From Suzy Chapman for http://dsm5watch.wordpress.com
23 July 2011
Since the circulation, a few days ago, of a preprint (approved but =
awaiting copy-editing and proof correction) version of the 'Myalgic =
Encephalomyelitis: International Consensus Criteria' there have been =
references to and discussion of ICD classifications and codings for =
PVFS, (Benign) ME and Chronic fatigue syndrome on a number of platforms.
It may be helpful to recap, briefly:
International ICD-10:
The international ICD-10 is used in the UK and in over 110 countries.
For international ICD-10, "Chronic fatigue syndrome" is not included in =
Volume 1: The Tabular List.=20
"Chronic fatigue syndrome" is included in Volume 3: The Alphabetical =
Index, where it is indexed to G93.3 (the same coding to which "Postviral =
fatigue syndrome" and "Benign myalgic encephalomyelitis" are coded).
The ICD-10 Tabular List entry for G93.3 is here: =
http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933=20
This is the only information that appears for the ICD entities =
"Postviral fatigue syndrome" and "Benign myalgic encephalomyelitis" in =
ICD-10. There are no definitions or any other textual content for these =
terms and the relationship between these terms is not specifed.
(ICD-10 does not classify, code or index the composite terms "CFS/ME" or =
"ME/CFS".)=20
How does ICD-10 view the relationship between "Chronic fatigue =
syndrome", "Postviral fatigue syndrome" and "Benign myalgic =
encephalomyelitis"?
The Introduction to ICD-10 Volume 3: The Alphabetical Index Version for =
2006 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".
So ICD-10 does not specify whether, in indexing "Chronic fatigue =
syndrome" to G93.3, it views the term as a synonym to "Postviral fatigue =
syndrome" or to "Benign myalgic encephalomyelitis" or as a sub-entity, =
or some other relationship. Nor does ICD-10 specify how it views the =
relationship between "Postviral fatigue syndrome" and "Benign myalgic =
encephalomyelitis". =20
A CDC document "A summary of the classification of Chronic Fatigue =
Syndrome in the International Classification of Diseases, ninth and =
tenth revisions, and their clinical modifications" to 2001, can be =
accessed here: http://www.co-cure.org/ICD_code.pdf
[Note that in 2001, the recommendation for the US specific, ICD-10-CM, =
had been that all three terms should be coded to G93.3, in line with the =
ICD-10.=20
That proposal has since changed to retaining CFS in the "R" codes under =
"R53 Malaise and fatigue > R53.82 Chronic fatigue, unspecified > Chronic =
fatigue syndrome NOS, Excludes1: postviral fatigue syndrome (G93.3)"; =
but this issue, tabled for discussion at the last CFSAC meeting and for =
which a new Recommendation was voted in favour of, is beyond the scope =
of this mailing.]
"Clinical Modifications" of ICD-10:=20
There are "Clinical Modifications" of ICD-10 in use in Canada, =
Australia, Germany and Thailand. The US currently uses a "Clinical =
Modification" of the WHO's long since retired, ICD-9, and will be =
implementing a "Clinical Modification" of ICD-10 in 2013, which will be =
known as "ICD-10-CM".
ICD-10-CA:
In ICD-10-CA version for 2009, which is the Canadian "Clinical =
Modification" of ICD-10, all three terms, PVFS, (Benign) ME and "Chronic =
fatigue syndrome" are classified within Volume One: The Tabular List, in =
Chapter 6 Diseases of the nervous system, at G93.3 under G93 Other =
disorders of brain.
A PDF of the ICD-10-CA (Canadian Clinical Modification) Volume One: The =
Tabular List can be accessed here:
http://www.cihi.ca/cihiweb/en/downloads/ICD-10-CA_Vol1_2009.pdf
ICD-11:
The revision of ICD-10 towards ICD-11 has been underway since 2007. =
ICD-11 is scheduled for implementation in 2015+.
The Alpha Draft for ICD-11 proposes the following:
The information below is extracted from two DSM-5 and ICD-11 Watch =
reports:
Update on ICD-11 development: July 3, 2011: http://wp.me/pKrrB-1eb
and=20
PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring =
Platform: http://wp.me/pKrrB-KK
The codings for all chapters and categories for ICD-11 are being =
reorganized, including those in Chapter VI of ICD-10 (which will be =
known as "Chapter 6" in ICD-11).
It is not yet known what codes will eventually be assigned to the =
categories within ICD-11 Chapter 6 Diseases of the nervous system.=20
Chapter 6 categories for ICD-11 are currently assigned the codes 06A =
thru 06L02.=20
Screenshot from ICD11 Alpha May 17 - Chapter 6 Diseases of the nervous =
system: Foundation Tab selected
http://dsm5watch.files.wordpress.com/2011/05/icd-alpha1-17-05.png=20
Screenshot from ICD11 Alpha May 19 - Chapter 6: Linearizations Tab > =
Morbidity selected
http://dsm5watch.files.wordpress.com/2011/05/icd-alpha4-19-05-11.png=20
The parent class "G93 Other disorders of brain" is recorded in the iCAT =
ICD-11 Alpha Draft as proposed to be removed.
An Alpha Draft "Discussion Note" and a "Change history" entry dated May =
1, 2010, record a "Change in hierarchy for class: G93.3 Postviral =
fatigue syndrome" because its parent category (G93 Other disorders of =
brain) is removed.
Screenshots here:
http://dsm5watch.files.wordpress.com/2010/05/2icatnotegj92cfs.png
http://dsm5watch.files.wordpress.com/2010/06/change-history-gj92-cfs.png
Note that the removal of the parent class "G93 Other disorders of brain" =
affects many other categories that are currently "children" to "G93 =
Other disorders of brain" in ICD-10, not just those currently coded at, =
or indexed to G93.3.=20
Note also that the label "Gj92" that was initially assigned to "Chronic =
fatigue syndrome" in the iCAT drafting platform as it stood from June to =
November, last year, was a temporary "Sorting label". The code =
currently assigned to "Chronic fatigue syndrome" is "06L00".
What is proposed for ICD-11?
For ICD-11, "06L00 Chronic fatigue syndrome" is proposed to be =
classified in Chapter 6 Diseases of the nervous system under "06L Other =
disorders of the nervous system" as an ICD Title category, with a =
Definition and potentially up to 12 other parameters that will be used =
to describe ICD entities. =20
The 13 parameters that will eventually be completed according to a =
common ICD-11 "Content Model" aren't all visible in the current public =
version of the Alpha Browser but see the more expansive iCAT version =
here: http://dsm5watch.files.wordpress.com/2010/05/2icatgj92cfsdef.png=20
[For ICD-11, there will be a Definition for all ICD entities of around =
100 words in the print edition but a longer Definition in the online =
edition. Note that "External Definitions" in the screenshot above were =
imported from other classification systems as part of the "Start-up" for =
the Alpha Drafting process and are not expected to appear in the final =
version.]=20
In the Details for "Chronic fatigue syndrome", "Benign myalgic =
encephalomyelitis" is specified as an Inclusion term to "06L00 Chronic =
fatigue syndrome".
"Postviral fatigue syndrome G93.3 -> Gj92 (now 06L00) Chronic fatigue =
syndrome" is specified as an Exclusion in the Details for
Chapter 5 F48.0 Neurasthenia
Chapter 18 R53 Malaise and Fatigue=20
Relationships between Title terms and other terms:
In ICD-10, ICD-10-CA (Canada) and the forthcoming US specific, =
ICD-10-CM, relationships between terms coded under the same code is not =
specified. =20
For ICD-11, the relationship between Inclusion terms will be specified =
(that is, whether an Inclusion term is considered a "Synonym", =
"Subclass" or whatever, to a Title entity) though for many categories =
across all chapters of ICD-11 this field has yet to be completed. =20
The ICD-11 Alpha Draft is a work in progress and comes with WHO caveats; =
not everything is explicit in the draft and clarifications have been =
requested. =20
But in classifying "Chronic fatigue syndrome" in Chapter 6, as an ICD-11 =
Title category, with a Definition and other descriptive parameters in =
the process of being populated, with "Benign myalgic encephalomyelitis" =
specified as an Inclusion term to "06L00 Chronic fatigue syndrome" and =
with a "Change of hierarchy" recorded for class "G93.3 Postviral fatigue =
syndrome", the ICD-11 Alpha Draft would appear to propose consolidating =
the status of "Chronic fatigue syndrome" as a category term within ICD.
(Ne nuntium necare)
Suzy Chapman
_____________________
me.agenda@virgin.net
http://dsm5watch.wordpress.com
http://meagenda.wordpress.com
http://www.facebook.com/MEagenda
http://twitter.com/MEagenda
---------------------------------------------
Send posts to CO-CURE@listserv.nodak.edu
Unsubscribe at http://www.co-cure.org/unsub.htm
Select list topic options at http://www.co-cure.org/topics.htm
---------------------------------------------
Co-Cure's purpose is to provide information from across the spectrum of
opinion concerning medical, research and political aspects of ME/CFS and/or
FMS. We take no position on the validity of any specific scientific or
political opinion expressed in Co-Cure posts, and we urge readers to
research the various opinions available before assuming any one
interpretation is definitive. The Co-Cure website <www.co-cure.org> has a
link to our complete archive of posts as well as articles of central
importance to the issues of our community.
---------------------------------------------
