CFS and M.E. were placed in the same category in the neurology chapter of I=
CD-10-CM, the "clinical manual" of ICD-10 that will be adopted for use in th=
e United States.
But the fact of the matter is that in ICD-10, CFS already IS coded to G93.3,=
"PVFS and M.E." in the index, which is as authoritative as the tabular vers=
ion. [PVFS stands for Post-Viral Fatigue Syndrome, and is not diagnosed very=
frequently any more - not at all in the U.S.]. It already IS coded in neuro=
logy.
110 nations use ICD-10 as-is, including the UK. Australia has a clinical ve=
rsion that does not alter the codes for M.E. or CFS. But Canada and Germany=
have clinical versions that place CFS in the tabular version of ICD-10, in G=
93.3 with M.E. In fact, it was the Canadian clinical version, ICD-10-CA, wh=
ich led to the highly regarded Canadian Consensus Criteria for ME/CFS in 20=
03.
NOBODY EXCEPT THE UNITED STATES CODES CFS IN THE "R" CHAPTER. If we coded C=
FS at R53.82, which was the plan of NCHS, we would have been the ONLY nation=
in the world to do so.
Furthermore, M.E. is not a known diagnosis in the U.S. (WE know about it, b=
ut very few doctors do.) There is no definition for it approved by CDC. We=
can now point to the new definition that was published in the Journal of In=
ternal Medicine, but that is more likely to enable researchers in the US and=
Canada to use M.E. if they want to, than to trickle down to U.S. clinicians=
. Part of the problem is that when M.E. replaced atypical polio as a diseas=
e name in British commonwealth nations and Europe, in the U.S. the new name w=
as epidemic neuromyesthenia, which has not (to my knowledge) been diagnosed i=
n decades.
So if CFS gets coded as R53.82 in the U.S.'s ICD-10-CM, yes, M.E. will be le=
ss likely to confuse with CFS - but that would only be in the U.S., and in t=
he U.S. we only get diagnosed with that revolting name CFS anyway. At least=
we could get them scratching their heads and asking, "What is M.E.?" if bot=
h diseases were placed together where those of you outside the U.S. already h=
ave it. =20
Given that U.S. doctors do not have a high opinion of CFS, keeping it under "=
R" in "vague signs and symptoms" would only reinforce their prejudice agains=
t it as a "garbage diagnosis" - something you diagnose when you run out of i=
deas.
Finally, there was an inadvertent error in an earlier Co-Cure message about g=
etting CFS out of the "R" category. The "R" category is not for psychiatric=
diagnoses. =20
British psychiatrists use "fatigue syndrome," which is coded at F48.0 under n=
euroses at "neurasthenia.". Then when they write about it, they mix and matc=
h terms so it looks as if CFS is the same thing, and therefore it goes in F4=
8.0. That is a serious problem in the UK. [I have to admit to being alarme=
d recently when a U.S. virologist connected CFS not to the history of post-p=
olio syndrome, which is pretty well established, but to the arcane nineteent=
h century diagnosis of neurasthenia. Please don't do that!]
We are not (I hope) in current danger of being coded under neuroses at F48.0=
, neurasthenia, in the U.S. But the "R" diagnosis is sufficiently vague tha=
t it wouldn't be difficult to use it to claim CFS patients really have CSSD (=
Complex Somatic Symptom Disorder), the category British psychiatrist and CBT=
advocate Michael Sharpe is trying to shoehorn into DSM-5, the new version o=
f the American Psychiatric Association's huge diagnostic tome. So it does l=
eave us vulnerable.
To those outside the US I would say, look to ICD-11. That's what will affec=
t you the most. To those in the US (where we are finally getting around to a=
dopting ICD-10-CM two decades after ICD-10 was written), what WE need is sim=
ply to get in step with the rest of the world now. =20
Mary M. Schweitzer=
---------------------------------------------
Send posts to CO-CURE@listserv.nodak.edu
Unsubscribe at http://www.co-cure.org/unsub.htm
Too much mail? Try a digest version. See http://www.co-cure.org/digest.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.
---------------------------------------------
