ME and cfs to be classified as seperate illnesses

[Dx Revision Watch]

A webcast of the entire CFSAC meeting with subtitles is now available to view at:

http://videocast.nih.gov/PastEvents.asp

Chronic Fatigue Syndrome Advisory Committee
Monday, May 10, 2010
HHS Office on Womens Health (OWH)
Total Running Time: 05:47:57

More information here: http://videocast.nih.gov/Summary.asp?File=15884

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I've watched only the last 15 minutes or so. Rather frustrating.

Nancy Klimas appears to start talking about ICD-11 and ICD-10 and ICD-10-CM without having first made the distinction between the three systems for the benefit of the committee.

Strictly speaking, she was incorrect to state that ICD-10-CM proposes to place CFS in the "psychiatric section" as we have already discussed. So when Lenny Jason sets out, correctly, that it is currently proposed to place CFS in the R codes (Chapter 18) confusion ensues amongst those present.

It would have been preferable if Lenny J could have set out how PVFS, ME and CFS are represented in the current US modification; where it is proposed to code them in ICD-10-CM, what the concerns are, and how these proposed codes relate to international ICD-10 BEFORE Nancy Klimas spoke.

Time was wasted disentangling.

I didn't get the impression that Nancy K was fully conversant with the difference between US modifications and international ICD-10, and evidently not clear about which chapter of the forthcoming US CM it was proposed to code CFS in.

That is not to say that the placing of CFS in Chapter 18 R codes is not problematic - but it is not correct to say that in placing it in Chapter 18 it is being placed under "psychiatric", since that is Chapter 5.

It would have been helpful, perhaps, for Nancy K to have had print outs from the proposed ICD-10-CM for Chapter 6 and Chapter 18 with her, to refer to.

 

[justinreilly]

Hi The only mandatory critiria in the Oxford cookbook is fatigue(which they define as weariness)Nice have actually used the only FUKUDA presentation capable of diagnosing ME or at least seperating ME from chronic depression.They made a song and dance about it in the many paged document which i had the misfortune of reading.They resisted the pressure put on them by our "friends" to adopt the Oxford inee miney mo approach
_________________

OK. I was looking at the definition they have on the NHS website for the public and it struck me as Oxford + PEM. I assumed that was the same as the NICE definition, but it's not? NICE uses a modified Fukuda?

 

[justinreilly]

Nancy Klimas

Strictly speaking, she was incorrect to state that ICD-10-CM proposes to place CFS in the "psychiatric section" as we have already discussed. So when Lenny Jason sets out, correctly, that it is currently proposed to place CFS in the R codes (Chapter 18) confusion ensues amongst those present.

That's too bad. The recommendation is useless because they didn't have a good enough grip on the facts. It will probably make the committee look a bit amateurish to the HHS Secretary which hurts our credibility a little.

 

[Dolphin]

OK. I was looking at the definition they have on the NHS website for the public and it struck me as Oxford + PEM. I assumed that was the same as the NICE definition, but it's not? NICE uses a modified Fukuda?

But remember, they didn't have this requirement when looking at the evidence base. Oxford studies were acceptable as evidence.

 

[Dx Revision Watch]

That's too bad. The recommendation is useless because they didn't have a good enough grip on the facts. It will probably make the committee look a bit amateurish to the HHS Secretary which hurts our credibility a little.

As far as clarifying the proposed location of CFS within ICD-10-CM and setting out the difference between ICD-10 and the US Clinical Modifications, Lenny Jason did get it straightened out for the committee and appeared to be speaking from prepared notes, but the initial confusion was unfortunate.

Because I've been monitoring the revisions of ICD-10 and DSM-5 for over a year now, it's been necessary for me to differentiate between ICD-10 and the forthcoming US modification on my websites, in my reports and on these forums. But as a resident of the UK, I don't feel it's really for me to comment on the current proposals for ICD-10-CM, only to document within the context of the revisions towards DSM-5 and ICD-11 and from the UK perspective.

But what I did do this morning, was to email Dr Jason a copy of my report on the forthcoming ICD-11 Alpha Draft for reference.

ICD-11 Alpha Draft scheduled to launch in May


The history of the development of the ICD-10-CM is on this page:

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

and this page:

http://www.cdc.gov/nchs/icd/icd10cm.htm#10update

In their 10 December 2009 News Release, the APA said:

"The extension will also permit the DSM-5 to better link with the U.S. implementation of the
ICD-10-CM codes for all Medicare/Medicaid claims reporting, scheduled for October 1, 2013.
Although ICD-10 was published by the WHO in 1990, the Clinical Modification version (ICD-
10-CM) authorized by the U.S. Centers for Medicare and Medicaid Services (CMS) and the
Centers for Disease Control (CDC) is not being implemented in the U.S. until 23 years later.
The ICD-10-CM includes disorder names, logical groupings of disorders and code numbers but
not explicit diagnostic criteria. The APA has already worked with CMS and CDC to develop a
common structure for the currently in-use DSM-IV and the mental disorders section of the ICD-
10-CM.

"The International Classification of Diseases (ICD) is published by the WHO for all member
countries to classify diseases and medical conditions for international health care, public health,
and statistical use. The WHO plans to release its next version of the ICD, the ICD-11, in 2014.
APA will continue to work with the WHO to harmonize the DSM-5 with the mental and
behavioral disorders section of the ICD-11. Given the timing of the release of both DSM-5 and
ICD-11 in relation to the ICD-10-CM, the APA will also work with the CDC and CMS to
propose a structure for the U.S. ICD-10-CM that is reflective of the DSM-5 and ICD-11
harmonization efforts. This will be done prior to the time when the ICD-10-CM revisions are
frozen for CMS and insurance companies to prepare for the October 1, 2013, adoption."

I have no information on the date by which ICD-10-CM is to be "frozen" nor how open to review the document might be, at this stage.

I have some archived Co-Cure posts from 2007 and 2008 in which the issue of ICD-10-CM was being discussed by US advocates, Mary S and Jean Harrison. So this is an issue that has been on the agenda for several years but it's not one that I was following, myself, back then and I don't know what advocacy work has been done in the last year or so, in the US, around this proposal that CFS should be coded in Chapter 18 under the R codes, with PVFS and ME classified in Chapter 6 at G93.3 or whether it had been raised at the previous meeting.

The Minutes of the two day 29-30 October 2009 CFSAC meeting are here: http://www.hhs.gov/advcomcfs/meetings/minutes/cfsac102909min.html

PDF: http://www.hhs.gov/advcomcfs/meetings/minutes/cfsac102909min_pdf.pdf

 

[Dx Revision Watch]

Some differences between ICD-10 and proposed ICD-10-CM for the code for Neurasthenia

http://apps.who.int/classifications/apps/icd/icd10online/?gf40.htm+f480

ICD-10 version for 2007

F48 Other neurotic disorders
F48.0 Neurasthenia

Considerable cultural variations occur in the presentation of this disorder, and two main types occur, with substantial overlap. In one type, the main feature is a complaint of increased fatigue after mental effort, often associated with some decrease in occupational performance or coping efficiency in daily tasks. The mental fatiguability is typically described as an unpleasant intrusion of distracting associations or recollections, difficulty in concentrating, and generally inefficient thinking. In the other type, the emphasis is on feelings of bodily or physical weakness and exhaustion after only minimal effort, accompanied by a feeling of muscular aches and pains and inability to relax. In both types a variety of other unpleasant physical feelings is common, such as dizziness, tension headaches, and feelings of general instability. Worry about decreasing mental and bodily well-being, irritability, anhedonia, and varying minor degrees of both depression and anxiety are all common. Sleep is often disturbed in its initial and middle phases but hypersomnia may also be prominent.

Fatigue syndrome
Use additional code, if desired, to identify previous physical illness.
Excludes: asthenia NOS ( R53 )
burn-out ( Z73.0 )
malaise and fatigue ( R53 )
postviral fatigue syndrome ( G93.3 )
psychasthenia ( F48.8 )

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

http://www.cdc.gov/nchs/icd/icd10cm.htm#10update

http://dxrevisionwatch.files.wordpress.com/2009/12/i10tab2010.pdf (4.7MB)

ICD-10-CM Tabular Page 268 2010

F48 Other nonpsychotic mental disorders

F48.1 Depersonalization-derealization syndrome

F48.8 Other specified nonpsychotic mental disorders

Dhat syndrome
Neurasthenia
Occupational neurosis, including writer's cramp
Psychasthenia
Psychasthenic neurosis
Psychogenic syncope

F48.9 Nonpsychotic mental disorder, unspecified Neurosis NOS

 

[Dx Revision Watch]

http://www.forums.aboutmecfs.org/sh...e-XMRV-articles)&p=80477&viewfull=1#post80477

 

[Dx Revision Watch]

PowerPoint Slides: ICD Revision: Future Direction, Vancouver, November 2009

http://www.imecchi.org/IMECCHI/Agenda/20091110_LM.pdf

ICD Revision: Future Direction

Lori Moskal, CHIM

Prepared for The International Methodology Consortium for Coded Health Information

Vancouver November 2009


[...]

Slide 28/29

ICD-11 in Canada

2018 is the earliest possible date -implementation is F/P/T decision

Would not be implemented in Canada until French translation available

WHO preference is to avoid national clinical modificationsneed for an ICD-11-CA will be determined later

ICD-10 (and subsequently ICD-10-CA) will continue to be updated until 2016 to minimize transition to ICD-11

 

[Doogle]

CFSAC submitted the following recommendation to the Secretary in August 2005.

Recommendation 10: We would encourage the classification of CFS as a 'Nervous System Disease,' as worded in the ICD-10 G93.3.

The discussions must have been in subcommittee because I couldn't find reference to the topic in the January 10, 2005 or April 4, 2005 meeting minutes.

 

[Dx Revision Watch]

Thank you Doogle.

Suzy

 

[Dx Revision Watch]

PDFs for proposals for US ICD-10-CM clinical modification

It's a little difficult locating the file for the Tabular List on this site and it downloads as a zipped file:

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

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
Note: The 2010 update of ICD-10-CM is now available. It replaces the July 2009 version.

On the site below, the ICD-10-CM files are available in (non zipped) PDF format.


2010 ICD-10-CM

The 2010 ICD-10-CM files below contain information on the new diagnosis coding system, ICD-10-CM, that is being developed as a replacement for ICD-9-CM, Volumes 1 and 2.

http://www.cms.gov/ICD10/12_2010_ICD_10_CM.asp#TopOfPage

2010 Version - What's New [PDF, 12KB]

ICD-10-CM Quick Reference Guide [PDF, 484KB]

2010 Diagnosis Code Set General Equivalence Mappings [ZIP 1.19MB] - Updated GEMs file on 3/12/10

2010 Reimbursement Mapping Guide [PDF 67KB]

2010 Reimbursement Mappings - Diagnoses [ZIP, 195KB]

2010 ICD-10-CM Indexes to Diseases & Injuries, Neoplasm, External Cause, and Drugs [ZIP, 4.83MB]

2010 ICD-10-CM Tabular List of Diseases & Injuries [PDF, 4.64MB]

2010 ICD-10-CM Official Coding Guidelines [PDF, 343KB]

 

[Dx Revision Watch]

Four ICD-10-CM related articles

ETA: Are you aware that the right to edit your own posts beyond 4 days was removed on 2 June and that you cannot now delete your posts?

If you share my concerns for the implications for this change and for the cavalier manner in which it has been imposed without prior discussion please add your concerns to the thread below and vote against this sanction in the poll.

To vote and register your objection go to:

http://www.forums.aboutmecfs.org/showthread.php?5368-Forum-adjustment-editing-your-post

EDIT 2: Please see Cort's message. Editing rights are now reinstated.


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


Please note that ICD10Watch has no connection with any of my sites with a similar name.


"ICD10Watch.com, brought to you in partnership with Infosys, is your news source for all the latest developments on ICD-10 transition planning, events, technology and more."

http://www.icd10watch.com/node/5944

ICD10 Watch
by Tom Sullivan

Couldn't the U.S. just leapfrog ICD-10 for ICD-11?
Posted on Fri, May 28, 2010 - 09:43 am

Since nearly every major nation except the U.S. is already eyeing ICD-11 while U.S. payers and providers essentially dread the conversion to ICD-10, it's tempting to think that perhaps we could just skip the former altogether and hold out for the latter.

A preliminary version of ICD-11 is promised for later this year, after all, and it appears that plenty of providers will not even have started down the ICD-10 road by then, while many payers are finding that as they move from assessment into remediation, the migration is more challenging than expected...

Read full article here

[Related: Will ICD-10 spark coder chaos? See also: ICD-9 to ICD-10 crosswalks: There's got to be a better way.]

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

http://www.icd10watch.com/blog/will-icd-10-spark-coder-chaos

ICD10 Watch
by Tom Sullivan

Will ICD-10 spark coder chaos?
Posted on Mon, May 24, 2010 - 09:18 am

When drawing up those ICD-10 strategies, healthcare organizations ought to be sure that having enough coders is on their priority list.

That's because ICD-10 threatens to simultaneously require more coders and make proficient folks even harder to come by. Given the current shortage of ICD-9 coders, one certainty is that providers will feel a productivity pinch as they transition to ICD-10. New technologies will help, and coders' roles will evolve, but providers will still rely on them for that most basic of business tasks, getting paid...

Read full article here

[Related: ICD-10 putting Americans back to work, part 3: Job security. Podcast: The upside of a sibling rivalry between HIPAA 5010 and ICD-10.]

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

http://www.healthcarefinancenews.com/news/why-move-icd-10-if-icd-11-horizon

Why move to ICD-10, if ICD-11 is on the horizon?
May 11, 2010 | Chelsey Ledue, Associate Editor

While the United States is already a decade behind the rest of the world in using the most up-to-date International Disease Classification system ICD-10 the alpha version of ICD-11 is due out later this year.

Some are wondering if it would be less time-consuming and more cost-efficient to jump from ICD-9 to ICD-11 when it comes out in 2014 particularly since many healthcare providers may not even meet the Oct. 1, 2013 deadline for ICD-10 implementation.

ICD-10 is the pathway to ICD-11, she said. You have to treat it like youre building a structure starting with a first floor. You cant build a fourth one without constructing a second and third.

[...]

The nation should not expect to move to ICD-11 until well after 2020, according to Bowman, assuming that an ICD-11 beta is produced around the 2014-2015 projection.

Read full article here

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

http://www.healthcaretechnologyonli...10-Compliance-In-The-Cloud-0001?VNETCOOKIE=NO

ICD-10 & HIPAA 5010 Compliance In The Cloud
May 25, 2010

By Ken Congdon, editor in chief, Healthcare Technology Online

While much of the national news coverage has focused on EHR (electronic health record) adoption/meaningful use and healthcare reform, perhaps the most significant IT challenge for healthcare providers over the next few years will be HIPAA (The Health Insurance Portability and Accountability Act) 5010 and ICD-10 (International Classification of Diseases, 10th edition) compliance. HIPAA 5010 is a new set of standards that regulate the electronic transmission of specific healthcare transactions including eligibility, claim status, referrals, claims, and remittances. Version 5010 carries at least 1331 modifications spanning all 9 standard electronic transactions and includes improvements in structural, technical, and data content (including improved eligibility responses and better search options). It also is more specific in requiring the data that is needed, collected, and transmitted in a transaction (such as tightened and clear situational rules).

ICD-10, on the other hand, is a coding of diseases, symptoms, abnormal findings, social circumstances, and causes of injury as classified by the World Health Organization. ICD-10 calls for a complete replacement of the ICD-9 code sets used to report medical diagnoses and procedures. ICD-10 does more than just replace the old ICD-9 code set, it also adds five times as many codes to the classification structure...

Read full article here

Ken Congdon is Editor In Chief of Healthcare Technology Online.

 

[Dx Revision Watch]

New post on DSM-5 and ICD-11 Watch: US Clinical Modification ICD-10-CM

New post on Dx Revision Watch site

US Clinical Modification ICD-10-CM
June 6, 2010

by Suzy Chapman

Shortlink Post #45: http://wp.me/pKrrB-Ka

This post is intended to clarify any confusion between ICD-10, ICD-11 and the forthcoming US Clinical Modification, ICD-10-CM.

Read full post here


In a forthcoming post, I shall be publishing important information about proposals for parent terms, classifications and codings in the ICD-11 Alpha Draft.

 

[Dx Revision Watch]

Important new post on Dx Revision Watch

PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform

Shortlink Post #46: http://wp.me/pKrrB-KK

The information in this report relates to proposals for ICD-11. It does not apply to ICD-10-CM, the forthcoming US "Clinical Modification" of ICD-10.

or go to Post # 5 on this PR thread:

http://www.forums.aboutmecfs.org/sh...to-launch-in-May&p=89995&viewfull=1#post89995

Suzy

 

[justinreilly]

Whom do we Contact to Protest this Travesty?

This is a VERY important issue. We're going to be further screwed for many years after October in the US, with "CFS" officially a supposedly "vague" collection of symptoms distinct from ME.

Sorry, I don't have time to read thru the whole thread. To whom should we write to protest? Thanks!

 

[justinreilly]

"CFS" defined as the symptom of "unspecified chronic fatigue"!!

Uggh. This is worse than what we have now under ICD-9 CM in the US. They define "CFS" as the symptom of "unspecified chronic fatigue"!! They really are taking a page from the British scumbags like Sharpe who got "CFS" defined there as idiopathic CF. Reeves puts out his bs "CFS" definition which includes depression without ME or any other co-morbidity and now they are getting "CFS" officially defined as idiopathic CF, just like the "Oxford/Sharpe" definition!!

Has CAA responded to this?

R53.82 Chronic fatigue, unspecified
Chronic fatigue syndrome NOS

Excludes: postviral fatigue syndrome (G93.3)

 

[justinreilly]

US ICD 10-CM defines "CFS" as the symptom of "unspecified chronic fatigue"!!

Uggh. This is an absolute disaster for us. The ICD 10-CM (the official diagnostic and insurance codes) for the US are set to be written in stone (for the next several years) in October. It's even worse than what we have now under ICD-9 CM in the US.

ME is split from "CFS" and called "benign ME" ie- doesn't cause death (plus also has the benefit to the usual criminals that it sounds totally benign to the casual reader- ie totally harmless). They define "CFS" as the symptom of "unspecified chronic fatigue"!! They really are taking a page from the British scumbags like Sharpe who got "CFS" defined there as idiopathic CF. Reeves puts out his bs "CFS" definition which includes depression without ME or any other co-morbidity and now they are getting "CFS" officially defined as idiopathic CF, just like the "Oxford/Sharpe" definition!!

Has CAA responded to this?

R53.82 Chronic fatigue, unspecified
Chronic fatigue syndrome NOS

Excludes: postviral fatigue syndrome (G93.3)

 

[eric_s]

Is there a code for "ME" in there, too? Or is there only R53.82 and G93.3?

 

[justinreilly]

Idiopathic CF officially merged into CFS!

It looks like there isn't a code for "Idiopathic Chronic Fatigue" under that name in ICD 9 CM or ICD 10 CM. Does anyone know what ICF is currently coded as? ICD 9 CM- 780.79 Other malaise and fatigue (Asthenia NOS, Lethargy or Tiredness)? If there is currently a way to code ICF, this is great. There looks like there will be no way to code ICF separately from "CFS" under ICD 10-CM as the only listing under "Chronic fatigue, unspecified" will be "CFS, NOS"!! A total disaster! God, these scumbags are good! We're going to get crushed even worse than now!

 

[justinreilly]

Is there a code for "ME" in there, too? Or is there only R53.82 and G93.3?

Just
"G93.3 Post-Viral Fatigue
Benign M.E."