The paragraph below is an extract from the NCHS ICD-9-CM Coordination meeting agenda document:
"The Coalition 4 ME/CFS has submitted a proposal asking that chronic fatigue syndrome be deleted as an inclusion term under code R53.82 and that the term be added as an inclusion term under code G93.3."
In the other thread on this issue, at
Post #16:
http://forums.phoenixrising.me/show...ernmental-Body&p=206904&viewfull=1#post206904
I had set out:
According to documentation, the Coalition4ME/CFS had proposed this:
ICD-10-CM TABULAR PROPOSED CHANGES
Option 1 (proposed by Coalition 4 ME/CFS)
G93 Other disorders of brain
Retain "G93.3 Postviral fatigue syndrome"
Add "Chronic fatigue syndrome" here
Delete "Excludes1: chronic fatigue syndrome NOS (R53.82)"
R53 Malaise and fatigue
R53.8 Other malaise and fatigue
Retain "R53.82 Chronic fatigue, unspecified" here
Delete "Chronic fatigue syndrome NOS"
Add "Excludes 1: chronic fatigue syndrome (G93.3)"
(Ed: Note: it is implicit that the existing term "Benign myalgic encephalomyelitis" remains under the G93.3 Title term, Postviral fatigue syndrome, since no instruction to delete "Benign myalgic encephalomyelitis" is given.)
In this post
http://forums.phoenixrising.me/show...E-CFS-Proposal&p=205393&viewfull=1#post205393
Tina had clarified to Rlc:
"Ric is absolutely incorrect.
ME would remain the same if the Coalition 4 ME/CFS proposal is adopted."
Then Mary Dimmock followed this up in a post at
Post #7 in which she says (the blue bolding is SC's not MD's):
"UsedToBePerkyTina is absolutely correct.
"The proposal that was submitted by the Coalition 4 ME/CFS is to reclassify CFS from "Signs and Symptoms/CHronic Fatigue, Unspecified" to 'Diseases of the Nervous System" at G93.3 in the ICD-10-CM (the U.S. specific clinical modification of the ICD-10). G93.3 is the code already in use for ME and PVFS.
"The proposal is not asking for the deletion of ME or reclassification of ME away from G93.3. The proposal is not asking to modify the ICD-10 itself. The only thing the proposal is asking for is to move CFS to G93.3 where ME is. This will make the U.S. clinical modification consistent with how it is in every other country - CFS listed as a neurological disease at G93.3. Background and specifics on the proposal are below..."
Mary Dimmock also set out some clarifications in this post on the other thread:
http://forums.phoenixrising.me/show...ernmental-Body&p=207252&viewfull=1#post207252
On 26 September, I emailed Mary and asked if she could clarify the following for me:
I note that the Summary document of the Coordination meeting on September 14, that is posted on the CDC site at:
http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm
states:
"Though the requestor had asked to have the term benign myalgic encephalomyelitis deleted NCHS indicated it should remain somewhere at G93.3 to maintain compatibility with WHO ICD-10. Comments on this indicated that it should be added to proposed new code G93.31 with benign as a nonessential modifier."
Is the "requestor" being referred to here, the Coalition or another "requestor" and if so, who was this? If it does refer to the Coalition, is this an error in the writing up of the notes of the meeting?
My understanding has been that in their initial proposal, the Coalition had set out the existing draft proposal for the G codes for Chapter 6 as they stand in the ICD-10-CM version for 2011, then set out beneath their proposed Deletions and Additions to the existing code structure and that (Benign) ME was not necessary to include because no change or revision was being requested to that specific ICD category subclass or sub-entity to G93.3 Postviral fatigue syndrome.
However, the note of the meeting above, states that the
"requestor had asked to have the term benign myalgic encephalomyelitis deleted".
When I have received a clarification from Mary for why the summary report of the meeting has been worded thus, I will update the thread.
At
Post #50 in this thread, I have said:
"I do not consider that this joint initiative, led by Marly Silverman and Mary Dimmock, should have been taken forward without prior announcement; in my view, an announcement should have been made prior to the letter to Donna Pickett, dated July 14, that the Coalition had agreed to take this issue forward.
So although I support in principle the taking forward of the ICD-10-CM issue at the Coordination and Maintenance Committee meeting and the initiative to lobby for CFS not to be retained under "Symptoms, signs and ill-defined conditions" and coded in Chapter 18 at R53.82, I do not support the way in which the C4ME/CFS has set about their initiative.
I have a big thing about transparency and I would like to know why it was agreed with the other Coalition member groups that this initiative would be taken forward without openness?"
I have also raised the following in the other thread:
...has the IMEA set out its rationale for proposing that the current entry for
"Chronic fatigue syndrome NOS"
should be deleted from the R53.82 section of Chapter 18 for "Symptoms, signs and ill-defined conditions" but inserted under
"G93.33 Chronic fatigue syndrome"
as per the NCHS's proposal?
Because I am interested to know why the IMEA considers it advantageous to have both an entry for
"Chronic fatigue syndrome" and an entry for
"Chronic fatigue syndrome NOS"
under its proposed new sub class
"G93.3 Viral and infectious and post-infectious diseases of the nervous system with post-exertion symptoms"
and under what circumstances the IMEA considers that "Chronic fatigue syndrome NOS" would be selected by the clinician in preference to any of the other category codings currently being proposed under parent class G93 by IMEA?
So far, I've seen no rationale set out by the IMEA. Neither have I seen any rationale from the IMEA for the IMEA's proposing that the "Excludes2" class of Exclude should be applied rather than the "Exclude1" class of Exclude. I understand that the IMEA's communication containing its own proposal has already been submitted.
As I've stated in my recent position statement, my position, as an individual, is this:
That I consider
that it will hurt patients if Chronic fatigue syndrome is coded in ICD-10-CM under Chapter 18, the chapter for Symptoms, signs and ill-defined conditions, under R53.82 Chronic fatigue, unspecified > Chronic fatigue syndrome NOS;
that Chronic fatigue syndrome should be classified in Chapter 6 to the G93? parent class, in line with ICD-10, ICD-10-CA (Canada) and ICD-10-GM (Germany), and in line with ICD-11 proposals that Chronic fatigue syndrome should be classified within Chapter 6: Diseases of the nervous system;
that classifying Chronic fatigue syndrome under the Chapter 18 R codes, in ICD-10-CM, will render patients more vulnerable to the proposals of the DSM-5 Somatic Symptom Disorders workgroup.
At no point have I expressed any desire to see Benign myalgic encephalomyelitis
deleted from under the G93 parent code.
At no point have I expressed any desire to see Chronic fatigue syndrome
reclassified as ME.
I would however like to see Chronic fatigue syndrome
reclassified from R53.82 to Chapter 6 under the G93 parent code and I would be equally concerned if ICD-11 were proposing to classify Chronic fatigue syndrome (which is currently indexed to G93.3 in ICD-10) under the R codes for ICD-11. [Which is not what they are proposing to do.]
If I was asked what I would prefer to see for ICD-10-CM, it would be this.
If separate codes can be accommodated for all three terms, I'd prefer to see the following structure for G93, rather than the proposals of the C4, NCHS or IMEA. Note that I would not propose the use of
"Excludes2" or the inclusion of a
"Chronic fatigue syndrome NOS", as the IMEA submission calls for.
So this is what I would prefer to see:
Chapter 6 Diseases of the nervous system
[...]
G93 Other disorders of brain
G93.3 Postinfectious Fatigue Syndromes (something other than this parent term that would encompass viral and non viral insult and ideally no "Fatigue" word, but ICD-10-CM may be restricted to what extent an existing ICD Title term (in this case G93.3 Postviral fatigue syndrome) can be modified, as they are obliged to work within the framework of complex WHO classificatory guidelines.)
G93.31 Postviral fatigue syndrome
Excludes1: chronic fatigue, unspecified (R53.82)
neurasthenia (F48.8)
G93.32 Benign Myalgic encephalomyelitis
Excludes1: chronic fatigue, unspecified (R53.82)
neurasthenia (F48.8)
G93.33 Chronic fatigue syndrome
Excludes1: chronic fatigue, unspecified (R53.82)
neurasthenia (F48.8)
Neurasthenia (F48.8) in Chapter 5, would also need to have all three codes above listed as Excludes.
ETA: Someone has made out a good case to me for transposing G93.32 with G93.33, so I've adjusted the order of CFS and MBE, above. The reason I've left the positioning of Postviral fatigue syndrome at G93.31 is because of the legacy hierarchy within ICD-10 for Postviral fatigue syndrome, and for congruency with the order of the three terms within the ICD-10-CA and the ICD-10-GM (Germany).
In international ICD-10,
Neurasthenia (with
Fatigue syndrome underneath it) is coded in Chapter 5 at F48.0 with an Exclusion for postviral fatigue syndrome (G93.3). But ICD-10-CM has a slightly different structure for the F48 codes and has Neurasthenia coded at F48.8, with no Exclude for G93.3 Postviral fatigue syndrome (the Title term under which (B)ME sits). I note the submission of the IMEA does not have an Exclude or Exclude1 under F48.8 for any of the proposed G93.xx terms.
In both ICD-10 and ICD-10-CM, the entire R code chapter is excluded from the Chapter 5 F codes.
---------
I hope the above will pull together clarifications which have already been posted in this thread.
Information about what the "code freeze" means has been put out on Co-Cure, several times, and is also included on
Page 8 of the NCHS meeting document:
ICD-9-CM Coordination and Maintenance Committee Meeting September 14, 2011, Diagnosis Agenda, which is available here:
http://www.cdc.gov/nchs/data/icd9/TopicpacketforSept2011fpdf.pdf
Suzy
