Links for ICD-10-CM documents, codings and commentary
@ Willow
As a UK resident, I don't involve myself in the politics and advocacy around the current proposals for the coding of CFS, PVFS and ME in the forthcoming US specific "Clinical Modification",
ICD-10-CM.
But I maintain a site called
Dx Revision Watch which does carry some information about ICD-10-CM, in order to clarify between the proposed codings for ICD-10-CM, current codings in ICD-10 and proposed codings for the forthcoming ICD-11, which is anticipated in 2014+.
There are also comparisons between the proposed codings for ICD-10-CM and the existing codings for CFS, PVFS and ME in a couple of other country modifications, namely Canada (ICD-10-CA) and Germany (ICD-10-GM).
So below, I'm posting a compilation of information which I'm hoping will be of interest to readers who were not following a previous thread on ICD-10-CM.
There was a previous thread on these forums with a lot of discussion on ICD-10-CM started in April 21, 2010, here:
http://forums.aboutmecfs.org/showthread.php?4510-ME-and-cfs-to-be-classified-as-seperate-illnesses
ME and cfs to be classified as seperate illnesses
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On my own site, towards the end of this page (which is Page 2 of two sub pages on ICD codings) I have set out the current proposed codings for ICD-10-CM for CFS in Chapter 18 (the R codes) and PVFS and ME in Chapter 6 (the G codes) as they are set out in the
ICD-10-CM Tabular List:
http://dxrevisionwatch.wordpress.com
http://dxrevisionwatch.wordpress.com/icd-11-me-cfs/2/
Forthcoming US Clinical Modification ICD-10-CM
Current proposals for the US Clinical Modification ICD-10-CM, scheduled for implementation in October 2013, propose classifying Chronic fatigue syndrome in ICD-10-CM Chapter 18 at R53.82 etc.
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In June, last year, I also published this posting on my own site which further clarifies between ICD-10 and the proposed codings for ICD-10-CM:
US Clinical Modification ICD-10-CM
http://wp.me/pKrrB-Ka
It also includes this link for an archive CDC document that sets out the history of codings for these three terms up to March 2001 and shows that, at that point, all three were proposed to be placed in Chapter 6 (the G codes).
CDC document: A Summary of Chronic Fatigue Syndrome and Its Classification in the International Classification of Diseases, March 2001 proposals:
http://www.co-cure.org/ICD_code.pdf
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The URL for the CDC site for information on ICD-10-CM and from where documents like the latest version of the Tabular List can be downloaded is:
http://www.cdc.gov/nchs/icd/icd10cm.htm
See heading: ICD-10-CM Files - 2011 release
The CDC site was updated in December and new versions of the documents were added. If you click on any of the links for 2011, it will take you to these files:
12/20/2010 09:05AM 690,231 DiagnosisGEMs_2011.zip
12/20/2010 07:40AM 14,131,267 icd10_cm_pdf.zip
12/20/2010 07:40AM 2,000,540 icd10cm_addenda_2010_2011.zip
12/20/2010 07:40AM 2,046,858 icd10cm_xml_2011.zip
12/20/2010 07:40AM 616,190 ICD10CMdescriptions_2011.zip
It's a little difficult to see which files you might want. I already had a copy of the 2010 version for the proposed Tabular List but also wanted the most recent version. So I downloaded the largest file, which is this one:
14,131,267 icd10_cm_pdf.zip
This unZips to a file which contains a number of PDFs and the Tabular List and Index for 2011 are within this file. It would have been so much easier if the PDFs could have been uploaded separately!
The Tabular List is around 7MB unZipped and the Index around 4.7MB.
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If you go to this site:
http://www.cms.gov/ICD10/12_2010_ICD_10_CM.asp#TopOfPage
The 2010 versions of the various documents are available as unZipped PDFs and much easier to locate what you are looking for. But the page does not yet appear to have been updated with the latest versions for 2011.
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I have several URLs for sources for the information that the ICD-10-CM is proposed to be frozen by October 1, 2011 for example:
CMS, CDC call for ICD-9 and ICD-10 code freeze
http://icd10watch.com/headline/cms-cdc-call-icd-9-and-icd-10-code-freeze
"CMS, the Centers for Medicare and Medicaid Services, along with CDC, the Centers for Disease Control and Prevention, proposed that both ICD-9-CM and ICD-10-CM/PCS code sets be frozen two years before the compliance deadline.
"What that means: As of October 1, 2011, only limited updates would be instituted into the code sets so that providers, payers, clearinghouses, and health IT vendors, will not have to simultaneously keep pace with code updates while also reconfiguring their existing systems for ICD-10-CM/PCS." Source:
ICD10 Watch.com
(That site with a similar name has no connection with my own site.)
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Finally, a couple of recent Co-Cure mailings around ICD-10-CM codings from US advocates:
From Mary Schweitzer
Sent: Wednesday, January 26, 2011 8:42 PM
Subject: Re: [CO-CURE] ACT, RES, NOT: ME/CFS State of the Knowledge Workshop
To clarify a few things:
ME/CFS is the name used in the Canadian Consensus Criteria, so it does have a formal usage.
The name was chosen in 2003 to reflect the placement of both ME and CFS in ICD-10 under the chapter on neurology at G93.3. Many patient advocates believe the Canadian Consensus Critera represents the best current definition in use.
In the US, myalgic encephalomyelitis was never used. When British researchers began using M.E., the US instead used Epidemic Neuromyesthenia. However, Alex Shelekov, the national expert on epidemic neuromyesthenia, sided with those at the 1988 Holmes meeting who said the cluster outbreaks were M.E. That was not even included in a footnote, but in a companion article the same year, the late Stephen Straus wrote that CFS was also once known as epidemic neuromyesthenia and, without using the term M.E., nevertheless referenced the two McAvedy and Beard articles suggesting M.E. was really mass hysteria, using them to lend authority to his assertion that researchers knew CFS patients actually had mental problems.
To introduce the term ME to the US medical establishment, many advocates - dating back to the late 1990s - had suggested the use of ME/CFS and ultimately dropping the CFS part. I suggested it myself when presenting at a special name change session on the AACFS program in 1998, but I was not the only one.
In 1998 CDC removed 323.9, the designation for M.E., from ICD-9-CM. Doctors in the U.S. have to use those codes for insurance reimbursement, so that was tantamount to rendering the disease nonexistent. As it was, most doctors in the US refused to give that diagnosis when asked. Now it required a second diagnosis for reimbursement.
After patients began clamoring for the adoption of the Canadian Consensus Criteria that linked M.E. and CFS, CDC added a statement to ONE of their websites to the effect that the two were not the same thing. I thought at the time it was not a recognition of M.E. (because you will find nothing on M.E. anywhere else at CDC), but an effort to negate the movement to adopt the Canadian Criteria.
Personally, I was surprised and delighted that the CFSAC recommended the use of the term ME/CFS because it would place CFS in G93.3 in ICD-10-CM, which is still not scheduled for adoption until at least 2013. The rest of the world is looking on to ICD-11, but the US is still on ICD-9.
The CFSAC is an advisory committee to the Secretary of Health and Human Services, who oversees both CDC and NIH. It is well within their purview to recommend the use of ME/CFS, and well within the purview of NIH to follow that recommendation in an exploratory workshop on the state of the knowledge, for now.
Finally, while I fully appreciate why patients in nations that have a history of M.E. would like to get rid of CFS entirely and not see it paired with M.E., please understand that doing so in the US means that CFS, the only name used in the vast majority of the medical establishment in the US (who never heard of M.E.), will be placed in R53 under "vague signs and symptoms" - not G93.3, in neurology, in ICD-10-CM.
Mary Schweitzer
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and from Kelly Latta:
Sent: Friday, January 21, 2011 10:54 PM
Subject: [CO-CURE] NOT: DHHS study At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans:
Note: The question remains, will CFS become an uninsurable condition?
Although CFS is not on the current HHS list, many other neurological
and virally-induced diseases are. And then it gets complicated.
Insurance billing and diagnosis categorization are done through the
World Health Organization's International Classification of Diseases
(ICD).
Currently CFS is listed in the ICD-9 CM under R53.82 a classification
which is used only in the United States and falls under the purview of
the CDC. The initials CM stand for clinical modification.
With only a few other exceptions, other countries are required to use
the ICD-10 G93.3 classification for myalgic encephalomyelitis which is
the tabular listing with post viral fatigue syndrome and CFS in the
alphabetical listing.
In 2013 the United States will switch over to the ICD-10 CM. As it
stands now, CFS will remain in the malaise and fatigue category of
generalized symptoms whereas post viral fatigue syndrome and myalgic
encephalomyelitis will be listed under G93.3.
The currently proposed tabular ICD-10 CM index on page 264 states it thusly:
G93.3
Postviral fatigue syndrome
Benign myalgic encephalomyelitis
Excludes1:
chronic fatigue syndrome NOS (R53.82)
Something to note may be that the amalgamation of ME/CFS as is now
used by the NIH doesn't technically exist although for classification
purposes the international WHO may consider the three terms synonymous
(the literature is unclear here) although the U.S. CDC clearly does
not.
The resulting misclassification in the doctor's office for doctors
unfamiliar with the definitions could ultimately result in incomplete
reporting on CFS- related deaths as well as inaccurate epidemiology -
two areas for which the ICD was initially created to provide such
statististics. As noted in previous posts the Somatic Disorders DSM V
working group's proposed CSSD, and particularly the new SSSD
categories would benefit from CFS remaining in the R Chapter as this
implies that the symptoms are medically unexplained.
Further information on the ICD-10 can be found here:
http://www.cdc.gov/nchs/icd/icd10cm.htm#10update
At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans:
129 Million People Could Be Denied Affordable Coverage Without Health Reform
Introduction
According to a new analysis by the Department of Health and Human
Services, 50 to 129 million (19 to 50 percent of) non-elderly
Americans have some type of pre-existing health condition. Up to one
in five non-elderly Americans with a pre-existing condition 25
million individuals is uninsured. Under the Affordable Care Act
starting in 2014, these Americans cannot be denied coverage, be
charged significantly higher premiums, be subjected to an extended
waiting period, or have their benefits curtailed by insurance
companies.
As many as 82 million Americans with employer-based coverage have a
pre-existing condition, ranging from life-threatening illnesses like
cancer to chronic conditions like diabetes, asthma, or heart disease.
Without the Affordable Care Act, such conditions limit the ability to
obtain affordable health insurance if they become self-employed, take
a job with a company that does not offer coverage, or experience a
change in life circumstance, such as divorce, retirement, or moving to
a different state. Older Americans between ages 55 and 64 are at
particular risk: 48 to 86 percent of people in that age bracket have
some type of pre-existing condition. And 15 to 30 percent of people
in perfectly good health today are likely to develop a pre-existing
condition over the next eight years, severely limiting their choices
without the protections of the Affordable Care Act.
For the full DHHS study:
http://www.healthcare.gov/center/reports/preexisting.html
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Hope these links may be of interest to those coming fresh to this issue.
Suzy