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

[Dx Revision Watch]

Location of CFS in WHO's ICD-10 compared with the U.S. "clinical modification" ICD-10-CM, which is the responsibility of NCHS:

I've edited this screenshot into an earlier post in this thread but if anyone needs a screenshot showing the WHO's ICD-10 coding of PVFS and (B)ME, with CFS displaying as Index term coded to G93.3, here is an image from the online ICD-10 Version: 2015:

(Index term designated by orange symbol.)


ICD-10-CM

This is the current location of CFS (as CFS NOS) in the U.S. specific ICD-10-CM which is scheduled for implementation on October 1, 2015:


ICD-10-CM FY 2015 Release:

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

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

(...)

And here's a screenshot from ICD-10-CM Chapter 6, showing an Excludes1 for CFS NOS:

 

[Dx Revision Watch]

http://on.fb.me/1LeAOe3

By Jerrold Spinhirne

Jerrold Spinhirne writes:

"No ICD code is given [within the IOM report] for "SEiD" further disguising what it might be."​

There appears to be a lack of understanding here over how ICD codes are assigned within the U.S. specific clinical modifications derived from WHO's ICD-9 and ICD-10.

In order for an ICD code to be allocated within ICD-9-CM, a request for a modification or addition to the code set would need to be submitted via the NCHS/CMS Coordination and Maintenance Committee public meeting process.

ICD-9-CM is currently subject to code freeze. From October 1, 2015, there will be no further updates to ICD-9-CM, as it will no longer be used for reporting. It will be retired and ICD-10-CM will be mandatory.

In order to be included within the forthcoming ICD-10-CM, again, a proposal to NCHS/CMS ICD-10-CM Coordination and Maintenance Committee would be required to be submitted for the Committee's consideration and for public scrutiny and comment.

A proposal would need to be made for the addition of a new term with:

a discrete new code created in the Tabular List and Alphabetical Index, or
addition as an Inclusion term to an existing code, or
as a replacement for an existing code, or
as an addition to the Index only, indexed to an existing code.

As mentioned in earlier posts, ICD-10-CM is also subject to partial code freeze and only limited classes of modification can be considered during a freeze. The code freeze lifts in October 2016, when the regular update cycle for ICD-10-CM will begin.

Meetings take place, in public, in March and September.

So it is to be expected that no ICD code has been assigned to SEID within the U.S. ICD versions.


Additionally, WHO terminology is not set in stone. For the WHO's ICD-11 (ETA 2018+), there will be many changes to coded-for disease and disorder terminology, chapter relocation, parent class and hierarchy reorganization and the introduction of multiple parentage within one chapter or across two or more chapters.

 

[Dx Revision Watch]

From Twitter exchanges:


Heath ‏@MEawareness 13h13 hours ago
@LBatemanMD may I ask where should #SEID be classified in ICD10? Will it stay in Disorders of the Nervous system? TY in advance. #MEcfs

Dx Revision Watch @dxrevisionwatch · 50m 50 minutes ago
@LBatemanMD @MEawareness Do recomm'ations include projected timeline for submitting proposal to NCHS C & M Com for inclusion in ICD-10-CM?


Lucinda Bateman ‏@LBatemanMD 13h13 hours ago
@MEawareness The IOM report suggests keeping it out of mental health but doesn't dictate. It will take more research to seat it properly


Dx Revision Watch ‏@dxrevisionwatch 24m24 minutes ago
@LBatemanMD @MEawareness This suggests panel don't envisage early submission by stakeholder agency to NCHS for inclusion in ICD-10-CM?


Dx Revision Watch @dxrevisionwatch · 24m 24 minutes ago
@LBatemanMD @MEawareness In order to request inclusion within ICD-10-CM, proposal would need to propose chapter location and parent code.


Dx Revision Watch @dxrevisionwatch · 3m 3 minutes ago
@LBatemanMD @MEawareness Does panel consider, then, that SEID can't be added to ICD-10-CM until future research defines chapter location?

 

[medfeb]

From Twitter exchanges:
Dx Revision Watch @dxrevisionwatch · 3m 3 minutes ago
@LBatemanMD @MEawareness Does panel consider, then, that SEID can't be added to ICD-10-CM until future research defines chapter location?

Stating the obvious but Its going to be pretty difficult to roll out the name and criteria in the U.S. unless a new code is created to use in medical records, insurance submissions.

 

[Dx Revision Watch]

Stating the obvious but Its going to be pretty difficult to roll out the name and criteria in the U.S. unless a new code is created to use in medical records, insurance submissions.

Absolutely, as I've been putting to ME Association's Tony Britton.

I've also asked Dr Bateman:

Dx Revision Watch ‏@dxrevisionwatch
@LBatemanMD @MEawareness Which agency would take responsibility for drawing up and submitting a proposal for insertion in ICD-10-CM?

But I've had no response, as yet.

 

[Dx Revision Watch]

Stating the obvious but Its going to be pretty difficult to roll out the name and criteria in the U.S. unless a new code is created to use in medical records, insurance submissions.

Assuming HHS (or whichever agency is designated to lead on this) were to accept all, or the majority of the IOM report's Recommendations, and irrespective of how much time would be required for the preparation of a Toolkit and associated materials, dissemination etc., the earliest a new term could be inserted with a unique code (or inserted as an inclusion term to an existing code) would be October 1, 2016, because of the partial code freeze on modifications to ICD-10-CM.

 

[medfeb]

the earliest a new term could be inserted with a unique code (or inserted as an inclusion term to an existing code) would be October 1, 2016, because of the partial code freeze on modifications to ICD-10-CM.

I'm not sure about that - I thought that, while codes couldn't be changed during the partial freeze, new codes could be added.

 

[Dx Revision Watch]

I'm not sure about that - I thought that, while codes couldn't be changed during the partial freeze, new codes could be added.

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

Partial Freeze of Revisions to ICD-9-CM and ICD-10-CM/PCS

The ICD-9-CM Coordination and Maintenance Committee implemented a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes prior to the implementation of ICD-10. The partial freeze is scheduled to end one year after the implementation of ICD-10. There was considerable support for this partial freeze. On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services issued a final rule on August 4, 2014 that changed the compliance date for ICD-10 from October 1, 2014 to October 1, 2015. The final rule also requires HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015. Links to the final rule are provided at http://www.cms.gov/Medicare/Coding/ICD10/Statute_Regulations.html.

The partial freeze will be implemented as follows:

• The last regular, annual updates to both ICD-9-CM and ICD-10 code sets were made on October 1, 2011.
• On October 1, 2012, October 1, 2013, and October 1, 2014 there were only limited code updates to both the ICD-9-CM and ICD-10 code sets to capture new technologies and diseases as required by section 503(a) of Pub. L. 108-173.
• On October 1, 2015, there will be only limited code updates to ICD-10 code sets to capture new technologies and diagnoses as required by section 503(a) of Pub. L. 108-173. There will be no updates to ICD-9-CM, as it will no longer be used for reporting.
• On October 1, 2016 (one year after implementation of ICD-10), regular updates to ICD-10 will begin.

The ICD-9-CM Coordination and Maintenance Committee will continue to meet twice a year during the partial freeze. At these meetings, the public will be asked to comment on whether or not requests for new diagnosis or procedure codes should be created based on the criteria of the need to capture a new technology or disease. Any code requests that do not meet the criteria will be evaluated for implementation within ICD-10 on and after October 1, 2016 once the partial freeze has ended.

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

My understanding is that the adding of new codes during a partial code freeze is intended for things like new strains of viruses.

For example, the submissions from the APA for insertion of a number of new DSM-5 disorders with new codes created were proposed for implementation on or after the code freeze had lifted because these requests would not fulfill the criteria for adding during a freeze.

If HHS (or other stakeholder agencies) were to pressure NCHS to fast track a new term through, either outside the C & M Committee public meeting mechanism, or during a code freeze, you will need to create merry hell.


Edited to insert:

http://www.the-rheumatologist.org/details/article/1038887/ICD-9_Freeze_and_ICD-10_Code_Update.html

(...) The code freeze will be partial to allow room for the creation of codes needed to capture new technologies and diseases that may be necessary for public safety and disease management.