Hey Otis,
Can you find a link and time to the part of the CFSAC meeting where Klimas makes that statement? Offhand, based on what you said above, I would say that she is mistaken about the psych category thing.
In its current form, the ICD-10CM (the one that will be used in the United States) will not put CFS in the psych category.
It will, however, keep it in the vague section on "Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified". But this is not part of the "Mental and behavioral disorders" section.
Insurance problems may become greater due to the label "NOS" being attached to the chronic fatigue syndrome, and even more likely due to the fact that CFS will be shut out from the neurological disease section and from any association with "postviral fatigue syndrome". Since ME will be included (finally), it would be nice if American doctors could start diagnosing people with ME, though what criteria will they use?... A Ramsay criteria that a patient points them to? Or some new, deliberately B.S. definition from the CDC?
In the past the CFSAC has called for inclusion of CFS in the neurological disease section that will now contain ME and postviral fatigue syndrome (hey, maybe we could all become PVFSers...). I don't know if that was mentioned at this meeting.
It is the case that the most recent proposals for the forthcoming US ICD-10-CM proposes classifying Chronic fatigue syndrome in
Chapter 18 at
R53.82.
CHAPTER 18
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.
This is
not the
Mental and Behavioural chapter which is:
CHAPTER 5
Mental and behavioral disorders (F01-F99)
Includes: disorders of psychological development
Excludes2: symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)
The PDF of the most recent proposals for ICD-10-CM Tabular List on the CDC site is a little hard to locate and is in a Zipped PDF file of approx 4MB when unZipped. I have a copy on file and if anyone would like a copy, email me and I'll send you one. I might also upload a copy to my site for ease of reference.
This is from the Zipped PDF from the CDC site:
Proposals for ICD-10-CM (scheduled for October 2013):
http://www.cdc.gov/nchs/icd/icd10cm.htm#10update
[...]
ICD-10-CM
Chapter 6
G93 Other disorders of brain
G93.0 Cerebral cysts
Arachnoid cyst
Porencephalic cyst, acquired
Excludes1: acquired periventricular cysts of newborn (P91.1)
congenital cerebral cysts (Q04.6)
G93.1 Anoxic brain damage, not elsewhere classified
Excludes1: cerebral anoxia due to anesthesia during labor and delivery (O74.3)
cerebral anoxia due to anesthesia during the puerperium (O89.2)
neonatal anoxia (P28.9)
G93.2 Benign intracranial hypertension
Excludes1: hypertensive encephalopathy (I67.4)
G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis
Excludes1: chronic fatigue syndrome NOS (R53.82)
-------------------
Chapter 18
ICD-10-CM Tabular Page 1165 2010
R53 Malaise and fatigue
R53.0 Neoplastic (malignant) related fatigue
Code first associated neoplasm
R53.1 Weakness
Asthenia NOS
Excludes1: age-related weakness (R54)
muscle weakness (M62.
senile asthenia (R54)
R53.2 Functional quadriplegia
Complete immobility due to severe physical disability or frailty
Excludes1: frailty NOS (R54)
hysterical paralysis (F44.4)
immobility syndrome (M62.3)
neurologic quadriplegia (G82.5-)
quadriplegia (G82.50)
R53.8 Other malaise and fatigue
Excludes1: combat exhaustion and fatigue (F43.0)
congenital debility (P96.9)
exhaustion and fatigue due to:
depressive episode (F32.-)
excessive exertion (T73.3)
exposure (T73.2)
heat (T67.-)
pregnancy (O26.
recurrent depressive episode (F33)
senile debility (R54)
R53.81 Other malaise
Chronic debility
Debility NOS
General physical deterioration
Malaise NOS
Nervous debility
Excludes1: age-related physical debility (R54)
R53.82 Chronic fatigue, unspecified
Chronic fatigue syndrome NOS
Excludes1: postviral fatigue syndrome (G93.3)
R53.83 Other fatigue
Fatigue NOS
Lack of energy
Lethargy
Tiredness
---------
Innocent
Dr Yes (and I do like your wimple) wrote:
In the past the CFSAC has called for inclusion of CFS in the neurological disease section that will now contain ME and postviral fatigue syndrome (hey, maybe we could all become PVFSers...). I don't know if that was mentioned at this meeting.
Yes. The CDC document from 2001
"A Summary of Chronic Fatigue Syndrome and Its Classification in the International Classification of Diseases" Prepared by the Centers for Disease Control and Prevention, National Center for Health Statistics, Office of the Center Director, Data Policy and Standards,
included this text on the earlier proposal that CFS should be coded
G93.3. Highlighted in blue, but the other content is worth a skim for those who haven't already seen it (full document here:
http://www.co-cure.org/ICD_code.pdf ) and full text in an earlier Suzy posting here
Post #151
[...]
ICD-9-CM
For morbidity data the United States uses the International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM), a clinical modification of ICD-9. ICD-9-CM has been used in the United States since 1979 and has an annual update process that has been in place since 1985. The update process begins with the convening of the public forum, ICD-9-CM Coordination and Maintenance Committee. Proposals to modify the classification are presented and discussed during these public meetings. Information about future meetings of the ICD-9-CM Coordination and Maintenance Committee may be found on the NCHS website at
http://www.cdc.gov/nchs/about/otheract/icd9/maint/maint.htm
In 1990, a recommendation to create a specific code for chronic fatigue syndrome was presented. At that time, there was no consensus about the etiology of the syndrome, which is needed to accurately classify a condition in the ICD. A new code could not be created because of this problem; however, a modification to the alphabetic index was made to direct users of the classification to code 780.7, Malaise and fatigue. This is the same code used to identify cases of postviral syndrome. This change became effective October 1, 1991.
In 1998, subcategory 780.7 was expanded to include new five-digit codes. The new codes created included code 780.71, Chronic fatigue syndrome. The placement of this condition in this category was consistent with the WHO version of ICD-9 and with its placement within ICD-9-CM.
ICD-10
WHO published ICD-10 in 1992 and included many modifications, among them relocation of some diagnoses to different chapters within the classification. WHO created a new category G93, Other disorders of brain, in Chapter VI, Diseases of the Nervous System, and created a new code G93.3, Postviral fatigue syndrome, a condition which was previously in the symptom chapter of ICD-9. WHO also moved benign myalgic encephalomyelitis to the new code G93.3.
The alphabetic index contains other terms, such as chronic fatigue syndrome, that WHO considers synonymous or clinically similar.
Changes made in ICD-10 are unique to that version of the classification and not retrospectively applied to previous revisions of the ICD. Therefore, any changes in ICD-10 such as the creation of new categories or relocation of conditions from one chapter to another are not retroactively added to ICD-9 or ICD-9-CM.
ICD-10-CM
In keeping with the placement in the ICD-10, chronic fatigue syndrome (and its synonymous terms) will remain at G93.3 in ICD-10-CM.
While it appears most appropriate to classify chronic fatigue syndrome in ICD-10-CM in the same way that it is classified in ICD-10, this placement is not without problems. The primary concern with the current WHO placement in ICD-10 has been that the abnormalities of the brain in chronic fatigue syndrome patients most often cited in the literature are not found in all chronic fatigue syndrome patients. While chronic fatigue syndrome may be a heterogeneous group of disorders, some but not all are neurological in nature. Likewise, not all patients have experienced a viral infection prior to being diagnosed with chronic fatigue syndrome, nor are immune system anomalies universally found. Also of potential concern is the similarity between the type of neurological findings in chronic fatigue syndrome and in depression, which is a psychiatric disorder. Involvement of multiple systems has complicated the classification of chronic fatigue syndrome.
It should be noted that issues related to reimbursement have not been a factor in deliberations regarding placement of chronic fatigue syndrome in ICD. Modifications to ICD-9-CM (the classification currently in use) and in ICD-10-CM, its intended replacement, are based on relevant clinical information and adherence to the structure and conventions of the ICD. The decision of third party payers regarding their coverage and reimbursement policies are independent of the decisions regarding modification of the classification.
[Extract from 2001 document ends]
@ Bob
With regard to ICD-10 only
Extracts from:
[CO-CURE] ACT: Information on the launch of ICD-11 Alpha Draft, Suzy Chapman, 06 May 2010
In ICD-10, "Chronic fatigue syndrome" is listed in Volume 3: The Alphabetical Index, only, where it is indexed to G93.3.
To date, ICD Revision has been silent around the inclusion (or not) of "Chronic fatigue syndrome" in Volume 1: The Tabular List, in ICD-11.
Nor has ICD Revision published any intention that it proposes to revise the existing Index code for "Chronic fatigue syndrome" for ICD-11 or that "Chronic fatigue syndrome" should be placed in a chapter other than Chapter VI (6), to which it is currently indexed, if it were the case that ICD Revision is considering the inclusion of "Chronic fatigue syndrome" in Volume 1: The Tabular List.
[...]
[2] The Introduction to
ICD-10 Volume 3: The Alphabetical Index lists several possible relationships between a term included in the Alphabetical Index and a term included in the Tabular List to which it is indexed:
"The terms included in the category of the Tabular List are not exhaustive; they serve as examples of the content of the category or as indicators of its extent and limits. The Index, on the other hand, is intended to include most of the diagnostic terms currently in use. Nevertheless, reference should always be made back to the Tabular List and its notes, as well as the guidelines provided in Volume 2, to ensure that the code given by the Index fits with the information provided by a particular record.
"Because of its exhaustive nature, the Index inevitably includes many imprecise and undesirable terms. Since these terms are still occasionally encountered on medical records, coders need an indication of their assignment in the classification, even if this is to a rubric for residual or ill-defined conditions. The presence of a term in this volume, therefore, should not be taken as implying approval of its usage."
and, according to a February 2009 response from WHO HQ Classifications, Terminology and Standards Team, terms that are listed in the Index may be:
a synonym to the label (title) of a category of ICD;
a sub-entity to the disease in the title of a category;
or a "best coding guess".
In indexing "Chronic fatigue syndrome" to G93.3, ICD-10 does not specify how it views the term in relation to "Postviral fatigue syndrome" or in relation to "Benign myalgic encephalomyelitis". Nor does ICD-10 specify how it views the relationship between "Postviral fatigue syndrome" and "Benign myalgic encephalomyelitis".
Although the 2001 CDC document above had stated:
"The alphabetic index contains other terms, such as chronic fatigue syndrome, that WHO considers synonymous or clinically similar."
in ten years, I have yet to see a document by the WHO, or a formal statement of clarification or a response to a request for clarification from a member of the public that specifies how ICD views the relationship between the three terms.
In correspondence, WHO classification experts and secretariat skirt round this issue, and instead will confirm which volumes, chapters and codes the three terms are coded and indexed to, but have thus far avoided being nailed down on how they
view the relationship between the three terms.
My websites and reports make no assumptions about how ICD-10 views the relationship between the three terms nor any assumptions about what proposals might be made by any of the Topic Advisory Groups for the potential inclusion of "Chronic fatigue syndrome" in Volume 1, in ICD-1 . But since all three volumes of ICD-11 will be integrable, it's reasonable to anticipate that "Chronic fatigue syndrome" might be included in Volume 1, in this forthcoming edition and also that definitions might be included for all three terms, in accordance with the "Content Model".
The ICD-11 Alpha Draft was scheduled for release between 10 - 17 May. No sign of a launch yet. A delay would not surprise me.
All we have to go on so far is the demo iCAT for which the Content Model fields are incomplete and the author status of what content has been included, unspecified.
If you want to see the section for the G93.3 codes in the iCAT demo (and the F codes in Chapter 5), there are instructions on my website, in this posting, for accessing the server which hosts the demo iCAT platform:
ICD-11 Alpha Draft scheduled to launch between 10 and 17 May
Shortlink Post #42: http://wp.me/pKrrB-GT
But bear in mind this is only the demo and until ICD Revision issues a draft and launches the iCAT, and unless the fields for the three terms have been completed, at this stage it may not be clear in the alpha, what ICD Revision Steering Group is proposing for CFS in ICD-11.
