ICD-11 Beta drafting platform: Update (2): Neurasthenia, Postviral fatigue syndrome (PVFS), Benign myalgic encephalomyelitis (ME), Chronic fatigue syndrome (CFS), Fibromyalgia (FM), Irritable bowel syndrome (IBS)
Post #193 Shortlink: http://wp.me/pKrrB-2mC
The information in this report relates to proposals for the World Health Organization’s forthcoming ICD-11, currently scheduled for pilot dissemination in 2015+; it does not apply to the existing ICD-10 or to the forthcoming US specific “clinical modification” of ICD-10, known as ICD-10-CM.
Caveat: The ICD-11 Beta drafting process is a work in progress over the next two to three years. The Beta draft is updated on a daily basis. Parent terms, category terms and sorting codes assigned to categories are subject to change as chapter reorganization progresses. Images and text in this posting may not reflect the most recently assigned categories and codes. This post reflects the Beta draft as it stood at July 25, 2012. Please also read the ICD-11 Beta Draft Caveats.
Post #190 Changes to ICD-11 Beta drafting platform: Bodily Distress Disorders (1) reported on proposals for including three Bodily distress disorder categories in the Somatoform Disorders section of the ICD-11 Beta drafting platform which appear potentially to replace or subsume a number of existing ICD-10 Somatoform Disorder categories.
That post has been revised to reflect clarifications from Professor, Sir David Goldberg, M.D., around the Primary care version of ICD-11 and to include additional material.
The report in this post updates on current proposals for the ICD-11 Beta drafting platform for revision of the following ICD-10 categories: Neurasthenia, Postviral fatigue syndrome (PVFS), Benign myalgic encephalomyelitis (ME), Chronic fatigue syndrome (CFS), Fibromyalgia (FM) and Irritable bowel syndrome (IBS) for the full version of ICD-11.
ICD Revision Steering Group and the various Topic Advisory Groups are developing the ICD-11 Beta draft on a non public access collaborative authoring platform where change histories can be tracked, which looks similar to this:
The publicly viewable version of the Beta drafting platform looks like this:
and displays less information. It can be accessed here:
Beta draft Foundation Component (FC) view:
Beta draft Linearization Morbity (LM) view:
Increased access to content and interaction with the drafting process can be obtained by registering.
Neurasthenia is not classified in DSM-IV and is not proposed to be classified in DSM-5.
In ICD-10, Neurasthenia is classified in Chapter V Mental and behavioural disorders under parents:
F40-F48 Neurotic, stress-related and somatoform disorders
F48 Other neurotic disorders
› F48.0 Neurasthenia
For ICD-11 Beta, up until July 3, Neurasthenia was also classified under:
Neurotic, stress-related and somatoform disorders
9S1 Other neurotic disorders
› 9S1.1 Neurasthenia
Inclusions: Fatigue syndrome
postviral fatigue syndrome
malaise and fatigue
9S1.2 Other specified neurotic disorders
Inclusions: Dhat syndrome
Occupational neurosis, including writer’s cramp
9S1.3 Neurotic disorder, unspecified
On July 4, all child categories classified under parent class, 9S1 Other neurotic disorders, including Neurasthenia and its Inclusion, Fatigue syndrome, were removed from both the FC and LM view and from the PDF for the Chapter 5 Print version and there is currently no listing for any of these categories and child categories under any parent.
As no “Change history” records display in the public version of the Beta draft, it cannot be determined from what information is available whether these categories are temporarily omitted while this section of Chapter 5 is being reorganized, or whether all or selected of these ICD-10 categories are proposed to be retired for ICD-11 or are destined to be subsumed under the proposed Bodily distress disorders categories that ICD Revision has yet to define.
According to the Goldberg February 2011 report, terms included in the ICD11-PHC version of ICD-11 must have an equivalent disorder in the main classification. In February 2011, it was proposed not to include Neurasthenia in the ICD11-PHC version but to subsume under 13 Distress disorder. (It isn’t clear under which disorder group or subcategory Neurasthenia is proposed to be subsumed for the most recently published iteration for ICD11-PHC.)
Neurasthenia remains listed as an Exclusion to Chapter 5 Generalized anxiety disorder and Chapter 18 Malaise and fatigue but these Exclusions may be awaiting attention, if the intention is to retire a number of ICD-10 terms.
I will update when it becomes apparent what the intention is for these currently missing categories.
ICD-11 Chapter 06: Diseases of the nervous system
Postviral fatigue syndrome, Benign myalgic encephalomyelitis, Chronic fatigue syndrome:
In ICD-10, Postviral fatigue syndrome is classified as a Title term within Volume 1: The Tabular List in Chapter VI: Diseases of the nervous system under G00-G99 Other disorders of the nervous system > G93 Other disorders of brain, and coded at G93.3. See: http://apps.who.int/classifications/icd10/browse/2010/en#/G93.3
Benign myalgic encephalomyelitis is also coded in the Tabular List to G93.3 Postviral fatigue syndrome.
Chronic fatigue syndrome is not classified within the Tabular List but is indexed to G93.3 in Volume 3: The Alphabetical Index.
An unauthorised copy of Volume 3: The Alphabetical Index Version for 2006 can be accessed here: (See Page 528)
In indexing Chronic fatigue syndrome to G93.3, ICD-10 does not specify whether it views the term as a synonym, subclass or “best coding guess” to Title term, Postviral fatigue syndrome or to Benign myalgic encephalomyelitis.
Nor does ICD-10 specify the relationship between Postviral fatigue syndrome and Benign myalgic encephalomyelitis.
(For ICD-11, a mechanism will be provided to identify whether an inclusion term is a synonym or a subclass.)
In June 2010, I reported that in May 2010, a change of hierarchy had been recorded in the ICD-11 iCAT Alpha drafting platform “Change History” and “Category Discussion Notes” for class: G93.3 Postviral fatigue syndrome.
See these two screenshots from the original iCAT Alpha drafting platform:
From current information in the Beta draft, it would appear that for ICD-11, the proposal is for a change of hierarchy between Postviral fatigue syndrome and Chronic fatigue syndrome with Chronic fatigue syndrome elevated to an ICD-11 Title term, with a Definition (not currently populated) and with potentially up to 12 other descriptive parameters, populated in accordance with the ICD-11 “Content Model.”
There are a number of terms listed under Synonyms to Title term Chronic fatigue syndrome including Benign myalgic encephalomyelitis and Postviral fatigue syndrome.
Mouse hover over the asterisk at the end of Benign myalgic encephalomyelitis and the following hover text displays, “This term is an inclusion term in the linearizations.”
Also listed under “Synonyms” are “chronic fatigue syndrome nos” and “chronic fatigue, unspecified” (both imported from current proposals for locating Chronic fatigue syndrome in Chapter 18: Symptoms and Signs in the forthcoming US specific, ICD-10-CM).
See this Beta drafting platform page:
There is currently no discrete ICD Title term listed for Postviral fatigue syndrome in either the Foundation Component or Linearization Morbidity view and no discrete ICD Title term for Benign myalgic encephalomyelitis.
It remains unconfirmed, but from the Beta draft as it currently stands, it suggests that for ICD-11:
- Chronic fatigue syndrome is proposed to become the Chapter 06 Title term
- Benign myalgic encephalomyelitis is specified as an Inclusion term to CFS under “Synonyms”
- Postviral fatigue syndrome and a number of other terms are listed under “Synonyms” to CFS
For definitions of Synonyms, Inclusions, Exclusions and other ICD-11 terminology see the iCAT Glossary:
In ICD-10, Fibromyalgia is classified under:
Chapter XIII: Diseases of the musculoskeletal system and connective tissue > M79 Other soft tissue disorders > M79 Other soft tissue disorders, not elsewhere classified > M79.7 Fibromyalgia
ICD-10 Version: 2010: http://apps.who.int/classifications/icd10/browse/2010/en#/M79.7
For ICD-11 Beta draft, Fibromyalgia is currently classified under:
Chapter 13: Diseases of the musculoskeletal system and connective tissue > Soft tissue disorders > Other soft tissue disorders > QG6 Other soft tissue disorders, not elsewhere classified > QG6.7 Fibromyalgia
Irritable bowel syndrome (IBS):
In ICD-10, Irritable bowel syndrome is classified under:
Chapter XI: Diseases of the digestive system > K55-K63 Other diseases of intestines > K58.0 Irritable bowel syndrome with diarrhoea > K58.9 Irritable bowel syndrome without diarrhoea > Irritable bowel syndrome NOS
ICD-10 Version: 2010: http://apps.who.int/classifications/icd10/browse/2010/en#/K58
For ICD-11 Beta draft, Irritable bowel syndrome is currently classified under:
Chapter 11: Diseases of the digestive system > Functional gastrointestinal disorders > FS6 Irritable bowel syndrome and other functional bowel disorders > FS6.1 Irritable bowel syndrome
I shall continue to monitor the Beta drafting process and update on any significant developments for both ICD-11 Chapter 5 and Chapter 6 and for ICD11-PHC for the categories that are the focus of this post and post #190.
References and related material:
1] ICD-10 Version: 2010 Volume 1 Tabular List online:
2] ICD-11 Beta drafting platform:
3] Goldberg, D. Guest editorial. A revised mental health classification for use in general medical settings: the ICD11–PHC 1. International Psychiatry, Page 1, February 2011.
4] 21st Century Global Mental Health by Dr Eliot Sorel, Professor, George Washington University, Washington D.C.
Publication date: August, 2012: http://www.jblearning.com/catalog/9781449627874/
Page 51, Sample Chapter 2: http://samples.jbpub.com/9781449627874/Chapter2.pdf