The “harmonization” of DSM-5 and ICD-11

The APA participates with the WHO in the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders and the DSM-ICD Harmonization Coordination Group.

There is already a degree of correspondence between DSM-IV categories and Chapter V of ICD-10. For the next editions, the APA and the WHO have committed as far as possible:

To facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria.

with the objective that:

The WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.

The WHO acknowledges that there may be areas where congruency may not be achievable.

With the timelines for DSM-5 and ICD-11 running out of synch, this may present barriers to “harmonization.”

Are the two revisions on schedule?

Update: DSM-5 published in May 2013.

The original dissemination date for ICD-11 had been 2012, with the timelines for revision of both systems running more or less in parallel. The dissemination date for ICD-11 was later extended to 2014, then to 2015, now 2017. Work on the ICD-11 Alpha and Beta drafts is reported to be running behind schedule.

The timeline for DSM-5 has also slipped. APA originally planned to publish DSM-5 in May 2012. But in a press release issued in December 2009, APA announced that it was postponing publication for a further year, until May 2013 “to allow more time for public review, field trials and revisions.”

The press release also stated:

The extension will also permit the DSM-5 to better link with the U.S. implementation of the ICD-10-CM codes for all Medicare/Medicaid claims reporting, scheduled for October 1, 2013.

The ICD-10-CM includes disorder names, logical groupings of disorders and code numbers but not explicit diagnostic criteria. The APA has already worked with CMS and CDC to develop a common structure for the currently in-use DSM-IV and the mental disorders section of the ICD-10-CM. Update: ICD-10-CM implementation date is currently October 1, 2014 2015.

APA will continue to work with the WHO to harmonize the DSM-5 with the mental and behavioral disorders section of the ICD-11. Given the timing of the release of both DSM-5 and ICD-11 in relation to the ICD-10-CM, the APA will also work with the CDC and CMS to propose a structure for the U.S. ICD-10 CM that is reflective of the DSM-5 and ICD-11 harmonization efforts. This will be done prior to the time when the ICD-10-CM revisions are “frozen” for CMS and insurance companies to prepare for the October 1, 2013, adoption. Update: ICD-10-CM implementation date is currently October 1, 2015.

In a June 2011 presentation to the International Congress of the Royal College of Psychiatrists, APA President, John M. Oldham, MD, MS, spoke of “Negotiations in progress to ‘harmonize’ DSM-5 with ICD-11 and to ‘retro-fit’ these codes into ICD-10-CM” and that DSM-5 would need “to include ICD-10-CM ‘F-codes’ in order to process all insurance claims beginning October 1, 2011.”

With the three systems: DSM-5 (publication date: May 2013), ICD-10-CM (subject to partial code freeze on October 1, 2011 until 2014+ 2015, to allow insurance companies to reprogram and train professionals in the use of the new codes; new compliance date tba) and ICD-11 (dissemination in 2015 or 2016) set to become potentially more closely aligned, the proposed structure of ICD-11 may have implications for US patient populations, even though the US might not anticipate moving on to a clinical modification of ICD-11 before 2020*.

*Source: DHSS Office of Secretary Final Rule document“We estimated that the earliest projected date to begin rulemaking for implementation of a U.S. clinical modification of ICD–11 would be the year 2020.” [Based on ICD-11 being ready in 2014/15. ICD-11 since rescheduled to 2017 WHA Approval.]

WHO-FIC meeting materials suggest no earlier than 2018 for Canada (currently using ICD-10-CA). Australia (currently using ICD-10-AM) is discussing earlier adoption of ICD-11.

Will ICD-11 be implementing worldwide from 2015?

Update: In February 2014, WHO/ICD-11 Revision Steering Group revised the ICD-11 schedule, shifting the date by which ICD-11 is planned to be presented for World Health Assembly approval from 2015 to 2017.

No. Several countries have been authorized by WHO to develop their own “Clinical Modifications (CM)” of ICD. Canada, for example, uses an adaptation called ICD-10-CA, with a version published for 2009. Germany uses a version called ICD-10-GM. Australia (ICD-10-AM) and Thailand also use country specific adaptations of ICD-10.

The US currently uses a CM version of ICD-9 (long since retired by the WHO when it was replaced with ICD-10). But instead of moving onto ICD-11, once this is completed, the US had scheduled implementation of a clinical modification of ICD-10 called ICD-10-CM, for October 1, 2013 – four months after DSM-5 is slated for publication. (The compliance date was proposed to be postponed on January 16, 2012; a rule proposing a new compliance date of October 1, 2014 has been announced and put out for public comment but has yet to be ratified. Update: Since ratified.) Update: Since postponed to October 1, 2015.

There are disparities between some proposed codings for the forthcoming US Clinical Modification, ICD-10-CM, and those in ICD-10; for example, the indexing of Chronic fatigue syndrome in ICD-10 differs from the current proposal for chapter placement and coding within ICD-10-CM.

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