Category Archives: ICD-10-CM

DSM-5 released: Media, professional and advocacy reaction: Round up #3

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Post #253 Shortlink: http://wp.me/pKrrB-332

For earlier responses to release of DSM-5 see Posts #252, #251 and #249

Selected additional coverage of DSM-5 related issues will be added to a further post.

Update: An additional commentary by five authors has been published at The Conversation:

Five new mental disorders you could have under DSM-5, May 20, 2013

Authors: Christopher Fairburn, Professor of Psychiatry at University of Oxford; Christopher Lane, Professor of English at Northwestern University; David Mataix-Cols, Professor and Honorary Consultant Clinical Psychologist at King’s College London; Jon Grant; Professor of Psychiatry and Behavioral Neuroscience at University of Chicago; Karen M. von Deneen, Associate Professor at Xidian University

The Conversation

DSM-5 tells us more about psychiatry than psychiatrists
Prof, Sir Simon Wessely, Professor of Psychological Medicine at King’s College London, May 20, 2013

Under new psychiatric guidebook we might all be labelled mad
Allen Frances, Professor Emeritus of Psychiatry at Duke University, May 20, 2013

Explainer: What is the DSM?
Peter Kinderman, Professor of Clinical Psychology at University of Liverpool, May 20, 2013

Mental disorders: debunking some myths of the DSM-5
Perminder Sachdev, Scientia Professor of Neuropsychiatry, Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry at University of New South Wales, April 18, 2013

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The Dana Foundation Psychiatric Drug Development: Diagnosing a Crisis Steven E Hyman, MD, April 02, 2013

Steven E Hyman, MD, resigned from the DSM-5 Task Force in 2012. Dr Hyman remains listed as Chair of the APA-WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders

Commentary by Bernard Carroll at Health Care Renewal, April 6, 2013

 

Blogs Psych Central Video NIMH’s Thomas Insel on a New Understanding of the Brain Sandra Kiume, April 2013

Video: 13:04 mins

NIMH’s Thomas Insel on a New Understanding of the Brain By Sandra Kiume

Director of the National Institute for Mental Health Thomas Insel gives a TED Talk on the new domain criteria research direction, and how an important first step is to reframe mental illness as brain disorders.

By doing so, diverse fields like psychology, cognitive science, molecular neuroscience, genetics, psychiatry, and more can work together toward a new understanding of the mind.

NIMH: Mental Disorders as Brain Disorders: Thomas Insel at TEDxCaltech, April 23, 2013

Video 15:05 mins

Psycritic – A child psychiatrist takes a critical look at psychiatry, the news, culture, etc.

What If the NIMH Succeeds? What Then? May 11

Jonathan Turley From DSM-I to DSM-5 in the Legal System: Mental Illness Issues in the Courtroom Charlton Stanley (Otteray Scribe), guest blogger, May 19

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

Includes Allen Frances video

Radio New Zealand: New reference manual issued by Psychiatric Assn May 19

Healio Psychiatric Annals: APA President-Elect: ‘Our time is now’ May 19

Los Angeles Times Review of Books: Andrew Scull on The Book of Woe: The DSM and the Unmaking of Psychiatry and Hippocrates Cried : The Decline of American Psychiatry Andrew Scull, May 19

Delusions of Progress: Psychiatry’s Diagnostic Manual

Essay length article that includes reference to the legal threats issued on behalf of American Psychiatric Publishing against this site, in December 2011.

Truth Dig: British Psychologists Find Fault With DSM-V Alexander Reed Kelly, May 16

England’s Division of Clinical Psychology, which represents more than 10,000 practitioners, has criticized the latest edition of the field’s leading diagnostic manual for its categorizing of normal behaviors—such as shyness in children and depression after the death of a loved one—as medical problems treatable with drugs…

New York Post: We’re all mad here, New psychiatry manual turns ordinary American life into mental disorders Allen Frances, MD, May 18

Millions of people who went to sleep last night thinking they were normal woke up this morning with a new mental disorder…

Medscape Medical News, Psychiatry: Use DSM-5 ‘Cautiously, If at All,’ DSM-IV Chair Advises Pam Harrison, May 17

“I believe that the American Psychiatric Association (APA)’s financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to premature publication of an incompletely tested and poorly edited product,” Dr. Frances states.

“The problems associated with the DSM-5 prove that the APA should no longer hold a monopoly on psychiatric diagnosis…. The codes needed for reimbursement are available for free on the Internet.”

Spiked Online, UK: Our brains aren’t moulded by abuse Ken McLaughlin. May 16

So, is mental distress caused by faulty genes or by past experiences of childhood abuse? Maybe it’s neither.

For earlier responses to release of DSM-5 see Posts #252, #251 and #249

DSM-5 released: Media, professional and advocacy reaction: Round up #2

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Post #252 Shortlink: http://wp.me/pKrrB-32B

For earlier responses to release of DSM-5 see Posts #251 and #249

Medpage Today, US: APA Leaders Defend New Diagnostic Guide John Gever, Deputy Managing Editor,  May 18

…DSM-5 is now on sale for $199 in hardcover and $149 in paperback. The APA has never made the DSM freely available (it is an important source of revenue) and no change in that policy is planned…A digital version is promised within a few months through a secure website and also as mobile device applications. Revisions will be more frequent and most likely would be distributed only electronically, Kupfer said.

Wall Street Journal, US: Revised Psychiatric Manual Faces Mixed Reviews Shirley Wang, May 18

The widely criticized new version of the U.S. psychiatric diagnostic manual due out faces a potentially diminished role in research, which would mark a shift for what has been considered the bible of American psychiatry for 30 years.

…Dr. Kupfer, the DSM leader, said researchers should look at the DSM as “a guide but not necessarily the only framework they should use to carry out basic science.”

“For the DSM to be considered primarily a guide for clinicians is a “dramatic backtracking from their prior position as putting themselves out there as the best basis for research,” said Geoffrey Reed, senior project officer at the World Health Organization…Most of the research funded by the NIMH and published in psychiatry journals in the past 20-plus years had to use DSM diagnostic criteria; otherwise, scientists had no hope of publishing, said Dr. Reed.

The Guardian, UK: New US manual for diagnosing mental disorders published Ian Sample, science correspondent, May 18

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, has divided medical opinion

[Ed: Note according to a WPA-WHO 2011 Survey, around 11% of practising UK psychiatrists and around 23% of practising psychiatrists surveyed globally reported using DSM-IV more than ICD-10.]

…Though not used in the UK, where doctors turn to the World Health Organisation’s International Statistical Classification of Diseases (ICD), the US manual has global influence. It defines groups of patients, and introduces new names for disorders. Those names can spread, and become the norm elsewhere. More importantly, the categories redefine the populations that are targeted by drugs companies.

The Pharmaletter, US: Europe adopting US strategies to diagnose and treat ADHD Industry article, May 16

…Although Europe trails behind the USA in terms of market revenue, ADHD therapeutics markets are expected to show strong growth, with Spain predicted to witness a compound annual growth rate (CAGR) of 8% over 2012-2018, beating the USA’s CAGR of 6% during the same future period. European markets have not yet neared the saturation point that ADHD therapeutics are facing in the USA, and there is an optimistic view for ambitious growth in this region.

Medpage Today, US: DSM-IV Boss Presses Attack on New Revision John Gever, Deputy Managing Editor, May 17

Includes Complimentary Source PDF: http://annals.org/article.aspx?articleid=1688399

…Ironically, DSM-5 has come under attack from the autism community for rewriting the autism spectrum classification in ways that autism advocates have feared will disqualify many children from receiving autism diagnoses — a controversy that Frances did not address…But he did suggest that the DSM in general has become too important after a very modest beginning in the 1950s.

“The DSM … has since acquired perhaps too much real-world influence as the arbiter of who gets what treatment and whether it will be reimbursed; who is eligible for disability benefits, Veterans Affairs benefits, and school and mental health services; and who qualifies to receive life insurance, adopt a child, fly an airplane, or buy a gun,” Frances observed.

Biomedcentral: Patient advocacy and dsm-5 Dan J Stein and Katharine A Phillips, May 17

BMC Medicine 2013, 11:133 doi:10.1186/1741-7015-11-133

Published: 17 May 2013 Abstract (provisional). Complete article is available as free, provisional PDF here

Abstract (provisional)

The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a useful opportunity to revisit debates about the nature of psychiatric classification. An important debate concerns the involvement of mental health consumers in revisions of the classification. One perspective argues that psychiatric classification is a scientific process undertaken by scientific experts and that including consumers in the revision process is merely pandering to political correctness. A contrasting perspective is that psychiatric classification is a process driven by a range of different values and that the involvement of patients and patient advocates would enhance this process. Here we draw on our experiences with input from the public during the deliberations of the Obsessive Compulsive-Spectrum Disorders subworkgroup of DSM-5, to help make the argument that psychiatric classification does require reasoned debate on a range of different facts and values, and that it is appropriate for scientist experts to review their nosological recommendations in the light of rigorous consideration of patient experience and feedback.

Herald Online, PR Newswire: New Social Media Campaign Features Stories Of Individuals Who Rejected Psychiatric Association’s DSM-5

Campaign timed to coincide with rollout of American Psychiatric Association’s DSM-5, Open Paradigm Project

SAN FRANCISCO, May 18, 2013 — /PRNewswire-USNewswire/ — The Open Paradigm Project, in collaboration with MadinAmerica.com, Occupy Psychiatry, and leading organizations in the movement to reform mental health care, announces a social media campaign showcasing video testimonials by individuals negatively impacted by the traditional psychiatric model, which focuses on pathology and illness rather than wellness and recovery. The launch coincides with the American Psychiatric Association’s (APA) rollout of its latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), taking place at the APA’s annual meeting in San Francisco this weekend. In light of National Institute of Mental Health (NIMH) director Thomas Insel’s move away from the DSM (“lack of validity… patients deserve better”) and DSM-5 task force chair David Kupfer’s admission of an absence of biological markers of mental illness (“we’re still waiting”), these stories starkly unveil the failure of, and harm done by, the prevailing model of mental health care…

Vox, Gibraltar: Western Psychiatry in Crisis Vox Editor, May 17

DSM 5 and exclusively biological psychiatry must be completely rethought

The following is an extract of the Mental Health Europe article:

Western psychiatry is in crisis. The direction taken by the new Diagnostic and Statistical Manual of Mental Disorders (DSM 5), due to be published later this week, has received ample criticism. Moreover, in disagreement with the American Psychiatric Association, the United States National Institute of Mental Health (NIMH), the world’s largest research institute, has announced they will no longer fund projects based exclusively on DSM categories. Unfortunately, while Mental Health Europe considers the NIMH decision to be the right one, by focusing almost entirely on neuroscience and on so-called disorders of the brain, the NIMH is missing out on the critical importance of user experiences to psychiatric research and to the practice of psychiatry…

…For more information, please contact MHE Information and Communications Manager Silvana Enculescu at silvana.enculescu@mhe-sme.org. MHE Senior Policy Adviser Bob Grove and MHE Policy Officer Yves Brand will be available for interviews.

    Click link for PDF document   More harm than good – DSM 5 and exclusively biological psychiatry must be completely rethought

BBC Mental health ‘bible’ update due May 18

Psych Central, US: DSM-5 Released: The Big Changes John M Grohol, Psy.D., May 18

Wired Science, US: A Case That Tells the Weird Tale of DSM – and Other Recommended Reading David Dobbs, May 18

For a single post that shows how weirdly and unevenly psychiatric diagnosis actually works (and fails to work) in this country, and what that means for the new DSM, get over to Maia Svalavitz’s clear-eyed account of her own five diagnoses (and the one she never got)…

Independent, UK: Comment: Despite what the DSM implies, medical intervention is not always the answer to mental health issues Frank Furedi, May 18

You don’t need to be a mental health professional to take an interest in the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders

…Recently, the British Psychological Society’s division of clinical psychology has attacked the psychiatric profession for offering a biomedical model for understanding mental distress. But its criticism was not directed at the ethos of medicalisation as such, but only at the tendency to associate mental illness with biological causes. What it offered was an alternative model of medicalisation – one where mental illness was represented as the outcome of social and psychological cause. It seems that medicalization has become so deeply entrenched that even critics of the DSM accept its premise.

OUP Blog (Oxford University Press): Clinician’s guide to DSM-5 Joel Paris, MD, May 18

…The DSM system can be described as flawed but necessary. Clinicians need to communicate to each other, and even a wrong diagnosis allows them to do so.

For earlier responses to release of DSM-5 see Posts #251 and #249

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

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Post #251 Shortlink: http://wp.me/pKrrB-32h

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

Speakers:

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

http://www.bbc.co.uk/programmes/b01sf42v

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?

http://www.bbc.co.uk/programmes/p0195g8k

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

ICD-11 Round up: April #1

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ICD-11 Round up: April #1

Post #239 Shortlink: http://wp.me/pKrrB-2Qy

[PMID 23583019]

The Lancet, Early Online Publication, 11 April 2013
doi:10.1016/S0140-6736(12)62191-6

Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11

Maercker A, Brewin CR, Bryant RA, Cloitre M, Reed GM, Ommeren MV, Humayun A, Jones LM, Kagee SA, Llosa AE, Rousseau C, Somasundaram DJ, Souza R, Suzuki Y, Weissbecker I, Wessely SC, First MB, Saxena S.

Mental disorders specifically associated with stress are exceptional in needing external events to have caused psychiatric symptoms for a diagnosis to be made. The specialty of stress-associated disorders is characterised by lively debates, including about the extent to which human suffering should be medicalised, 1 and the purported overuse of the diagnosis of post-traumatic stress disorder (PTSD). 2 Most common mental disorders are potentiated or exacerbated by stress and childhood adversity…

Contributors
AM, CRB, RAB, MC, GMR, MvO, SW, MBF, and SS were the core writing group. AH, LJ, SAK, AEL, CR, DS, RS, YS, and IW discussed the text and gave feedback to the core writing group.
Conflicts of interest
AM, CRB, RAB, MC, AH, LJ, SAK, CR, DS, SCW, and YS are members of the WHO ICD-11 Working Group on the Classification of Disorders Specifically Associated with Stress, reporting to the WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. GMR, MvO, and SS are members of the WHO Secretariat, Department of Mental Health and Substance Abuse. AEL, RS, IW, and MBF are special invitees to Working Group meetings. However, the views expressed in this article are those of the authors and, except as specifically noted, do not represent the official policies or positions of the International Advisory Group or WHO.
[Subscription required for full paper. A PDF may be available on authors' personal websites or academic websites.]

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According to CDC’s, Donna Picket, as reported by AHIMA (American Health Information Management Association), “ICD-11 would likely not be ready for implementation in the US until after 2020.”

AHIMA

Update: ICD-11 on Track For 2015

Melanie Endicott | AHIMA & ICD-10 & ICD-10/CAC Summit | April 23, 2013

While the United States is preparing to implement ICD-10-CM/PCS on October 1, 2014, the World Health Organization (WHO) is anticipating a 2015 release of ICD-11. Taking into account the need to then clinically modify the WHO version, ICD-11 would likely not be ready for implementation in the US until after 2020. Donna Pickett, MPH, RHIA, medical systems administrator at Centers for Disease Control and Prevention/National Center for Health Statistics, delivered an update on the progress of ICD-11 development in Monday’s presentation “ICD-11 Update” at the 2013 AHIMA ICD-10-CM/PCS and Computer-Assisted Coding Summit, taking place in Baltimore, MD this week...  Read on

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Go here to view ICD-11 Beta drafting platform public version

http://www.who.int/classifications/icd/revision/betaexpectations/en/

ICD-11 Beta: Expectations, Concerns and Known Issues

Information for Beta Participants

ICD-11 Beta Phase started on 14 May 2012. The objective is to have a final ICD-11 version by 2015. This announcement clarifies that ICD-11 Beta version is not final, and will be enhanced by input from multiple stakeholders during the beta phase, which will last 3 years.

Caveats
Problems and Issues
Concerns and Criticisms etc

http://www.who.int/classifications/icd/revision/en/index.html

Revision

Participate in ICD Revision
Video invitation to participate
Frequently Asked Questions About ICD-11
ICD Information Sheet
ICD Revision Information Notes
Register to become involved
Timelines
Content Model
Definitions etc

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Presentation | T Bedirhan Üstün

ICD Revision Summary presentation: Quality and Safety Topic Advisory Group meeting, New York, April 2-3, 2013.

ICD11 Quality and Safety TAG 2013 Presentation | Slideshare

According to this presentation, by WHO’s Bedirhan Üstün, all ICD-11 Topic Advisory Groups (TAGs) have finished their editing of the structure. A good deal of work remains for the population of content, in accordance with the ICD-11 Content Model, across all chapters and on compatibility of linearizations across primary care, specialty and detailed research versions.

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Presentation [PDF Format, no PP viewer required]

Revising the ICD Definition of Intellectual Disability: Implications and Recommendations | March 19, 2013

Intellectual Disability’s Long Journey: George Jesien, Ph.D., Executive Director, Association for University Centers on Disabilities (AUCD)
Intellectual Disability and the Revision of ICD-10 Mental and Behavioural Disorders: Geoffrey M. Reed, Department of Mental Health and Substance Abuse, WHO
AAIDD Proposed Recommendations for ICD-11: Marc J. Tassé, Nisonger Center – UCEDD, The Ohio State University, Webinar

On Slides 17 and 18, Classification System Most Used and Classification Most Used by Country, graphics for data from WPA-WHO Survey of Practicing Psychiatrists* on global use of ICD-10, ICD-8/9, DSM-IV and Other diagnostic system(s).

*World Psychiatry. 2011 Jun;10(2):118-31.

The WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification.

Reed GM, Mendonça Correia J, Esparza P, Saxena S, Maj M.

Abstract

Full free paper

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Medscape

Schizophrenia Bulletin

Schizophr Bull.2012;38(5):895-898.

Status of Psychotic Disorders in ICD-11

Wolfgang Gaebel

Abstract and full report

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Flyer: DSM-5 Core titles from American Psychiatric Publishing

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Flyer: DSM-5 Core titles from American Psychiatric Publishing

Post #211 Shortlink: http://wp.me/pKrrB-2×5

The third stakeholder review and comment period on proposals for revisions to categories and criteria for the next edition of the Diagnostic and Statistical Manual of Mental Disorders, to be known as DSM-5, was launched on May 4.

Following closure of this final public review, revisions made by the DSM-5 Work Groups to criteria and disorder descriptions subsequent to June 15 are subject to embargo.

Final criteria sets and accompanying texts won’t be released until the DSM-5 is published, next year.

The release of DSM-5 is slated for May 18-22, 2013, during the APA’s 2013 Annual Meeting in San Francisco, CA.

A couple of days ago, the third draft was removed in its entirety from the DSM-5 Development website.

In advance of release of DSM-5, the publishing arm of the American Psychiatric Association has issued a promotional flyer for its DSM-5 CORE TITLES:

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

American Psychiatric Association

Desk Reference to the Diagnostic Criteria from DSM-5

American Psychiatric Association

DSM-5 Clinical Cases

John W. Barnhill, M.D., David J. Kupfer, M.D., and Darrel A. Regier, M.D., M.P.H.

DSM-5 Guidebook

Donald W. Black, M.D., and Jon E. Grant, M.D., M.P.H., J.D.

Study Guide to DSM-5

Laura Weiss Roberts, M.D., M.A.

DSM-5 Handbook of Differential Diagnosis

Michael B. First, M.D.

DSM-5 Self-Exam Questions

Test Questions for the Diagnostic Criteria

Philip R. Muskin, M.D.

Note that the flyer states:

• New disorders include, but are not limited to, somatic symptom disorder, hoarding disorder, mild and major neurocognitive disorder, anxiety illness disorder, and premenstrual dysphoric disorder…

According to DSM-5 draft three, the proposed name for the disorder that replaces “Hypochondriasis” in DSM-IV is intended to be “J01 Illness Anxiety Disorder” not “anxiety illness disorder,” as the flyer has it. It is to be hoped that proofs of the manual will be subject to closer scrutiny than this flyer evidently underwent.

The flyer can be opened here 

   DSM-5 flyer

or download here http://dsm5.org/SiteCollectionDocuments/AH1259%20DSM-5%20flyer.pdf

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Related material

Further DSM-5 spin-jobs:

Psychiatric News | November 16, 2012

Volume 47 Number 22 page 1b-10

Professional News

Results of DSM Field Trials Available on AJP in Advance

Mark Moran

The field trials provide new data for the ongoing review of proposed diagnostic criteria for DSM-5

Three papers discussing the results of the DSM-5 field trials were posted October 30 by AJP in Advance. These papers describe the methods and results of the 23 diagnoses that were assessed…

and from Task Force Chair, David J. Kupfer…

Huffington Post Blog

David J. Kupfer, MD | Chair, DSM-5 Task Force | November 7, 2012

Field Trial Results Guide DSM Recommendations

Written with Helena C. Kraemer, Ph.D.

Two years ago this month, APA announced the start of field trials that would subject proposed diagnostic criteria for the future DSM-5 to rigorous, empirically sound evaluation across diverse clinical settings. And now, as the first comprehensive analyses of that effort are published, what’s clear is just how well the field trials did their job…

For comment see:

1 Boring Old Man

OMG!…

1 Boring Old Man | November 9, 2012

Side Effects

From quirky to serious, trends in psychology and psychiatry

by Christopher Lane, Ph.D.

The DSM-5 Field Trials’ Decidedly Mixed Results

Far from being a ringing endorsement, the field trials set off fresh alarm bells

Christopher Lane, Ph.D. | November 11, 2012

“What’s the chance that a second, equally expert diagnosis will agree with the first, making a particular diagnosis reliable?” asks David Kupfer, chair of the DSM-5 task force, of the decidedly mixed results of the DSM-5 field trials. First off, are you sure you really want to know?…

You Can’t Turn a Sow’s Ear Into a Silk Purse

By Allen Frances, MD | November 11, 2012

also here on Psychiatric Times (registration required):

http://www.psychiatrictimes.com/blog/frances/content/article/10168/2113993

Summary: September 19 ICD-9-CM Coordination and Maintenance Committee Meeting

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Summary: September 19 ICD-9-CM Coordination and Maintenance Committee Meeting

Post #205 Shortlink: http://wp.me/pKrrB-2vc  

The September meeting of the ICD-9-CM Coordination and Maintenance Committee, jointly chaired by CMS and CDC, took place on September 19, 2012.

For further information on this public process see the CDC website page:

http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

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Meeting Summary document

The meeting Summary document has now been published.  The audio is not yet available.

The Summary document can be downloaded here:

September 19, 2012

Summary (10 pages) [PDF - 59 KB]

http://www.cdc.gov/nchs/data/icd9/2012_September_Summary.pdf

or opened in PDF format here:     Summary September 19 2012

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The Proposals and Agenda document can be downloaded here:

http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm#meeting_materials

ICD-9-CM Coordination and Maintenance Committee Meeting

September 19, 2012

Proposals (74 pages) [PDF - 730 KB]

http://www.cdc.gov/nchs/data/icd9/Topic_packet_for_September_19_2012.pdf

or opened in PDF format here:     Topic packet for September 19 2012

According to the Summary document, the deadline for receipt of public comments on proposals submitted at this meeting is November 16, 2012. If there is any change to this date, I will update.

Comments on proposals presented at the ICD-9-CM Coordination and Maintenance Committee meeting should be sent to the following email address: nchsicd9CM@cdc.gov. See Page One of the Summary document for important information on submission of public comment.

Extract, Summary document

Chronic fatigue syndrome

Andreas Kogelnik, MD, representing the Coalition 4 ME/CFS, was available via telephone to address questions and clinical concerns.

Lori Chapo-Kroger, representing the Coalition 4 ME/CFS, expressed that many nations, and the World Health Organization, put CFS at G93 in ICD-10, and that this would include everyone but the U.S.

Mary Dimmock, representing the Coalition 4 ME/CFS, questioned why the change must wait until after 2014 when they feel that this is an error in the classification right now (and has been since 2001).

Dr. Kogelnik indicated that the term myalgic encephalomyelitis is used in Europe while the U.S. continues to use the term chronic fatigue syndrome, and that the Coalition 4 ME/CFS considers these two conditions (CFS and ME) to be the same. That is why they want both terms included in the same code.

Nelly Leon-Chisen, AHA, noted support for a need for a code for chronic fatigue syndrome distinct from chronic fatigue, unspecified. She indicated also that with the cause being unknown it is better that the classification not be locked into placing CFS as a viral code. Also, if there is no consensus for ME and CFS being the same then it makes sense to keep them as two separate codes. If research later develops that says they are the same then the data can be aggregated together. However, if the research does not show this, then you don’t have them lumped into one code that does not allow you to separate out one from the other.

Sue Bowman, AHIMA, questioned counting all CFS as following a virus infection. She expressed a need for clinical consensus on this condition. Also, she stated that she did not see a rationale for an early change (before 2014).

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Note: Dx Revision Watch has no connection with the Coalition 4 ME/CFS or with the development of any proposals submitted by this organization. The views and opinions expressed in Coalition 4 ME/CFS submissions to ICD-9-CM  Coordination and Maintenance Committee meetings represent the views of the Coalition 4 ME/CFS and its representatives and not the views of Dx Revision Watch.

All enquiries about proposals submitted to CMS/CDC on behalf of the Coalition 4 ME/CFS should be addressed directly to the Coalition 4 ME/CFS.

Note also that the proposal from the Coalition 4 ME/CFS (Option 1) and the alternative proposal presented by CMS/CDC (Option 2) at the September meeting are set out in accordance with the requirements of the ICD-9-CM Coordination and Maintenance Committee for the submission of proposals. 

For Options 1 and Option 2 see post Proposals: September 19 ICD-9-CM Coordination and Maintenance Committee Meeting or Proposals document Topic packet for September 19 2012

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Related posts:

Proposals: September 19 ICD-9-CM Coordination and Maintenance Committee Meeting

Coding CFS in ICD-10-CM: CFSAC and the Coalition4ME/CFS initiative

Extracts: ICD-9-CM Coordination and Maintenance Committee Meeting Summary document (CFS coding)

Extracts: ICD-9-CM Coordination and Maintenance Committee Meeting September 14, 2011 (Coding of CFS in ICD-10-CM)

Proposals: September 19 ICD-9-CM Coordination and Maintenance Committee Meeting

Posted on by

Proposals: September 19 ICD-9-CM Coordination and Maintenance Committee Meeting

Post #204 Shortlink: http://wp.me/pKrrB-2uL

The next meeting of the ICD-9-CM Coordination and Maintenance Committee, which is jointly chaired by CMS and CDC, takes place on September 19, 2012. 

There is a very full agenda for this meeting. The meeting materials Proposals document has now been published.

For further information on this public process see the CDC website page:

http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

+++

The Proposals and Agenda document can be downloaded here:

http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm#meeting_materials

ICD-9-CM Coordination and Maintenance Committee Meeting

September 19, 2012

Proposals (74 pgs) [PDF - 730 KB]

http://www.cdc.gov/nchs/data/icd9/Topic_packet_for_September_19_2012.pdf

or opened in PDF format here:      Topic packet for September 19 2012

Note: I have no connection with the Coalition 4 ME/CFS or with the development of any proposals submitted by this organization. All enquiries about the proposal submitted to CMS/CDC on behalf of the Coalition 4 ME/CFS should be addressed directly to the Coalition 4 ME/CFS.

Note also that the proposal from the Coalition 4 ME/CFS and the alternative proposal from CMS/CDC are set out in accordance with the requirements of the ICD-9-CM C & M Committee for the submission of proposals.

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Coding of CFS in the forthcoming US specific ICD-10-CM

At the ICD-9-CM Coordination and Maintenance Committee’s September 14, 2011 meeting, a presentation had been made on behalf of the Coalition 4 ME/CFS in relation to the formal submission of a proposal.

The proposal requested that consideration be given to moving the classification of Chronic fatigue syndrome from its current proposed location within the ICD-10-CM R code chapter (Chapter 18: Symptoms and signs) to the G code chapter (Chapter 6: Diseases of the nervous system).

This would bring the chapter location of Chronic fatigue syndrome in ICD-10-CM in line with the international version of ICD-10, the Canadian ICD-10-CA and proposals for the forthcoming ICD-11.

No NCHS decision reached in response to the September 2011 proposals and the public comments received in respect of these proposals was conveyed following closure of the public comment period, last November.

However, further discussion of Chronic fatigue syndrome and two additional proposals are tabled on the agenda for discussion at the September 19, meeting, tomorrow.

I am appending the relevant extract from the Diagnosis Agenda and Proposals document which was published on the CDC  website overnight. An official audio and a Summary of the meeting should be available in due course on the CDC website. I will update with these when available.

+++

Extract Topic packet for September 19 2012 (Page 46)

[...]

Chronic fatigue syndrome

Andreas Kogelnik, M.D., Coalition 4 ME/CFS

Chronic fatigue syndrome

A proposal, submitted by the Coalition 4 ME/CFS, to modify codes for chronic fatigue syndrome (CFS) was presented and discussed at the September 2011 ICD Coordination and Maintenance Committee meeting. The National Center for Health Statistics also presented an alternative proposal, Option 2. There were many comments from the audience, and there was general support for the NCHS-proposed Option 2, moving CFS from Chapter 18, Symptoms, signs and abnormal clinical findings, not elsewhere classified, to Chapter 6, Diseases of the Nervous System but retaining separate codes for CFS and myalgic encephalomyelitis (ME). The rationale for retaining separate codes included agreement on the importance of being able to extract data on the two conditions separately or combine, as needed. It was also noted that term ME is not seen in medical record documentation. Written comments received on this issue were inconclusive. There was not agreement that the two conditions are the same. While some comments were from private citizens, others were from advocacy organizations and associations that represent health care providers and other large constituencies that use the classification. The public comment period following the meeting is not meant as a poll or survey. Analysis of public comment focused on the substance of the comments; whether there was a clear scientific consensus regarding the etiology and manifestations of the condition; and an understanding of the classification, its structure and conventions, and its uses by the health care industry.

As noted in the information from the September 2011 presentation, the cause or causes of CFS remain unknown, despite a vigorous search. While a single cause for CFS may yet be identified, another possibility is that CFS represents a spectrum of illnesses resulting from multiple possible pathways. Conditions that have been proposed to trigger the development of CFS include infections, trauma, immune dysfunction, stress, and exposure to toxins. Research in this area is ongoing.

There are several case definitions currently in use, some separating CFS from ME, and others merging the two conditions. The most widely used are the 1994 case definition (http://www.cdc.gov/cfs/case-definition/index.html ), the Canadian and the Oxford definitions. A new case definition for ME was published in the 2011 international consensus criteria that emphasized recent research and clinical experience that strongly point to widespread inflammation and multisystem symptoms and neuropathology. This new definition, which considers ME and CFS as synonymous terms, however, has not been widely vetted by the health care community at large. While there is no consensus on one case definition, there is consensus that this is a serious and complex syndrome, and it is likely that there are multiple subgroups. It has been noted that some providers use the terms interchangeably while others consider one condition a subgroup of the other. There is also some overlap with fibromyalgia and CFS/ME could be considered one of the multiple chronic overlapping pain conditions.

References

1. Fukuda et al. Ann Intern Med (1994) 121:953-959
(http://www.cdc.gov/cfs/case-definition/1994.html )
2. Holmes et al. Ann Intern Med (1988) 108:387-389.
3. Sharpe et al. J Roy Soc Med (1991) 84:118-121
4. Carruthers et al. J CFS (2003) 11:7-97
5. Carruthers et al.. J Intern Med (2011) 270: 327-38.

The Coalition 4 ME/CFS has stated that they do not support Option 2 proposed in September 2011 and have submitted a revised proposal. A revised Option 2 is also being proposed, consistent with comments received supporting Option 2 as noted above. The Coalition is also requesting that their proposal be considered for implementation prior to October 1, 2014 even though the condition is not a new disease and therefore does not meet the criteria for implementation during the partial freeze.

Based on the above, the following proposals for consideration are:

+++

+++
For comparison, the proposal that had been presented by CDC at the September 2011 meeting in counterpoint to an earlier proposal presented by the Coalition 4 ME/CFS at that same meeting was this:

 

 

• Instead of Title term G93.3 Postviral and other chronic fatigue syndromes (CDC Option 2, September 2011)

CDC suggests retaining the Title term G93.3 Postviral fatigue syndrome (CDC Option 2, September 2012).

+++
• Instead of Child category G93.31 Postviral fatigue syndrome, Benign myalgic encephalomyelitis

CDC is now suggesting two categories for Postviral fatigue syndrome, thus:

G93.30 Postviral fatigue syndrome, unspecified, Postviral fatigue syndrome NOS (not otherwise specified)

with a discrete Child category G93.31 Myalgic encephalomyelitis, Benign myalgic encephalomyelitis.

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• No suggested change to the September 2011 CDC Option 2 suggestion for Child categories:

G93.32 Chronic fatigue syndrome, Chronic fatigue syndrome NOS.

The+++

Related posts:

Coding CFS in ICD-10-CM: CFSAC and the Coalition4ME/CFS initiative

Extracts: ICD-9-CM Coordination and Maintenance Committee Meeting Summary document (CFS coding)

Extracts: ICD-9-CM Coordination and Maintenance Committee Meeting September 14, 2011 (Coding of CFS in ICD-10-CM)

Response to Recommendations from November 2011 CFSAC meeting

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Response to Recommendations from November 2011 CFSAC meeting

Post #203 Shortlink: http://wp.me/pKrrB-2ur

The response from the Assistant Secretary for Health to Recommendations from the November 2011 CFSAC meeting is now available on the CFSAC website at: http://1.usa.gov/OghDXF

http://www.hhs.gov/advcomcfs/asst-sect-letter2012.pdf

or open here  asst-sect-letter2012

Text:

DEPARTMENT OF HEALTH & HUMAN SERVICES Office of the Secretary

Office of the Assistant Secretary for Health Washington, D.C. 20201
AUG -3 2012
Gailen Marshall Jr., MD, PhD

Chair, Chronic Fatigue Syndrome Advisory Committee
Professor and Chair Professor of Medicine and Pediatrics
The University of Mississippi Medical Center 2300
North State Street, N416 Jackson, MS 39216-4505

Dear Dr. Marshall:

I have received the recommendations developed by the Chronic Fatigue Syndrome Advisory Committee (CFSAC) during its November 8-9, 2011, meeting. The advice and counsel provided by CFSAC serves as a valuable resource in the Department of Health and Human Services’ (HHS) efforts to properly address the issues and concerns pertaining to chronic fatigue syndrome.

Since the meeting the Department has carefully considered your recommendations. Dr. Nancy Lee, the Designated Federal Officer for CFSAC, has worked collaboratively with the ex officio representatives to the committee to provide responses to the recommendations developed at the meeting. The enclosed document contains information about activities currently undertaken by HHS to work with public health experts and members of the chronic fatigue syndrome community to increase knowledge and provide a better understanding of this debilitating health condition.

I have shared the committee’s recommendations with Secretary Kathleen Sebelius.

The Department is committed to addressing this condition. I commend you and your committee members for the important work you do.

Sincerely yours,
/s/Howard K. Koh
Howard K. Koh, M.D., M.P.H. Assistant Secretary for Health

Enclosure

cc: Dr. Christopher R. Snell
U.S. Public Health Service

RESPONSES TO RECOMMENDATIONS FROM THE CHRONIC FATIGUE SYNDROME ADVISORY COMMITTEE (CFSAC)

REF: November 8-9, 2011 CFSAC Meeting

Recommendation 1: This recommendation addresses the process by which CFSAC transmits recommendations to the Secretary and the Secretary communicates back to CFSAC whether or not a recommendation was acted upon. CFSAC recommends that this process be transparent and clearly articulated to include regular feedback on the status of the Committee’s recommendations. This communication could originate directly from the Office of the Secretary or be transmitted via the relevant agency or agencies.

Procedures are in place to ensure that recommendations made by federal advisory committees are properly handled. The CFSAC charter stipulates that the Committee provides advice and recommendations to the Secretary, through the Assistant Secretary for Health (ASH). Initially, the CFSAC recommendations are sent to the ASH for review. After reviewing the recommendations, the ASH forwards them to appropriate officials within the Office of the Secretary and the Operating and/or Staff Divisions that may be impacted by the Committee’s recommendations. A letter is sent to acknowledge receipt of the recommendations. A response may be prepared to accompany the letter which describes any actions that the Department may take in response to the recommendations made by the Committee. All pertinent information about the recommendations is provided to the designated Federal officer (DFO). The DFO then provides the information to the Chair and the Committee.

Recommendation 2: CFSAC recommends to the Secretary that the NIH or other appropriate agency issue a Request for Application (RFA) for clinical trials research on chronic fatigue syndrome/myalgic encephalomyelitis (ME/CFS).

The National Institutes of Health (NIH) funds research on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); investigators are encouraged to submit proposals for ME/CFS research, including clinical trials, through two funding announcements that are currently open for submission of applications. The next deadline for receipt of applications is October 24, 2012. In fiscal year 2011, NIH funded two applications for clinical trials on ME/CFS. NIH has received few applications proposing ME/CFS research, and even fewer applications proposing ME/CFS clinical trials. It is unclear whether the paucity of ME/CFS clinical trial applications reflects the current status of the field or an acknowledgement that clinical trials are difficult to design for a complex and multi-faceted illness. Clinical trials are challenging to design and conduct for all diseases, with basic requirements of a well-defined patient population, valid measurement instruments, appropriate safeguards for subjects, and generalizability of the clinical trial outcomes to the larger affected patient population. NIH is taking action to stimulate ME/CFS research across NIH through the regular monthly meetings of the Trans-NIH ME/CFS Working Group (WG). The WG discusses the current status of ongoing research on ME/CFS and proposes methods to increase the number and quality of research applications submitted to NIH ranging from preclinical research to clinical trials. In addition, the WG is focusing on the recommendations from the April 2011 State of the Knowledge Workshop on ME/CFS to develop priorities. The outcome from these planning sessions will suggest a range of activities and research.

Recommendation 3: CFSAC would like to encourage and support the creation of the DHHS Interagency Working Group on Chronic Fatigue Syndrome and ask this group to work together to pool resources that would put into place the “Centers of Excellence” concept that has been recommended repeatedly by this advisory committee. Specifically, CFSAC encourages utilizing HHS agency programs and demonstration projects, available through the various agencies, to develop and coordinate an effort supporting innovative platforms that facilitate evaluation and treatment, research, and public and provider education. These could take the form of appropriately staffed physical locations, or be virtual networks comprising groups of qualified individuals who interact through a variety of electronic media. Outreach and availability to underserved populations, including people who do not have access to expert care, should be a priority in this effort.

HHS leadership has identified the need for a Department-wide plan to address ME/CFS. The Department established the HHS Ad Hoc Workgroup on ME/CFS to develop a plan and to identify opportunities for interagency collaboration. The HHS ME/CFS plan will highlight recently initiated programs and future agency-specific and cross-agency activities. In developing the report, the Ad Hoc Workgroup will consider recommendations made by CFSAC. After completion, the ME/CFS plan will be posted on the CFSAC website. The DFO, Nancy C. Lee, M.D. is responsible for providing leadership and coordination for development of the HHS ME/CFS report.

Recommendation 4: This multi-part recommendation pertains to classification of CFS in ICD classification systems:

a) CFSAC considers CFS to be a multi-system disease and rejects any proposal to classify ME/CFS as a psychiatric condition in the U.S. disease classification systems.

b) CFSAC rejects the current classification of ME/CFS in Chapter 18 of ICD-9-CM under R53.82, chronic fatigue unspecified, chronic fatigue syndrome, not otherwise specified.

c) CFSAC continues to recommend that ME/CFS should be classified in ICD-IO-CM in Chapter 6 under Diseases of the Nervous System at G93.3 in line with ICD-IO, the World Health Organization, and ICD-I-CA [sic], the Canadian Clinical Modification and in accordance with CFSAC’s recommendations of August 2005 and May 2011. CFSAC rejects CDC’s National Center for Health Statistics (NCHS) Option 2 and recommends that ME/CFS remain in the same code and the same subcode as myalgic encephalomyelitis because CFS includes both viral and non-viral triggers.

d) CFSAC recommends that an “excludes one”* be added to G93.3 for chronic fatigue, R53.82, and neurasthenia, F48.8. CFSAC recommends that these changes be made in ICD-10-CM prior to its rollout in 2013.**

[*Ed: Should read "Excludes 1". For definitions for “Excludes1″ and “Excludes2″ see Post #118]

[**Ed: On August 3, HHS announced Final Rule to delay compliance date for ICD-10-CM/PCS to October 1, 2014.]

Development and implementation of the guidelines for the lCD-10 fall within HHS under the purview of the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services. Use of the revised codes will provide robust and specific data that will improve patient care and enable the international comparability of health care data. On February 16, 2012, the Department issued a press release announcing that HHS would initiate a process to postpone the date that certain health care entities must comply with the ICD-10.

A proposal to change the classification of ME/CFS in ICD-10-CM was presented at the September 2011 Coordination and Maintenance (C & M) Committee/CDC/NCHS; a subsequent proposal was received on January 12, 2012 and will be presented at the September 19, 2012 C & M meeting for additional discussion.

+++
Related posts

Notice of Meeting of the ICD-9-CM Coordination and Maintenance Committee

Coding CFS in ICD-10-CM: CFSAC and the Coalition4ME/CFS initiative

Extracts: ICD-9-CM Coordination and Maintenance Committee Meeting Summary document (CFS coding)

Extracts: ICD-9-CM Coordination and Maintenance Committee Meeting September 14, 2011 (Coding of CFS in ICD-10-CM)

HHS announces Final Rule on ICD-10-CM compliance date

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HHS announces Final Rule on ICD-10-CM compliance date

Post #202 Shortlink: http://wp.me/pKrrB-2uk

Update at August 26:

HHS Announces: ICD-10 Delayed One Year

The American Health Information Management Association (AHIMA) | August 24, 2012

Press release

 

…and finally…

Yesterday, August 24, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced a final rule to delay compliance for adopting ICD-10-CM and ICD-10-PCS (ICD-10) code sets to October 1, 2014.

“The rule also makes final a one-year proposed delay – from Oct. 1, 2013, to Oct. 1, 2014– in the compliance date for use of new codes that classify diseases and health problems.”

http://www.hhs.gov/news/press/2012pres/08/20120824e.html

News Release
FOR IMMEDIATE RELEASE
August 24, 2012 Contact: U.S. Department of Health & Human Services
202-690-6343

New health care standards to save up to $6 billion

Today, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced a final rule that will save time and money for physicians and other health care providers by establishing a unique health plan identifier (HPID). The rule is one of a series of changes required by the Affordable Care Act to cut red tape in the health care system and will save up to $6 billion over ten years.

“These new standards are a part of our efforts to help providers and health plans spend less time filling out paperwork and more time seeing their patients,” Secretary Sebelius said.

Currently, when a health care provider bills a health plan, that plan may use a wide range of different identifiers that do not have a standard format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility. The change announced today will greatly simplify these processes.

The rule also makes final a one-year proposed delay – from Oct. 1, 2013, to Oct. 1, 2014– in the compliance date for use of new codes that classify diseases and health problems. These code sets, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include codes for new procedures and diagnoses that improve the quality of information available for quality improvement and payment purposes.

The rule announced today is the fourth administrative simplification regulation issued by HHS under the health reform law:

On July 8, 2011, HHS adopted operating rules for two electronic health care transactions to make it easier for health care providers to determine whether a patient is eligible for coverage and the status of a health care claim submitted to a health insurer. The rules will save up to $12 billion over ten years.

On Jan. 10, 2012, HHS adopted standards for the health care electronic funds transfers (EFT) and remittance advice transaction between health plans and health care providers. The standards will save up to $4.6 billion over ten years.

On Aug. 10, 2012, HHS published an IFC that adopted operating rules for the health care EFT and electronic remittance advice transaction. The operating rules will save up to $4.5 billion over ten years.

More information on the final rule is available in a fact sheet at http://www.cms.gov/apps/media/fact_sheets.asp  

The final rule may be viewed at www.ofr.gov/inspection.aspx  

###

Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news  
You can follow HHS on Twitter @HHSgov and sign up for HHS Email Updates.
Last revised: August 24, 2012

CENTERS FOR MEDICARE & MEDICAID SERVICES

RULES

Administrative Simplification:

Adoption of Standard for Unique Health Plan Identifier; Addition to National Provider Identifier Requirements, etc.

2012-21238
[CMS 0040 F; Filed: 08/24/12 at 12:00pm; Publication Date: 9/5/2012]

http://www.ofr.gov/OFRUpload/OFRData/2012-21238_PI.pdf

or download here:     2012-21238_PI

Extract:

(3) ICD-10-CM and ICD-10-PCS Code Sets

In the January 16, 2009 Federal Register (74 FR 3328), HHS published a final rule in which the Secretary of HHS (the Secretary) adopted the ICD-10-CM and ICD-10-PCS (ICD-10) code sets as the HIPAA standards to replace the previously adopted International Classification of Diseases, 9th Revision, Clinical Modification, Volumes 1 and 2 (diagnoses), and 3 (procedures) including the Official ICD–9–CM Guidelines for Coding and Reporting. The compliance date set by the final rule was October 1, 2013.

Since that time, some provider groups have expressed strong concern about their ability to meet the October 1, 2013 compliance date and the serious claims payment issues that might ensue if they do not meet the date. Some providers’ concerns about being able to meet the ICD-10 compliance date are based, in part, on difficulties they had meeting the compliance deadline for the adopted Associated Standard Committee’s (ASC) X12 Version 5010 standards (Version 5010) for electronic health care transactions. Compliance with Version 5010 and ICD-10 by all covered entities is essential to a smooth transition to the updated medical data code sets, as the failure of any one industry segment to achieve compliance would negatively affect all other industry segments and result in returned claims and provider payment delays. We believe the change in the compliance date for ICD-10 gives covered health care providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition by all covered entities.

Notice of Meeting of the ICD-9-CM Coordination and Maintenance Committee

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Notice of Meeting of the ICD-9-CM Coordination and Maintenance Committee

Post #201 Shortlink: http://wp.me/pKrrB-2tv

Update at August 18:

CMS meeting to address more ICD-10 issues  Round up from Carl Natale for ICD10 Watch

September ICD-9-CM C & M meeting announced

The next meeting of the ICD-9-CM Coordination and Maintenance Committee has been announced for September 19, 2012 and a tentative agenda published.

For further information on this public process see the CDC website page:

The 2013 release of ICD-10-CM is available to download from the CDC site: International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

ICD-9-CM Coordination and Maintenance Committee

Upcoming meeting: September 19, 2012

    Tentative Agenda

Html: Federal Register Notice of Meeting of ICD-9-CM Coordination and Maintenance Committee

A Notice by the Centers for Disease Control and Prevention

Notice of Meeting of the ICD-9-CM Coordination and Maintenance Committee

The National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards Staff announces the following meeting:

Name: ICD-9-CM Coordination and Maintenance (C&M) Committee meeting.

Time and Date: 9 a.m.-5 p.m., September 19, 2012.

Place: Centers for Medicare and Medicaid Services (CMS) Auditorium, 7500 Security Boulevard, Baltimore, Maryland 21244.

Status: Open to the public, limited only by the space available. The meeting room accommodates approximately 240 people.

Security Considerations: Due to increased security requirements CMS has instituted stringent procedures for entrance into the building by non-government employees. Attendees will need to present valid government-issued picture identification, and sign-in at the security desk upon entering the building. Attendees who wish to attend a specific ICD-9-CM C&M meeting on September 19, 2012, must submit their name and organization by September 10, 2012, for inclusion on the visitor list. This visitor list will be maintained at the front desk of the CMS building and used by the guards to admit visitors to the meeting.

Participants who attended previous ICD-9-CM C&M meetings will no longer be automatically added to the visitor list. You must request inclusion of your name prior to each meeting you attend.

Please register to attend the meeting on-line at: http://www.cms.hhs.gov/apps/events/.Show citation box

Please contact Mady Hue (410-786-4510 or Marilu.hue@cms.hhs.gov ), for questions about the registration process.

Matters To Be Discussed: Tentative agenda items include: September 19, 2012.

ICD-10 Topics:
ICD-10 Implementation Announcements
Expansion of Thoracic Aorta Body Part Under Heart and Great Vessels System
Addendum Issues (Temporary Therapeutic Endovascular Occlusion of Vessel, changing body part from thoracic aorta to abdominal aorta)
ICD-10MS-DRGs
ICD-10HAC Translations
ICD-10MCE Translations

ICD-10-CM Diagnosis Topics:
Age related macular degeneration
Bilateral mononeuropathy
Bilateral option for cerebrovascular codes
Chronic Fatigue Syndrome
Complications of urinary devices
Diabetic macular edema
Food Protein Induced Enterocolitis Syndrome (FPIES)
Maternal care for previous Cesarean section/previous uterine incision
Metatarsus varus (congenital metatarsus adductus)
Microscopic colitis
Mid-cervical region and coding of spinal cord injuries
Multifocal motor neuropathy
Parity to supervision of pregnancy codes
Proliferative diabetic retinopathy
Retinal vascular occlusions
Salter Harris fractures
Sesamoiditis
Shin splints
Spontaneous rupture/disruption of tendon

Agenda items are subject to change as priorities dictate.

Note:

CMS and NCHS will no longer provide paper copies of handouts for the meeting. Electronic copies of all meeting materials will be posted on the CMS and NCHS Web sites prior to the meeting at http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp#  and http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

Contact Persons for Additional Information: Donna Pickett, Medical Systems Administrator, Classifications and Public Health Data Standards Staff, NCHS, 3311 Toledo Road, Room 2337, Hyattsville, Maryland 20782, email dfp4@cdc.gov :, telephone 301-458-4434 (diagnosis); Mady Hue, Health Insurance Specialist, Division of Acute Care, CMS, 7500 Security Boulevard, Baltimore, Maryland 21244, email marilu.hue@cms.hhs.gov , telephone 410-786-4510 (procedures).

The Director, Management Analysis and Services Office, has been delegated the authority to sign Federal Register notices pertaining to announcements of meetings and other committee management activities, for both the Centers for Disease Control and Prevention, and the Agency for Toxic Substances and Disease Registry.

Dated: August 9, 2012.

Catherine Ramadei,

Acting Director, Management Analysis and Services Office, Centers for Disease Control and Prevention.

[FR Doc. 2012-20019 Filed 8-14-12; 8:45 am]

BILLING CODE 4160-18-P

(c) 2012 US Federal Register

+++
Related posts:

At the ICD-9-CM Coordination and Maintenance Committee’s September 14, 2011 meeting, a presentation was made on behalf of the Coalition 4 ME/CFS in relation to the formal submission of a proposal that consideration be given to moving the classification of Chronic fatigue syndrome from its current proposed location within the ICD-10-CM R code chapter (Chapter 18: Symptoms and signs) to the G code chapter (Chapter 6: Diseases of the nervous system).

This would bring chapter location and parent class coding of Chronic fatigue syndrome in line with the international version of ICD-10, published in 1990, the Canadian ICD-10-CA and proposals for the forthcoming ICD-11.

No decision in response to the proposal, meeting discussions and public comment received has been conveyed following closure of the public comment period. Further discussion of Chronic fatigue syndrome has been tabled on the tentative agenda for the September 19, 2012 meeting.

I will post Summary documents and other relevant meeting materials as these become available. There are three posts on Dx Revision Watch that relate to and report on the presentation at the September 14, 2011 meeting:

Coding CFS in ICD-10-CM: CFSAC and the Coalition4ME/CFS initiative

Extracts: ICD-9-CM Coordination and Maintenance Committee Meeting Summary document (CFS coding)

Extracts: ICD-9-CM Coordination and Maintenance Committee Meeting September 14, 2011 (Coding of CFS in ICD-10-CM)