hi insearchof, did you know that the WHO define ME and Post Viral Fatigue Syndrome as exactly the same diseases?
G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis
http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933
Also, the only mention of 'CFS' in ICD-10 is in an index that directs to: G93.3 Postviral fatigue syndrome/Benign myalgic encephalomyelitis.
CFS does not have its own entry in ICD-10, but it is just an index entry that only directs to ME.
This suggests that CFS is just another name for ME, in the opinion of the WHO.
Interestingly, 'Fatigue Syndrome' (not 'CFS') is listed under: F48.0 'Neurasthenia', which is categorised under 'Other Neurotic Disorders', but Neurasthenia is described in some detail, and it sounds very much like ME to me. Anyway, this point isn't relevant to the discussion, I just thought it was interesting.
http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933
It all seems a bit confused to me.
(I may have made mistakes here, but this is my understanding of the ICD-10.)
Hi Bob,
The ICDs can be a challenge to understand. Sites today, like Susie Chapmans, makes this much easier. It was not so, when I studied them.
The ICDs are found in 3 volumes and they have their own unique rules, including those to aid in their interpretation and understanding. Essentially, the ICDs are volumes that classify diseases using a taxonomical approach.
Some principles I found useful in interpreting and understanding the ICDs were these:
1. Disease that are given a classification appear in the tabular body.
2. The tabular body is the primary coding tool
3. Space in the tabular body is regarded as premium and used very judiciously.
The Index is occasionally used to compensate here
4. Classification is about categorisation through distinction, with a view to ensure that they are mutually exclusive. For example, the same illness is not permitted to be classified under more than one rubric in the tabular body
5. A term in the index represent any one of the following possibilities:
- A diagnostic term currently in vogue or
- A term used by physicians but that does not fit into the ICD scheme.
- A synonym
- An imprecise and undesirable term or a rubric for ill defined conditions
See: Introduction to ICD 10 Vol 3 2nd Ed.
From my reading and understanding of matters specific to the index, the index does not operate in the same way as we would genrally understand an index to.
Meaning, CFS in the ICD index does not necessaryily mean that it is a direct reference to and to be taken as meaning that it is the same as, ME or PVFS. In fact, for terms inserted in the index that are there because they are regarded as an'' imprecise ''or ''undesirable term'' for example, the WHO goes on to say that their insertion in the index ''should not be taken as approval of its use''. The over all impression you are left with, is that the WHO places popular, undersirable or incorrect terms in the index to generally assist users of the ICDs to find ''associated'' reference material. However, ''associated'' does not mean the ''same'' as. Therefore, given the appearance of CFS in 1988 and because some might have referred to CFS as ME in the period between 1988-1990 ( the ICD 10 being settled in 1990) the WHO might have taken the view that this was not correct, (ie it was an incorrect term for ME or PVFS) but put CFS in the index in order to assist those who associated CFS with ME. Remeber, it was during this two year period when the terms were beginning to be erroneously used in an interchangable manner in some of the literature).
I should state, that there has been no statement issued by the WHO on the significance of CFS being placed in the index and its relationship to ME and PVFS at 93.3 to date, but it is hoped that this will change with the advent of ICD 11. I might say though, that the view of WHO in 1990 on this matter, might not be the view of the WHO today -20 years on. So any explanation that the WHO might subsequently provide, could not be applied retrospectively to ICD 10, in my view.
ICDs can be adopted by member countries and come into operations at different times.
As mentioned, ICD 10 was completed in or around 1990 just 2 years after the introduction of the CDC definition of CFS, which may explain one of the reasons why it appeared in the index( ie: another reason for its inclusion in the index could be that it represented a diagnostic term currently in vogue but was, at the time regarded as a term that did not fit into the ICD scheme).
ME is a term that first appeared at G93.3 in 1969.
The term PVFS appeared in the 1980s and it made its first appearance in ICD 10.
As you know, I have made previous references to Ramsay and his attempts to distinguish ME from PVFS or states circa 1988-1990.
ICD 10 was settled by WHO in 1990 and adopted by member countries (except the USA) in 1994.
As mentioned the ICDs are based on a taxonomic approach.
Taxonomic principles involve supertype and subtypes or the analogy often used, is that of parent and child relationship approaches to classification. With a sub type, it is similar to the parent but not the same. There are always features or additional properties or limitations that distinguish the child from the parent so to speak.
Looking at G93.3 it would appear at first instance that what you say is true: that WHO
defines ME and PVFS as the same.
However the first point is, that they
do not define anything. They categorise and classify illnesses using taxonomic principles.
I believe that ME and PVFS have both been inserted into the tabular body of the ICDs, because WHO (applying their taxomonic approach and principles) see them as being distinctive but belonging to the same supertype
I believe this to be true on the basis of:
* the historic dates that each of these illnesses arose and their appearances in the ICD
* historic supporting litrature that attempts to distinguish PVFS from ME
* statements issued by the WHO on G93.3 and taxonomic principles with regard to it but most importantly
* the interpretation of G93.3 on the basis of the taxonomic principles and distinctive rules used for interpreting ICDs as set out in them by the WHO in particular the following.
Given that :
(a) space in the tabular is at a premium and
(b) the strict taxonomic principles applied to ensure mutual exclusivity between diseases (whether applying to rubrics or generally so) ......
I believe that WHO would not have used a duplicate term in the tabular at G93.3 for ME.
Further, PVFS cannot be a synonym used for ME, as synonyms (if used) are given their place in the index.
On my general reading and understanding, I view PVFS as another illness in addition to ME, and given its own distinct place at G93.
