-11 straight out of the box.


NHS Digital:

No recent statement from NHS Digital, but an earlier statement:

https://hscic.kahootz.com/connect.ti/t_c_home/view?objectId=297939

"...A final version of ICD-11 will be published in 2018 for testing and implementation according to countries' specific timelines and requirements. Following field testing, planned to take place 01-Jun-2018 - 31 Mar-2019*, NHS Digital will consider the readiness of the health and care system for an ICD-11 migration and consider potential dates for this migration.

As a WHO Collaborating Centre, NHS Digital is supporting the testing of this classification..."

*Please note that these dates are indicative of current thinking only and will change as we develop our five-year strategic roadmap.

 

[Dx Revision Watch]

(Graphic may be reposted)

Note that January 01, 2022 is not a mandatory WHO implementation date.

It is the date from which WHO will begin accepting data reported using the new version.

Member States will be adopting and rolling out ICD-11 (or preparing a national adaptation of ICD-11) according to their own schedules.

There will be a lengthy period during which data will be accepted using both ICD-10 (and earlier versions) and ICD-11.

The last update for ICD-10 (apart from corrections) is planned for 2019. After 2019, WHO will continue to accept data using ICD-10.

When NHS Digital has announced a tentative roadmap for evaluation and migration to ICD-11, I will update the thread.


U.S. and ICD-10-CM:

CDC's Donna Pickett presented on ICD-11 in June 2017 and January 2018 to the U.S. Department of Health and Human Services National Committee on Vital and Health Statistics. CDC projects it could be 2027 before the U.S. begins rule making for implementation of a clinical modification of ICD-11. The U.S. would also need to develop an ICD-11 PCS for procedural codes. NCHS/CDC said several years ago that it cannot begin the work of developing a modification until the ICD-11 codes have been ratified.

NCVHS June 21, 2017 Full Committee Meeting
Agenda Item: ICD-10 CM and ICD-11
Mrs Donna Pickett (CDC) Transcript Donna Pickett:
https://ncvhs.hhs.gov/transcripts-m...-21-2017-ncvhs-full-committee-meeting/#icd-10


NCVHS January 9-10, 2018 Full Committee Meeting:
ICD-11 Update and Discussion:
Mrs Donna Pickett (CDC) Transcript Donna Pickett:
https://ncvhs.hhs.gov/transcripts-minutes/transcript-of-the-january-10-2018-ncvhs-full-committee-meeting/#content3

Donna Pickett's meeting slides:https://ncvhs.hhs.gov/wp-content/uploads/2018/05/Update-on-ICD-11-Pickett-NCVHS.pdf

 

[Dx Revision Watch]

Status of the "ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders"


Chapter V Mental and behavioural disorders

becomes Chapter 06 Mental, behavioural or neurodevelopmental disorders for ICD-11.

https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/334423054


A stand alone publication, "The ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders" will be the companion publication to ICD-11 Chapter 06 (the equivalent of ICD-10's Blue Book).

It has been developed by the WHO Department of Mental Health and Substance Abuse with review input from clinicians who have registered with the Global Clinical Practice Network, a platform initiated by ICD Revision's Dr Geoffrey Reed. The GCP.Network includes over 12000 clinicians from 151 countries:

https://gcp.network/en/icd-11-guidelines

"These draft guidelines include the Essential (Required) Features, Boundaries with Other Disorders and Normality, and Additional Features sections. Additional sections (e.g., Culture-Related Features) will be posted when completed."


There has been no platform where the public can review the draft for this publication; and although the GCP.Network site states that the publication was "due to be finalized in 2017, prior to the approval of the ICD-11 by the World Health Assembly in May, 2018" the timeline has been revised since then: WHO is not presenting ICD-11 to the WHA until May 2019 and WHA's endorsement will not come into effect until January 2022.


When WHO launched what it is now pitching as an "advance preview" of ICD-11 on June 18, no information on the current status of "The ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders" was released.

WHO has been asked: "In what year is the "ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders" (the ICD-11 equivalent of ICD-10's "Blue Book") projected for finalization and release, thank you."

with little expectation of any meaningful response.

The disorder descriptions on the blue and orange ICD-11 MMS and Maintenance platforms need to be read in the context of the full clinical descriptions and diagnostic guidelines, but the drafts for these texts are not available for public scrutiny.


Likewise, when the "advance preview" of ICD-11 was released on June 18, there was no indication of the status of the ICD-11 PC (aka ICD-11-PHC). It may be the case that this publication cannot be finalized until the core version codes have been WHA endorsed - but this is unclear.

On April 18, I submitted a WHO Information Request via the designated channel:

WHO has published its intention to release an initial version of ICD-11 in June 2018. It has also published its intention to defer WHA endorsement of ICD-11 until May 2019 [1].

There is no publicly available information for the Department of Mental Health and Substance Abuse's projected timeline for the finalisation and publication of the proposed "ICD-11 classification of mental disorders for primary care" for which recommendations have been made by the Primary Care Consultation Group (PCCG).

I request the following information:

a) By what date is the "ICD-11 classification of mental disorders for primary care" publication currently projected to be finalised?

b) By what date is the "ICD-11 classification of mental disorders for primary care" publication currently projected to be published?

1 ICD Project Plan 2015-2018
http://www.who.int/entity/classifications/icd/revision/icdprojectplan2015to2018.pdf​

There is a 60 day response period.

That has now been reached. I have received no response and a request on April 18 for an acknowledgement of receipt of my Information Request was not responded to, either. It appears that the WHO Information Request service is yet another WHO Black Hole.

On my advice, these same questions (with some additional questions) were also raised on behalf of Forward-ME directly with ICD Revision's, Dr Geoffrey Reed, on April 27.

 

[Dx Revision Watch]

For ease of access, key links for the June 18, 2018 ICD-11 "preview" release and related platforms and release materials are collated below:


Blue platform:
ICD-11 MMS 2018 preview release: https://icd.who.int/browse11/l-m/en

Coding Tool: https://icd.who.int/ct11_2018-2/icd11_mms/en/2018-05-18#/


Orange platform:
ICD-11 Maintenance Platform, Comments, Proposals
(Working Draft with daily updates. Registration required to view/interact with some parts of the platform)

Foundation Component: https://icd.who.int/dev11/f/en#/
Mortality and Morbidity Statistics (MMS) Linearization: https://icd.who.int/dev11/l-m/en
Coding Tool: https://icd.who.int/devct11/icd11_mms/en/current#/



ICD-11 Home Page: http://www.who.int/classifications/icd/en/
(Not all materials/tools listed on the Implementation Support tab, for example, "Specialty versions" are currently available.)

WHO introduces ICD-11: http://www.who.int/health-topics/international-classification-of-diseases

News Release (18.06.18): http://www.who.int/news-room/detail...rnational-classification-of-diseases-(icd-11)

Reference Guide: https://icd.who.int/browse11/content/refguide.ICD11_en/html/

(This is an html version of the Reference Guide. When the PDF version is available, I will add the URL.)

 

[Dx Revision Watch]

Dr. Robert Jakob on ICD10 Monitor's "Talk Ten Tuesdays"

On Tuesday, June 26, Dr. Robert Jakob, Team Leader of Classifications and Terminologies for the World Health Organization, will be the special guest on ICD10 Monitor's "Talk Ten Tuesdays" live broadcast reporting on key changes in ICD-11.

https://www.icd10monitor.com/talk-ten-tuesdays/coming-up-on-talk-ten-tuesdays

From 10:00 a.m. Eastern Time.

10-10:30 a.m. EST; 7-7:30 a.m. PST

Program 330


I asked ICD10 Monitor's Chuck Buck, via Twitter: If time permits, it would be good to have Dr Jakob confirm in what year the companion publication that expands on the Mental disorder chapter - The Clinical Descriptions and Diagnostic Guidelines for ICD-11 Mental and Behavioural Disorders, is slated for finalization and release.

Chuck says: We have contacted Dr. Robert Jakob and will have the answer by the broadcast on 6/24.


Register for live broadcast or listen later via podcast.

 

[Dx Revision Watch]

Mary Dimmock and I have updated our

Comparison of Classification and Terminology Systems

document to reflect this week's release of an "advance preview" version of ICD-11.

If you downloaded the document in Post #1 please replace v1 with


Comparison of Classification and Terminology Systems
Version 2 | June 2018

https://dxrevisionwatch.files.wordpress.com/2018/06/comparison-of-classification-and-terminology-systems-version-2.pdf

or http://bit.ly/2yC6sIe


Edited to add:

Version 2 has been amended. Please replace Version 2 to with Version 3

Version 3 | July 2018

https://dxrevisionwatch.files.wordp...lassification-and-terminology-systems-v-3.pdf

or

http://bit.ly/2JGUQUi

 

[Dx Revision Watch]

Current ICD-11 Foundation and MMS Linearization disorder Descriptions for

Bodily distress disorder (BDD) and its three severity specifiers:

(Blue browser) ICD-11 for Mortality and Morbidity Statistics (2018 Release):
https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/767044268

(Orange browser) Maintenance Platform:
(The content on the Orange browser is not a released version of the ICD-11, as frozen for release on June 18, 2018. It is a work in progress in between released versions)
https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/767044268


Current ICD-11 Foundation and MMS Linearization disorder Descriptions for Bodily distress disorder (BDD)

(Click on image for larger version)