Global creep of DSM-5′s Somatic symptom disorder

Post #303 Shortlink:

Update at April 14, 2014:

Written response (April 10, 2014) from Independent Hospital Pricing Authority (IHPA) to request for clarification regarding the term ‘Somatic symptom disorder’ and Australia’s clinical modification of ICD-10, ICD-10-AM:

PDF: IHPA response re SSD and ICD-10-AM


As previously posted:

In the previous posting Update on proposal to add DSM-5′s Somatic symptom disorder to ICD-10-CM I reported that NCHS is preparing to rubber stamp proposals to insert Somatic symptom disorder into the U.S.’s forthcoming clinical modification of ICD-10.

Comments/objections to Diagnosis Agenda proposals submitted at the March meeting need to be sent by email to NCHS at by June 20th.

1] According to this Australian legislative document:

Australian Government, Statement of Principles concerning somatic symptom disorder No. 24 of 2014

for the purposes of the Veterans’ Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004

“Somatic symptom disorder attracts ICD-10-AM code F45.1.”

For the purposes of the Statement of Principles:

“ICD-10-AM code” means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;”

The Australian ICD-10-CM, Eighth Edition, July 2013 is not in the public domain. As I do not have access to a copy, I have contacted the relevant body for clarifications.

I have asked whether Somatic symptom disorder has been added to the Eighth Edition of ICD-10-AM as an Inclusion term to F45.1 Undifferentiated somatoform disorder in the Tabular List and Alphabetical Index.

Or, whether this legislative document relies on the ICD cross-walk codes as published in the DSM-5 in May 2013 for the cross-walk between DSM-5 disorders and the disorders in the U.S.’s ICD-9-CM and forthcoming ICD-10-CM.

Or, whether the legislative document relies on a cross-walk between DSM-5 disorders and ICD-10-AM codes developed specifically in relation to the ICD-10-AM Eighth Edition, July 2013.

I will update this post when I have received clarification.

According to this page:

“[Australia's] ICD-10-AM has also enjoyed more widespread use, having been assessed, found suitable and adopted by many other countries, including: New Zealand, Ireland, Singapore, Slovenia.”

I am unable to confirm how many countries that have adopted ICD-10-AM have migrated from earlier editions to the July 2013 edition or are preparing to migrate to the most recent edition.

Other clinical modifications (CMs) of ICD-10:

Canada (ICD-10-CA): The most recent edition of ICD-10-CA is the 2009 edition Volume One: Tabular List 2009. Canada is anticipated to adopt a CM of ICD-11 before the U.S. does, but in meantime, an updated edition of ICD-10-CA might be anticipated, especially given the recent extension to the ICD-11 development timeline. Canadians will need to be alert to the potential for addition of SSD as an inclusion term to the next edition of ICD-10-CA.

Germany (ICD-10-GM): There is an ICD-10-GM version for 2014. There is no SSD under F45.x or under any other code, but watch for any updated versions released prior to transition to a CM of ICD-11.

Thailand (ICD-10-TM): There does not appear to be a more recent version of the Thai clinical modification than the online version for 2007, but watch for SSD in any updated versions prior to potential transition to a CM of ICD-11. ICD-10-TM Online version for 2007.

ICD-11 Beta drafting platform:

There is no documentary evidence of a proposal to add SSD, per se, to ICD-11. However, the wording for the Definition for Bodily distress disorder, as it currently stands in the Beta drafting platform, is drawn from the Gureje, Creed 2012 paper on the S3DWG sub working group’s emerging proposals for ICD-11 [1].

The paper described a simplified disorder framework – a construct into which DSM-5′s Somatic Symptom Disorder could be comfortably integrated, thus facilitating harmonization between the respective ICD-11 and DSM-5 disorder construct and criteria replacements for the Somatoform disorders classifications.

As with DSM-5′s SSD, for the emerging proposals for BDD, the focus was not on symptoms counts, or on strict symptom patterns or clusters from one or more body systems, or on whether symptoms were determined as being “medically explained” or “medically unexplained,” but on the perception of disproportionate or maladaptive psychobehavioural responses to, or excessive preoccupation with any troublesome chronic bodily symptom(s). And that in doing away with the “unreliable assumption of its causality” the diagnosis of BDD would not exclude the presence of a co-occurring physical health condition – which is very close to SSD’s defining characteristics.

1. Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry. 2012 Dec;24(6):556-67. [Abstract. Full text behind paywall]

2] On the site, a peer reviewed article on Somatic symptom disorder:

This article is not a recommendation and it draws heavily on the DSM-IV and current ICD-10 Somatoform disorders framework, criteria and literature. Though it does highlight that DSM-5 has a new, simplified framework and reformulated criteria that rely less on strict patterns of somatic symptoms and more on the degree to which a patient’s thoughts, feelings and behaviours about their symptoms are considered disproportionate or excessive; that for DSM-5, “medically unexplained” is de-emphasized – symptoms may or may not be associated with another medical condition and patients with organic comorbidities such as heart disease, osteoarthritis or cancer, who would have previously been excluded under DSM-IV, can now be included in the diagnosis of SSD.

There is little published research examining the reliability, utility, epidemiology, clinical characteristics or treatment of Somatic symptom disorder as a diagnostic construct and none of the article’s references are for papers specifically using the new Somatic symptom disorder criteria.

3] Somatic symptom disorder in a BMJ Rapid Response:

Rapid Response to: Clinical Review, Fibromyalgia by Anisur Rahman, Martin Underwood, Dawn Carnes [Full text for Clinical Review behind paywall]

Rapid Response: Fibromyalgia: an unhelpful diagnosis for both patients and doctors [Full text for Rapid Response accessible]

Christopher Bass, consultant in liaison psychiatry, John Radcliffe Hospital , Oxford OX3 9DU

Dr Max Henderson, senior lecturer in Epidemiology and Occupational psychiatry, Inststitute of psychiatry, Kings College London 

According to the authors, fibromyalgia ( coded in ICD-10 under Chapter XXIII Diseases of the musculoskeletal system and connective tissue, at M79.7 ) is more appropriately described in terms of “polysymptomatic distress”; “polysymptomatic distress has been recognised as a somatoform disorder, specifically as a somatic symptom disorder or SSD,” and that since “FM overlaps with other disorders with medically unexplained symptoms such as irritable bowel syndrome and chronic fatigue syndrome” it is more appropriate to treat them with multidisciplinary teams within the same specialised service in the general hospital.

4] This commentary by infectious disease specialist, Judy Stone, MD, at Scientific American blogs, mentions concerns around SSD:

Have Pain? Are You Crazy? Rare Diseases Pt. 2

By Judy Stone | February 18, 2014

“It’s all in your head,” patients with unexplained pain or unexpected symptoms often hear…

5] Halifax Somatic Symptoms Disorder Trial Identifier: NCT02076867

Sponsor: Capital District Health Authority, Canada

The purpose of this study is to compare the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) plus Medical Care As Usual (MCAU) compared to MCAU for Somatic Symptom and Related Disorders (SSRD). Consenting patients presenting to the emergency department with suspected SSRD will be randomly allocated to receive either 8 weekly individual sessions of ISTDP or to an 8-week wait list followed by ISTDP. MCAU including emergency department and/or family doctor consultation is available throughout trial participation. The primary outcome measure is participant self-reported somatic symptoms at week 8.


Update on proposal to add DSM-5′s Somatic symptom disorder to ICD-10-CM

Post #302 Shortlink:

Update at April 5, 2014: Implementation of the U.S.’s forthcoming adaptation of ICD-10, ICD-10-CM, has been kicked further down the road to October 1, 2015. Bill H.R. 4302, known as the PAM Act (Protecting Access to Medicare Act) was signed by President Obama on April 1, 2014. This means that the U.S. won’t now transition from ICD-9-CM to ICD-10-CM for another year. CMS has yet to issue a statement or update its webpages.

Update at April 5, 2014: The Summary of the March 19–20, 2014 meeting of the ICD-10-CM/PCS Coordination and Maintenance Committee meeting has now been posted

Lots of “outrage” over SSD and DSM-5 but I see little evidence of sustained “outrage” over proposals to add SSD as an Inclusion term to the U.S.’s ICD-10-CM.

If NCHS rubber stamps the addition of Somatic Symptom Disorder to ICD-10-CM it could leverage the future replacement of the existing Somatoform disorders categories with this new, poorly validated single SSD diagnostic construct, bringing ICD-10-CM in line with DSM-5.

There are implications for ICD-11, too.

Once SSD is inserted into ICD-10-CM, the presence of this term within the U.S. adaptation of ICD-10 may make it easier for ICD-11 Revision Steering Group to justify proposals to replace the existing ICD-10 Somatoform disorders categories with a single, new ICD construct contrived to incorporate SSD-like characteristics and facilitate harmonization between ICD-11 and DSM-5 disorder terms and diagnostic criteria.

This post updates on proposals at the March meeting of the ICD-10-CM/PCS Coordination and Maintenance Committee to add DSM-5′s controversial new Somatic symptom disorder to ICD-10-CM.

But first, a necessary recap of the September meeting:

ICD-10-CM/PCS Coordination and Maintenance Committee meetings provide a public forum to discuss proposed changes to the U.S.’s forthcoming ICD-10-CM and ICD-10-PCS, scheduled for implementation on October 1, 2014.

The meetings, which are co-chaired by representatives for CMS and NCHS, take place, in public, in March and September, followed by public comment periods.

The fall meeting of the ICD-10-CM/PCS Coordination and Maintenance Committee was held on September 18–19, 2013.

On Day Two of the September meeting, American Psychiatric Association’s Darrel Regier, MD, had proposed six new DSM-5 disorders for inclusion in ICD-10-CM.

On Page 45 and 46 of the Diagnosis Agenda, under Additional Tabular List Inclusion Terms for ICD-10-CM, a number of other changes to specific Chapter 5 F codes had also been proposed. These were introduced en masse, by CDC’s Donna Picket. (Reached on Day Two, at 1:22:21 in from the start of Videocast Four.)

This section of the Diagnosis Agenda included the proposals to add the new DSM-5 disorders: Somatic symptom disorder (proposed to Add as Inclusion term to F45.1 Undifferentiated somatoform disorder) and Illness anxiety disorder (proposed to Add as Inclusion term to F45.21 Hypochondriasis) to ICD-10-CM’s Chapter 5 codes.

(F45.1 and F45.21 are the ICD-10-CM codes to which these two new APA disorders are already cross-walked in the DSM-5.)


Source: Page 45, Diagnosis Agenda (Topic Packet), September 18–19, 2013 ICD-10-CM/PCS Coordination and Maintenance Committee Meeting

Videocasts of the entire September 2013 meeting proceedings, Diagnosis Agenda (Topic Packet), Procedural Agenda, Meeting materials etc can be found in Dx Revision Watch Post #277.

Note: there was no proposal at the September 2013 meeting to create a unique code for either Somatic symptom disorder (SSD) or Illness anxiety disorder, for either 2014 or October 1, 2015 implementation, and no proposal that Somatic symptom disorder should replace or subsume any of the existing ICD-10-CM F45.x Somatoform disorders. Note also, these proposals are specific to the forthcoming U.S. clinical modification of ICD-10.

In relation to the section of the Agenda on Pages 45 and 46, CDC’s, Donna Picket, had stated:

1:22:21 in: Diagnosis Agenda: “Additional Tabular List Inclusion Terms for ICD-10-CM”
Donna Pickett (CDC): “…And just to complete the package, there are other Tabular List proposals that appear on Page 45 and 46 that we would also invite your comments on. And again, with some of the terminology changes that Dr Regier has described the intent here is to make sure that if those terms are being used, that they do have a home somewhere within ICD-10-CM to facilitate people looking these up. So we invite comments. We’re showing the Tabular List proposed changes; however, there obviously would be associated Alphabetic Index changes with that which we didn’t show just to keep the package a little bit smaller…”
Source: [Unofficial transcription from Video Four, September 2013 ICD-9-CM C & M Committee meeting.]

There were no questions or comments from the floor or by phone link on any of the proposals listed on Pages 45 and 46 under “Additional Tabular List Inclusion Terms for ICD-10-CM” and no discussion or queries on any of the individual proposals listed under under this section of the Agenda between the meeting co-chairs and APA’s, Dr Regier.

NCHS’s decision on proposals to add Somatic symptom disorder (SSD) and Illness anxiety disorder as Inclusion terms to ICD-10-CM Tabular List Chapter 5, and to also add to the Index, isn’t known and may not be evident until the next ICD-10-CM Addenda is released, later this year, or the Final Addenda released.

Some of the objections submitted to the proposal to add Somatic symptom disorder (SSD) as an Inclusion term in ICD-10-CM are collated on Dx Revision Watch here.


March meeting of the ICD-10-CM/PCS Coordination and Maintenance Committee

This meeting took place on March 19–20, 2014. I was unable to attend as I live in the UK.

The ICD-9-CM and ICD-10-CM Timeline and Diagnosis and Procedure Codes Agenda (Topic Packet) can be found here, on the CDC website:

Proposals (Topic Packet) March 19-20, 2014

Procedure Agenda, Meeting Materials and Handouts can be downloaded from Zip files here, on the CMS website:

Meeting Materials March 19-20, 2014

A Summary Report of the Diagnosis part of the meeting is scheduled to be posted on the NCHS website, in June.

A Summary Report of the Procedure part of the meeting is scheduled to be posted on the CMS website, in June.

April 17, 2014: Deadline for receipt of public comments on proposed procedure code revisions discussed at the March 19, 2014 ICD-10 Coordination and Maintenance Committee meeting for implementation on October 1, 2014.

June 20, 2014: Deadline for receipt of public comments on proposed code revisions discussed at the March 19–20 meeting for implementation on October 1, 2015.

ICD-10-CM is currently subject to a partial code freeze. During the freeze, the public will be asked to comment on whether or not a proposal should be approved, and if not, why; and whether requests for new diagnosis or procedure codes should be created based on the criteria of the need to capture a new technology or disease. Any code requests that do not meet the criteria will be evaluated for implementation within ICD-10-CM on and after October 1, 2015 once the partial freeze has ended.

Comments on the diagnosis proposals presented at the ICD Coordination and Maintenance Committee meeting should be sent, preferably by email, to the following address by June 20th deadline:


The Two Day proceedings were streamed live and can be watched on YouTube:

Video One: Day One: Morning Session: Procedural Codes: 2014 Mar 19th, FY 2014 ICD-10 Coordination and Maintenance Committee

Video Two: Day One: Afternoon Session: Procedural Codes: 2014 Mar 19th, FY 2014 ICD-10 Coordination and Maintenance Committee

Video Three: Day Two: Diagnosis Codes: 2014 Mar 20th, FY 2014 ICD-10 Coordination and Maintenance Committee

Page 64, Topic Packet:


Chapter 5 Addenda

The American Psychiatric Association (APA) proposes the following addenda changes to the ICD-10-CM Tabular and Index, specifically to Chapter 5, Mental, Behavioral and Neurodevelopmental disorders (F01-F99).

The APA indicates that these revisions are necessary because DSM-5 contains several new diagnoses, as well as new disorder titles, that do not map well to any existing ICD-10-CM codes.

Because of this, they are proposing numerous new index entries and tabular inclusion terms to ensure that coders can correctly identify the codes to use. The APA proposes that these changes will also ensure that new DSM-5 disorder titles correspond to a valid ICD-10-CM code.

Many of the changes in the proposed addenda relate to the reconceptualization of the substance use disorders from having separate disorder names and codes for substance abuse and dependence. However, extensive scientific evidence was assembled to show that, rather than existing as two separate disorders, these conditions exist on a spectrum that the APA has now conceptualized as ranging from mild to moderate to severe. In order to make the closest approximations with existing ICD-10-CM codes, it is noted that codes for mild substance use disorders correspond to the abuse codes and codes for moderate and severe substance use disorders correspond to dependence codes. The APA may recommend changes in the structure and names of ICD-10-CM substance related disorders, in the future, however at the present time they are only recommending the addition of the new terminology as inclusion terms.

The following addenda are proposed for implementation on October 1, 2015


1:12:12 in from start of YouTube Three: Chapter 5 Addenda Proposed Tabular Modifications.

1:12:12 Beth Fisher (CMS): Introduces proposals for [Tabular] modifications from APA for Chapter 5. These are all Addenda type changes because [ICD-10-CM is] in code freeze mode, we didn’t have the opportunity to do new codes just yet. Hands podium to Darrel Regier, MD.

1:13:01 Darrel Regier (APA): Mapping DSM-5 to ICD-10-CM codes; Major change to rename Dementias group to Major Neurocognitive Disorders, because including in this group some neurocognitive deficit conditions such as Traumatic brain injury and other neurocognitive disorders that are not inherently some of the neurodegenerative diseases, such as Alzheimer’s, Picks Disease. (Page 64 Diagnosis Agenda)

1:14:02 Darrel Regier (APA): We’ve also introduced [in DSM-5] a Mild neurocognitive disorder that reflects the Mild cognitive impairment, MCI, that is currently in ICD-9, ICD-10…

1:15:06 Darrel Regier (APA): A lot of significant changes to substance abuse disorder area which will require some notes and guidelines…

1:15:27 Darrel Regier (APA): [APA has] a number of new disorders…15 new disorders that are in the DSM-5, but there were 50 disorders that were actually subsumed into a spectrum of conditions that dropped the total number of disorders by something like 28; so you had 50 disorders that collapsed into 22 disorders. Among those, some of the most prominent – Aspergers, Autism, Pervasive developmental disorder NOS, into a single Autism spectrum disorder…assessed on two domains…assessed in terms of level of severity instead of categorical distinctions…

1:17:04 Darrel Regier (APA): Eliminating distinction between abuse and dependence so that on a continuum of Mild, Moderate, Severe…no strict separation between abuse category and dependence…

1:21:00: Question from floor re Alcohol abuse, Alcohol dependence.

1:31:15 Beth Fisher (CDC): Some of these Inclusion terms may have been proposed at September 2013 meeting. (But does not explain the reason for their being resubmitted at the March meeting.)

1:31:34 Beth Fisher (CDC): Begins running through all Addenda Additions.

1:31:42 Beth Fisher (CDC): At F44 Dissociative and conversion disorders, Add Conversion disorder, in parenthesis, functional neurological symptom disorder as Inclusion term.

March 2014 C and M meeting Conversion disorder (FNSD)

Source: ICD-10-CM C & M Committee meeting, March 20, 2014, Screenshot Video Three

Note, there was no proposal under these Proposed Tabular Modifications to Add Somatic symptom disorder as Inclusion term to F45.1 Undifferentiated somatoform disorder to the Tabular List. But the proposal to Add Somatic symptom disorder as an Inclusion term to F45.1 Undifferentiated somatoform disorder to the Tabular List and to the Alphabetical Index had been proposed at the September 2013 meeting.

Also, no proposal to Add Illness anxiety disorder to the Tabular List, but again, this had been proposed at the September 2013 meeting (under F45.21), for both the Tabular List and the Index. (Decisions on all four of these September 2013 meeting proposals are unknown.)

1:34:06 Beth Fisher (CMS): Concludes proposed Addenda Additions to Chapter 5 Tabular List.

1:34:12 Beth Fisher (CMS) Moves onto Proposed Index Modifications from Page 82, Topic Packet.

1:42:36 Beth Fisher (CMS) Page 89: [Under main Index term "Disorder"] And then Somatic symptom disorder to F45.1.

Page 89, Diagnosis Agenda Add Somatic symptom disorder

March14 ICD-10-CM Cand M SSD to Index

Source: ICD-10-CM C & M Committee meeting, March 20, 2014, Screenshot Video Three

(No comments from floor regarding proposal to Add SSD to Index, or queries in respect of outcome of September meeting proposals. It was not feasible for me to participate in this meeting via phone link from UK to query.)

Note, there was no proposal under Proposed Index Modifications to add Illness anxiety disorder to the Index, but this proposal had been included in the September 2013 Topic Packet. Why SSD has been resubmitted for consideration for addition ro the Index at the March 2014 meeting is unclear, and as I say, the outcome of proposals for the September meeting for both SSD and IAD to be added to both Tabular List and to Index is unknown.

1:44:25 Beth Fisher (CMS): Concludes proposed Addenda Additions to Chapter 5 Alphabetical Index. Invites comments.

1:44:26: Questions from floor regarding Alcohol; Cannabis; Cocaine use; Implications for legal differences between states for use of cannabis. Question regarding Neurodegeneration due to alcohol.

1:50.02 Beth Fisher (CMS): Other Addenda (Ed: presumably Tab and Index Addenda on pp 91–93 and 93–97) were reached on Day One, as there was time, so not being presenting on Day Two. Invites further comments.

1:50.27 Donna Picket (CDC): Adjourns meeting. Reminds floor (and participants via phone link/videocasts and non attendees), to submit comments on Diagnosis proposals by June 20 deadline.

1:51:07 Question from floor: Process question: if these proposals are all approved, when will they be approved and when will they be effective, because we want to notify our members of what codes to use?

1:51:32: Donna Pickett (CDC): All of these being presented were for consideration for implementation in October 1, 2015. Within 2015, we have a huge body of work that has been accumulating during partial code freeze and we’ve encouraged comments to come in about the timing for making the Final Addenda available. The typical time frame we have used in the past is posting [Addenda] in June and proposals to become effective October 1, of that same year. However, issues have arisen because there is a huge body of work and it was mentioned, yesterday, [during Meeting Day One] that the industry may want to have an Addenda released earlier and we invited comment on that, because of the amount of work that would need to go into incorporating the changes into the relevant systems and programs etc. If we were to stay with the traditional process, the Addenda would be made available in June. Meeting concluded.

Comments on the diagnosis proposals presented at the ICD-10-CM Coordination and Maintenance Committee meeting should be sent, preferably by email, to the following address by June 20th deadline:

Clarification: Coalition for Diagnostic Rights

A website called Coalition for Diagnostic Rights has recently been launched.
The site includes references to Suzy Chapman and to Dx Revision Watch.
Suzy Chapman/Dx Revision Watch is not associated with or affiliated to the Coalition for Diagnostic Rights website or with any organization associated with that site, and has no responsibility for content published on that site, or published in the name of that site on other platforms.
Suzy Chapman
Dx Revision Watch

Final post on Dx Revision Watch

Post #294 Shortlink:

This will be the final post on Dx Revision Watch.

As from today, I am stepping back from advocacy work and from monitoring and reporting via this site.

Dx Revision Watch will remain online for the foreseeable future as a resource. Other than updating some existing posts, no new postings or reports will be added.

Before using this site or republishing content please read the Disclaimer Notes

Suzy Chapman
Dx Revision Watch

“He that reads and grows no wiser seldom suspects his own deficiency, but complains of hard words and obscure sentences, and asks why books are written which cannot be understood.”  Samuel Johnson


Reminder: Next meeting of ICD-10-CM/PCS Coordination and Maintenance Committee: March 19-20, 2014

Post #290 Shortlink:

Update at February 15, 2014:

Tentative diagnosis agenda posted for March 19–20, 2014 meeting on CDC site:

This list of tentative diagnosis agenda topics is not final. The final topics material will be available electronically from the NCHS web site prior to the meeting.

If you are unable to attend the meeting in person there will be conference lines available on the day of the meeting. Individuals do not need to register on line for the meeting if planning to dial in.

NCHS/CMS will be broadcasting the meeting live via Webcast at:

The next meeting of the ICD-10-CM/PCS Coordination and Maintenance Committee is scheduled for March 19–20, 2014. If you are planning to attend the meeting in person you will need to register, online, by March 14.

ICD-10-CM/PCS Coordination and Maintenance Committee Meeting

Public forum to discuss proposed changes to ICD-10-CM and ICD-10-PCS

Wednesday, March 19, 2014 – Thursday, March 2o, 2014

CMS Auditorium, Baltimore, MD

Agendas for the meeting will be posted in February 2014.

If phone lines and live webinar are made available the information will be posted closer to the meeting date.

Day One | Time: 03/19/2014 9:00 AM – 5:00 PM CMS Auditorium

Session: ICD-10-CM/PCS Coordination and Maintenance Committee Meeting
The first day of the meeting, March 19, 2014, will be devoted to procedure code issues.

Day Two | Time: 03/20/2014 9:00 AM – 5:00 PM CMS Auditorium

Session: ICD-10-CM/PCS Coordination and Maintenance Committee Meeting
The second day of the meeting, March 20, 2014 will be devoted to diagnosis code topics.

The National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS) are the U.S. governmental agencies responsible for overseeing all changes and modifications to the ICD-9-CM and draft ICD-10-CM/PCS.

NCHS is also responsible for the development of ICD-10-CM, adapted from the WHO’s ICD-10 for U.S. specific use.

The 2014 release of the draft ICD-10-CM (which replaces the July 2013 release) can be viewed or downloaded here.

ICD-10-CM is scheduled for implementation on October 1, 2014. Until that time the codes in ICD-10-CM are not valid for any purpose or use.

New concepts are added to ICD-10-CM based on the established update process for ICD-9-CM (the ICD-9-CM Coordination and Maintenance Committee) and the World Health Organization’s ICD-10 (the Update and Revision Committee).

Meetings of the Coordination and Maintenance Committee are co-chaired by a representative from NCHS and from CMS. Responsibility for  maintenance of the ICD-9-CM is divided between these two agencies, with classification of diagnoses by NCHS and procedures by CMS.

The name of the Committee will change to the ICD-10-CM/PCS Coordination and Maintenance Committee with the March meeting, as the last updates to ICD-9-CM/PCS took place on October 1, 2013.

Meetings are held twice yearly, in public, at CMS headquarters in Baltimore, MD. The next meeting is scheduled for March 19–20, 2014. The fall meeting is scheduled for September 23–24, 2014.


Coordination and Maintenance Committee

The Committee provides a public forum to discuss proposed modifications, code changes, updates and corrections to the diagnosis codes in ICD-10-CM and procedural codes in ICD-10-PCS.

Public participation can also take place via phone conference link and live webinar. (Details for both in the Agenda documents.)

Agendas are posted approximately one month prior to the meetings. Diagnostic and procedural proposal Topic Packets, meeting materials, hand outs and presentation slides are posted on the CDC and CMS websites shortly before a meeting.

Up until 2011, transcripts of meeting proceedings were provided. Provision of transcripts is now replaced with videocasts for the full, two-day proceedings, available from the CMS website and posted on YouTube, and a brief Meeting Summary report, available from the CDC site shortly after the meeting.

For attendance in person, prior registration is required, via the CMS meeting registration website. Registration opens approximately one month  prior to a meeting and closes a few days before Day One of a meeting.


Proposals for modifications, additions, corrections

Suggestions for modifications to ICD-10-CM/PCS come from both the public and private sectors. Since the draft ICD-10-CM is adapted from the WHO’s ICD-10, which is subject to an annual update process, some proposed modifications to ICD-10-CM may reflect updates to the ICD-10.

Interested parties (requestors) must submit proposals for modifications prior to a scheduled meeting and by a specific date. Proposals should be consistent with the structure and conventions of the classification. See Submission of Proposals for submission requirements and proposal samples.

Once proposals have been reviewed, requestors are contacted as to whether their proposal has been approved for presentation at the next Coordination and  Maintenance Committee meeting or not.

Approved proposals are presented at the meetings by representatives for professional bodies, advocacy organizations, clinicians, other professional stakeholders or members of the public with an interest, or are sometimes presented by an NCHS/CMS representative on behalf of a requestor.

No decisions on proposed modifications are made at the meetings. Recommendations and comments are reviewed and evaluated, once the comment period has closed, before final decisions are made.

The Coordination and Maintenance Committee’s role is advisory. All final decisions are made by the Director of NCHS and Administrator of CMS.

Final decisions are made at the end of the year and become effective October 1 of the following year.


Submitting written comment on proposals presented at meetings

Comments on proposals are invited, at the meeting, at the end of each presentation, or may be submitted in writing following the meeting, during a one to two month duration public comment period.

Addresses for submitting comments are included in the Agenda Topic Packets published before the meetings. NCHS/CMS state that electronic submissions are greatly preferred over snail mail in order to ensure timely receipt of responses.


Partial code freeze and timing of proposals

According to the Summary of Diagnosis Presentations for the September 18–19, 2013 meeting (for which the comment period closed on November 15):

“Except where noted, all topics are being considered for implementation on October 1, 2015. The addenda items are being considered for implementation prior to October 1, 2014.”

(“ICD-10-CM TABULAR OF DISEASES – PROPOSED ADDENDA” Tabular and Index modification proposals are set out on Diagnosis Agenda Pages 60-66.)

Note that some proposals in the Diagnosis Agenda were requested for insertion in October 2014 as Inclusion Terms to existing codes, with new codes proposed to be created for October 2015, notably, the 6 proposals to insert new DSM-5 disorders into ICD-10-CM presented by Darrel Regier, MD, on behalf of the American Psychiatric Association (Diagnosis Agenda Pages 32-44).

Whether the 17 modifications proposed on Pages 45-46 under “Additional Tabular List Inclusion Terms for ICD-10-CM” which were presented en masse by CDC’s, Donna Pickett, (which include the proposals to add the new DSM-5 “Somatic symptom disorder” and “Illness anxiety disorder” as Inclusion Terms to existing ICD-10-CM F45.x codes) are intended for implementation in October 2014 or in October 2015 is not explicit in the Diagnosis Agenda.

For the September 18–19, 2013 meeting, when submitting written comments, responders were asked to consider the following:

Whether they agree with a proposal, disagree (and why), or have an alternative proposal to suggest. But were also invited to comment on the timing of those proposals that were being requested for approval for October 2014:

Does a request for a new diagnosis or procedure code meet the criteria for implementation in October 2014 during a partial code freeze* based on the criteria of the need to capture a new technology or disease; or should consideration for approval be deferred to October 2015? And separately, to comment on the creation of a specific new code for the condition effective from October 1, 2015 (where requested).

Any code requests that do not meet the criteria [for inclusion during a partial freeze] will be evaluated for implementation within ICD-10-CM on and after October 1, 2015 once the partial freeze has ended and regular (at least annual) updates to ICD-10-CM/PCS resume.

*Partial Code Freeze of Revisions to ICD-9-CM and ICD-10-CM/PCS

  • October  1, 2011 is the last major update of ICD-9-CM. Any further revisions to ICD-9-CM will only be  for a new disease and/or a  procedure  representing new technology.  Revisions will  be posted on this website as addenda (revisions to procedures are posted on  the CMS website).
  • After  October 1, 2011 there will be no further release of ICD-9-CM on CD-ROM.
  • October  1, 2011 is the last major update of ICD-10-CM/PCS until October 1, 2015.
  • Between  October 1, 2011 and October 1, 2015 revisions to ICD-10-CM/PCS will be for new  diseases/new technology procedures, and any minor revisions to correct reported errors in these classifications.
  • Regular (at least annual) updates to ICD-10-CM/PCS will resume on October 1, 2015.

Public comments not made public

Note that written public comments received by NCHS (Diagnosis) and CMS (Procedural) on proposals requested via these meetings are not aggregated and made publicly accessible. Nor are the names of organizations, professional bodies, individuals or others who have submitted comments listed publicly. It is not possible to scrutinize the number, provenance or substance of the comments received in support of, or in opposition to requests for modifications to ICD-10-CM presented via these meetings. Nor are NCHS/CMS’s rationales for the approval or rejection of requests for modifications to diagnosis or procedural codes on public record.


September 18–19, 2013 meeting

A substantial number of modifications were proposed via the September 2013 meeting for both procedural and diagnosis codes. These are set out in the Agenda/Topic Packet PDF documents:

Diagnosis Codes Agenda

Procedural Codes Agenda

Meeting Materials

Videocasts for full two day meeting proceedings and Meeting Materials (collated on Dx Revision Watch site)

Summary of Diagnosis Presentations 

The ICD-9-CM timeline (for the remainder of its life) and the ICD-10-CM/PCS timeline are set out on Pages 3-8 of the Diagnosis Agenda.


Key dates for the forthcoming March 19–20, 2014 meeting

January 17, 2014: deadline for submitting topics to be discussed at the March 19–20, 2014 ICD-10-CM/PCS Coordination and Maintenance Committee (reached).

February 14: registration for attendance opens.

March 14: deadline for registration.

Go here for registration details. (CMS confirmed to me via email on 01.23.13 that the deadline for registration is March 14, not February 14, as incorrectly published in the Diagnosis Agenda timeline.)

April 18, 2014: deadline for receipt of public comments on proposed codes and modifications tabled for March meeting. (Note there is only a 4 week period following this meeting during which written comments can be submitted.)


Key ICD-10-CM/PCS Timeline dates extracted from full timeline, Pages 3-8, September 18-19, 2013 Diagnosis Agenda

March 19–20, 2014: ICD-10-CM/PCS Coordination and Maintenance Committee meeting.

April 1, 2014: There will be no new ICD-9-CM codes to capture new diseases or technology on April 1, 2014, since the last updates to ICD-9-CM will take place on October 1, 2013.

April 2014: Notice of Proposed Rulemaking to be published in the Federal Register as mandated by Public Law 99-509. This notice will include references to the complete and finalized FY 2015 ICD-10-CM diagnosis and ICD-10-PCS procedure codes. It will also include proposed revisions to the MS-DRG system based on ICD-10-CM/PCS codes on which the public may comment. The proposed rule can be accessed at:

April 18, 2014: Deadline for receipt of public comments on proposed code [at March meeting.]

June 2014: Final addendum posted on web pages as follows:

Diagnosis addendum

Procedure addendum

September 23–24, 2014: ICD-10-CM/PCS Coordination and Maintenance Committee 2014 meeting.

October 1, 2014: New and revised ICD-10-CM and ICD-10-PCS codes go into effect along with DRG changes. Final addendum posted on web pages as follows:

Diagnosis addendum

Procedure addendum

November 2014: Any new ICD-10 codes required to capture new technology that will be implemented on the following April 1 will be announced. Information on any new codes to be implemented April 1, 2015 will be posted on the following websites:

DSM-5 released: Media, professional and advocacy reaction: Round up #1

Post #251 Shortlink:

Eureka Alert: American Psychiatric Association Press Release: American Psychiatric Association releases DSM-5 May 17

Science Media Centre, UK: Press briefing: Has psychiatry gone too far? May 17


Prof Elizabeth Kuipers, Professor of Clinical Psychology, Head of Department of Psychology, King’s College London’s Institute of Psychiatry;
Prof David Clark, Professor of Experimental Psychology, University of Oxford and Honorary Fellow of the British Psychological Society;
Prof Nick Craddock, Professor of Psychiatry, University of Cardiff and Director of the National Centre for Mental Health, Wales;
Prof David Taylor, Royal Pharmaceutical Society expert and spokesperson on mental health medicines and Editor of the Maudsley Prescribing Guidelines;
Andy Bell, Deputy Chief Executive, The Centre for Mental Health

Medscape Medical News from The American Psychiatric Association’s 2013 Annual Meeting: DSM-5: Setting the Record Straight Jeffrey A Lieberman, MD

…The NIMH’s position on the DSM and need for scientific progress in understanding the genetic and neurobiologic basis of mental disorders has not changed. The DSM is an essential guide to clinicians to facilitate accurate diagnosis and treatment. At the same time, biomedical research cannot be confined by traditional diagnostic constructs and their boundaries. Tom and I, and the APA and NIMH, are in complete agreement on this. The DSM is a valuable guide that helps clinicians in the evaluation of patients to establish an accurate diagnosis and facilitate the most effective treatment. It is designed to reflect the latest scientific knowledge and translate this into a “user-friendly” instrument for clinicians and patients…

Medscape Medical News from The American Psychiatric Association’s 2013 Annual Meeting: DSM-5 Officially Launched, But Controversy Persists Caroline Cassels, May 18

…diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated.

American Psychological Association: Practice Central Update: Nine frequently asked questions about DSM-5 and ICD-10-CM Practice Research and Policy staff, May 16

APA Practice staff answer questions about billing, determining diagnoses and more related to the two diagnostic classification systems.

Market Place, Health Care, US: How much is the DSM-5 worth? Dan Gorenstein, May 17

It’s 19 years old and it still brings in about $4-5 million a year…with 150,000 pre-orders the DSM-5 is a hot seller. We may do a second printing more quickly than we originally thought,” says Scully. At $199 dollars for the hardcover, $149 for paperback — that’s more than $20 million in sales right there.

BBC Radio 5 live: Friday 10:00, 120 mins

One of the country’s leading psychologists tells this programme that the way mental health conditions are diagnosed in the UK is “deeply flawed” and too many people are being labelled with specific syndromes like post traumatic stress disorder, attention deficit hyperactivity disorder and personality disorders. Dr Lucy Johnstone, from the division of clinical psychology, says we shouldn’t be labelling behaviour as illnesses when in most cases people are just reacting in understandable ways to life experiences. Victoria speaks to Dr Johnstone and to listeners who have been diagnosed with mental health problems.

Clip 14:52: Are we too quick to diagnose mental health illnesses?

RCPSYCH, UK: Troubled waters Blog of the President of the Royal College of Psychiatrists, Prof Sue Bailey

The Monthly, Australia: DSM-5 and the Mental Illness Make-over Prof Nick Haslam, May 2013

ABC News, Australia: Psychiatry bible receives a makeover Sophie Scott, Michelle Brown, Gillian Bennett, May 19

Daily Telegraph, Australia: New psychiatry manual, DSM5, reclassifies previously normal behaviours as illnesses Sue Dunlevy, May 18

Toronto Star, Canada: DSM-5: Controversial changes to psychiatry’s bible Nancy White, May 17

El Confidential, Madrid: El DSM-5, la nueva biblia de los psiquiatras, atacada por los psicólogos May 14

Sinc habla en exclusive con David J. Kupfer

Psychiatric News, US: Ink Meets Paper as DSM-5 Goes to Press Aaron Levin, May 17

Slate, US: The DSM-5 Is Not Crazy, Psychiatry’s new diagnoses of picking, bingeing, and tantrums sound silly, but they’re useful for me and my patients, Marla W Deibler, May 17

Ottowa Citizen, Canada: Infighting, boycotts, resignations: Psychiatry faces another crisis of confidence Sharon Kirkey, Postmedia News, May 17

Independent, UK: Doctors in dispute: What exactly is normal human behaviour? Jeremy Laurance, May 17

Japan Times: Psychiatrists under fire in mental health battle Jamie Doward, May 18

Reuters: Psychiatrists unveil their long-awaited diagnostic “bible” Sharon Begley, May 17

APA to release DSM-5 at Annual Meeting (May 18-22): What next?

Post #249 Shortlink:

Media coverage following release of DSM-5 is compiled in Posts #251 and #252

Update: APA issued this press release today

Click link for PDF document   APA Press Release No. 13-31 May 17, 2013

American Psychiatric Association Releases DSM-5, Publication of diagnostic manual culminates 14-year development process

Purpleblue1DSM-5 is scheduled for release at the 2013 American Psychiatric Association Annual Meeting (May 18-22), in San Francisco. The official APA publication date is May 22.

Amazon US had been quoting a release and shipping date of May 22, but the site currently gives May 27 for both hardback and paperback editions. Amazon UK currently gives the release and shipping date for both hardback and paperback as May 31.

APA is anticipated to release DSM-5 on Saturday, May 18, with an early morning press briefing.

No heads-up yet from UK Science Media Centre, but SMC New Zealand has already put out press briefing materials here.

Australian SMC DSM-5 background briefing materials and presentation here:
BACKGROUND BRIEFING: DSM 5 – Psychiatric bible or fatally flawed?

DSM-5 will launch; a lot of stuff will be written about it.

What next?

On Monday, May 13, the Division of Clinical Psychology, a division of the British Psychological Society, published a “Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses, Time for a Paradigm Shift.”

You can download a copy of this document here: Position Statement on Diagnosis.

Two new platforms for discussion launched this week:

The first, Dx Summit website. Article on Mad in America here DxSummit Officially Launches, by Jonathan Raskin, May 15.

DxSummit Officially Launches

by Diagnostic Summit Committee

DSM-5 Is Widely Criticized, and Pursuit Of Alternatives in Mental Health Care Is Underway

For Immediate Release:

The latest edition of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association is being released on May 22, 2013. It is the fifth revision of this widely influential manual for diagnosing mental distress and illness, and has been the subject of national and international criticism for the quality of its science, its criteria for defining disorders and categories, its rationale for inclusion or exclusion of particular symptoms or features, and the considerable inflation in its number of diagnosable disorders since the original DSM was published in the 1950s. Over the past several decades, there has been sharp criticism of the various DSM revisions, but in the case of DSM-5, a critical mass of scholarly opposition has reached a tipping point, including an unprecedented rebuke by the U.S. government’s National Institute of Mental Health, which has stated it will be reorienting away from research that involves the DSM-5. For many mental health professionals it seems clear that fresh thinking–about ways to possibly improve the DSM, prospects for developing possible alternatives to it, and what those prospects might look like–are called for. Regardless of where one stands on these issues, it is clear that new approaches to diagnosis are sorely needed, as both a national and global health concern.

To that end, a new website ( has been launched to help create an on-line, on-going global forum for scholarly and professional dialogue of humane approaches to mental health diagnosis. Sponsored by the Diagnostic Summit Committee (DSC), a national committee of concerned psychologists, this collaborative effort provides an opportunity for the widest possible input and deliberation of mental health diagnosis from the ground-up. Offering blogs, discussion posts, and psychiatric and psychological articles by stakeholders and leaders in the field, will open up the discussion of diagnosis to its full range of possibilities, from brain science to cultural variations to the examination of normal human responses to difficult life challenges. The website, underwritten by the efforts of the Society for Humanistic Psychology (SHP) will be a platform for international debate and consensus of comprehensive and valid approaches to mental health diagnosis.

Media inquiries should be directed to Dr. Frank Farley, co-chair of the DSC, and former President of the American Psychological Association and the SHP, at or (215) 668-7581; or Dr. Donna Rockwell.

The second new platform is Tom Nickel’s DSMOOC, introduced by Allen Frances, MD, in a May 16 blog at Huffington Post:

DSM-5: Where Do We Go From Here? 

Dr Frances writes:

“That’s why I am so pleased that Thomas Nickel Ph.D., Head of Continuing Education at Alliant International University, has set up a new interactive DSMOOC web site that will undoubtedly become the focal point for diagnostic discussion and remediation. Check it out.

Dr. Nickel writes:

“Now that DSM-5 is about to be released, it is time to determine how best to reduce, if not entirely eliminate, the risk that people will be misdiagnosed and improperly treated.”

“Solutions will not come from one group or one project. As one of what will hopefully be many initiatives, we have developed a MOOC (Massive Open Online Conversation) to bring together concerned clinicians and the public in order to give voice to the many different perspectives about psychiatric diagnosis.”

“Our intention is to stimulate conversations that will lead to useful products. People will find each other and work together to produce materials that can empower patients and influence practitioners. Suggestions for guidelines, practice standards, public policy, and research will hopefully emerge. Certainly, we will make every effort to facilitate this.”

“Previous MOOCs have resembled traditional university courses with lectures and quizzes on technical topics like artificial intelligence or mechanical engineering. Until now, MOOCs have not been closely linked to events happening in the world, nor have they been a channel for real world action. In this regard, a MOOC focused on DSM-5 may be pioneering.”

“Our MOOC will consist of about 15 channels, each one dedicated to one area of significant change or controversy in DSM-5. Each will provide background information; videotaped discussions by leading experts and consumer advocates; references; links; vivid portrayals of psychiatric diagnosis in films and fiction; and an opportunity for discussion. There are even Google Hangouts all set up for study groups to use.”

“Our DSMOOC should be equally interesting for professionals and consumers- and will provide a uniquely open forum for interaction between them.”

“We hope that you will roll up your virtual sleeves, join us at:

Follow DSMOOC on Twitter @RethinkingDSM


DSM-5 Development site

The APA’s DSM-5 Development site will remain online.

On May 15, the Home Page text was revised and the site’s content is being reorganized. As everything on the site is nailed down with Licensing and Permissions clauses, you will need to visit the site to read what new text has gone up so far. No doubt APA would like to register the trademark rights to hex #260859, too.

See: UNDER CONSTRUCTION: DSM-5 Implementation and Support

According to what little text is currently displaying, the site will be reorganized to serve as a resource for stakeholders: providers, payers, researchers and patients.

New content is planned to include FAQs, information on implementation of the manual and a mechanism for submitting questions and feedback. Professional users will be able to provide feedback on online assessment measures; there will be links to educational webinars and training courses for US and other countries. The site will list DSM-5 corrections.

Additional media coverage from this week

Too much to include this week, so just a few links:

Concern for the implications of DSM-5‘s new Somatic Symptom Disorder was highlighted by Allen Frances in a Diane Rehm radio broadcast, on May 14. The programme also included an interview with DSM-5 Task Force Chair, David J Kupfer, MD, on the understanding that he would not be engaging with Dr Frances.

The Diane Rehm Show May 14, 2013:


Listen again:  [51.40 mins including listener phone in]

The site page includes an excerpt from the book “Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life” by Allen Frances. Published by William Morrow. Copyright © 2013 by Allen Frances. Reprinted with permission.

Somatic Symptom Disorder also featured in a Susan Donaldson James’ article, for ABC News Health, on May 14:

Brain Science Upstages DSM-V, So-Called Mental Health ‘Bible’

Christopher Lane, Ph.D., published The Distortion of Grief on May 14, which has been widely syndicated.

DSM-5: Mental Health Professionals, Critics Face Off Over Upcoming Psychiatric Manual by Lindsey Tanner at Huffington Post, May 15:

“The psychiatric industry, allied with Big Pharma, have massively misled the public,” the Occupy Psychiatry group contends. Organizers include Alaska lawyer Jim Gottstein, who has long fought against overuse of psychiatric drugs.

“The new manual “will drastically expand psychiatric diagnosis, mislabel millions of people as mentally ill, and cause unnecessary treatment with medication,” says the website for the Committee to Boycott the DSM-5, organized by New York social worker Jack Carney.”

More on Occupy APA from Jack Carney, DSW, for Mad in America, May 17:
Occupy APA in San Francisco: Joined in Spirit


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