Changes to SNOMED CT and Read Codes (CTV3) for CFS, ME and PVFS

Post #327 Shortlink: http://wp.me/pKrrB-4aD

Recent changes to SNOMED CT for CFS, ME and PVFS

  • Correspondence between Forward-ME and UK Health and Social Care Information Centre
  • SNOMED CT retires Mental disorder parent for Chronic fatigue syndrome and ME
  • Projected changes to April 2016 release of Read Codes Clinical Terms Version 3 (CTV3)
  • Read Codes system to be phased out as part of wider SNOMED CT implementation

In addition to ICD-10, a number of terminology and electronic health and medical record systems are used in the UK in primary, secondary, and health and social care clinical settings, which include:

OPCS-4 (classification of Surgical Operations and Procedures)

SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms, a comprehensive, multilingual clinical terminology system)

Read Codes (a coded thesaurus of clinical terms for recording patient findings and procedures in health and social care IT systems across primary and secondary care, e.g. GP surgeries and reporting of pathology results).

The National Information Board (NIB) has specified that all primary care systems adopt SNOMED CT by the end of December 2016 and that SNOMED CT is to be used as the single terminology in all health care settings in England, with a projected adoption date for the entire health system of April 2020 [3].

You can access a public SNOMED CT browser here: IHTSDO browser

This is an online browser and does not require any software to be downloaded. You will need to accept the license and then select for the UK “Local Extension” of SNOMED CT. Click on the “Search” tab to enter clinical terms.

The SNOMED CT International Edition and “Local Extensions” for a number of other countries, including the US, are also available via the browser. All editions release new updates twice a year, on a staggered schedule. The Release schedule for the UK Extension is April and October.

Read Codes system to be retired

The Read Codes system of clinical terms has been used in the NHS since 1985. As part of the adoption of SNOMED CT in primary care, Clinical Terms Version 3 (CTV3) is being deprecated.

More information on the phasing out of Read Codes, here:

Retirement of Read Version 2 and Clinical Terms Version 3

Click link for PDF document Retirement Schedule

There was no new release for CTV3 issued in October, but the April 2016 release is scheduled for Friday, 18th March 2016. The last release of CTV3 will be published in April 2018.

How have CFS and related terms been listed within SNOMED CT and CTV3?

SNOMED CT

Prior to July 2015, all editions of SNOMED CT had the following listings for CFS, ME and PVFS:

Chronic fatigue syndrome (with ME – Myalgic encephalomyelitis and several other related and historical terms listed under Synonyms) was assigned two parent disorder classes: Mental disorder, and Multisystem disorder.

Postviral fatigue syndrome was listed under Children to Chronic fatigue syndrome.

Read Codes (CTV3)

The twice yearly Read Codes releases (April and October) are available only to license holders but the codes can be viewed through this public resource (caveat: it is unclear how often this NCBO BioPortal ontology resource is updated with new releases for individual ontology systems):

See: BioPortal Xa01F

For CTV3, Xa01F Chronic fatigue syndrome (with ME – Myalgic encephalomyelitis and PVFS – Postviral fatigue syndrome under Synonyms) is listed, hierarchically, under two parent disorder classes: as a Sub Class of both Neurasthenia, under parent: Mental health disorder, and as a Sub Class of Neurological disorder.

See: http://purl.bioontology.org/ontology/RCD/Xa01F

Mental health disorder > Neurotic disorder > Somatoform disorder > Neurasthenia > Chronic fatigue syndrome

and

Neurological disorder > Chronic fatigue syndrome

See also the Visualization tab for a diagrammatic representation of dual parentage:

http://bioportal.bioontology.org/ontologies/RCD?p=classes&conceptid=Xa01F#visualization

Correspondence between Countess of Mar and UK Health and Social Care Information Centre

Forward-ME is an informal group for ME charities and voluntary organizations, chaired by the Countess of Mar, who also serves as Co-chair to the All-Party Parliamentary Group on Myalgic Encephalomyelitis (ME).

Between November 2014 and June 2015, Lady Mar was in correspondence with Mr Leon Liburd, Senior Support Analyst Systems and Service Delivery, and Ms Elaine Wooler, Advanced Clinical Terminology Specialist, UK Health and Social Care Information Centre.

Their correspondence (in reverse date order) was published on the Forward-ME website in June and can be read here Correspondence re SNOMED added June 2015

or open PDF here on Dx Revision Watch

Click link for PDF document  Correspondence re SNOMED

Changes to SNOMED CT

As a result of these exchanges, Lady Mar was advised that the relationship between the entry for 52702003 Chronic fatigue syndrome and the Mental disorder parent had been retired. In future editions, Chronic fatigue syndrome would be listed under the single parent, 281867008 Multisystem disorder.

See here

Additionally, 51771007 Postviral fatigue syndrome was being removed as a subtype of 52702003 Chronic fatigue syndrome (disorder) – though no rationale for this specific decision appears to be provided within the correspondence.

See here

[So 51771007 Postviral fatigue syndrome would be no longer be listed as a sub class under Children to 52702003 Chronic fatigue syndrome but directly under two parents: 281867008 Multisystem disorder and 123948009 Post-viral disorder.]

These changes were effected in the July 2015 release for the International Edition (Release 20150731).

They were subsequently incorporated into the September 2015 US Extension (Release 20150901), the October 2015 UK Extension (Release 20151001) and the November 2015 Swedish Extension (Release 20151130). It is expected that other country Extensions will also reflect these changes in their forthcoming releases.

Within the correspondence, on 11 November 2014, Mr Leon Liburd had also advised Lady Mar:

“It is also noted that the corresponding representation in the UK’s Clinical Terms Version 3 terminology product Xa01F | Chronic fatigue syndrome is classified as both a Neurological disorder and a Mental health disorder. As such, any conclusions emerging from the SNOMED CT discussions would also be reflected in the CTV3 UK product.”

Clarification re CFS and CTV3

In November, I contacted the UK Health and Social Care Information Centre for clarification of how CFS and its various Synonyms are currently listed within CTV3.

On 20 November, I was advised by Karim Nashar, Terminology Specialist, UK Terminology Centre, Health and Social Care Information Centre, that:

“[Xa01F | Chronic fatigue syndrome was being moved] under a single supertype 281867008 | Multisystem disorder (disorder) as to reflect the SNOMED correction in CTV3″

and that this change should be reflected in the April 2016 CTV3 release.

As noted above, Clinical Terms Version 3 (CTV3) is being deprecated and the last release of CTV3 will be published in April 2018.

The ICD-11 Beta draft and proposed classification of the G93.3 legacy terms

In June, WHO’s Dr Robert Jakob had told me that if TAG Neurology’s proposals and rationales for the G93.3 legacy terms were not ready for public release in September, he projected their release by December, latest (see towards end of Post #324).

No proposals were released in September and none in December. Eight years into the revision process and stakeholders still don’t know how ICD Revision proposes to classify the ICD-10 G93.3 legacy terms for ICD-11.

On 28 December, I called again, via the ICD-11 Beta Comments mechanism, for these terms to be restored to the public version of the Beta drafting platform.


 References

1 UK Terminology Centre (UKTC): http://systems.hscic.gov.uk/data/uktc/

2 SNOMED CT: http://systems.hscic.gov.uk/data/uktc/snomed

3 NIB document ‘Personalised Health and Care 2020: A Framework for Action’:
https://www.gov.uk/government/publications/personalised-health-and-care-2020

4 IHTSDO browser: http://browser.ihtsdotools.org

5 Retirement of Read Version 2 and Clinical Terms Version 3: http://systems.hscic.gov.uk/data/uktc/readcodes

6 NCBO BioPortal Read Codes (CTV3) Xa01F Chronic fatigue syndrome

7 Forward-ME Correspondence re SNOMED added June 2015

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DSM-5 Round up: April #3

Post #240 Shortlink: http://wp.me/pKrrB-2T2

“…Psychiatry has already reached far into our daily lives, and it’s not by virtue of the particulars of any given D.S.M. It’s because the A.P.A., a private guild, one with extensive ties to the drug industry, owns the naming rights to our pain. That so significant a public trust is in private hands, and on such questionable grounds, is what we ought to worry about.”
           The New Yorker, April 9, 2013

The Book of Woe

Gary Greenberg is a Connecticut psychotherapist, author of four books and cultivator of an impressive braid.

Greenberg’s new book The Book of Woe: The DSM and the Unmaking of Psychiatry on the politics and controversies surrounding the making of DSM is published by Blue Rider Press on May 2. Read an excerpt here.

Extracts from “Manufacturing Depression” (Harpers, May 2007), essays, articles and other writings can be read here. Media interviews and podcasts here.

Gary Greenberg blogs here.

Interview with Gary Greenberg:

The Atlantic

The Real Problems With Psychiatry

A psychotherapist contends that the DSM, psychiatry’s “bible” that defines all mental illness, is not scientific but a product of unscrupulous politics and bureaucracy.

“…take the damn thing away from them.”

Hope Reese | May 2, 2013

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DSM-5 Media Round up: April #3

Nature | News Feature

Nature Volume: 496, Pages: 416–418 Date published: (25 April 2013) DOI:doi:10.1038/496416a

Mental health: On the spectrum

Research suggests that mental illnesses lie along a spectrum — but the field’s latest diagnostic manual still splits them apart.

David Adam | April 24, 2013

p. 397 Editorial

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Globe and Mail (Canada)

When did life itself become a treatable mental disorder?

Patricia Pearson | Special to The Globe and Mail | April 27, 2013

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Plos Open Access

Perspective doi:10.1371/journal.pbio.1001544

Subgrouping the Autism “Spectrum”: Reflections on DSM-5

Meng-Chuan Lai, Michael V. Lombardo, Bhismadev Chakrabarti, Simon Baron-Cohen

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Monitor on Psychology (Organ of the American Psychological Association)

The Next DSM

A look at the major revisions of the Diagnostic and Statistical Manual of Mental Disorders, due out next month.

Rebecca A Clay | April 2013

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Psychology Today

Saving Normal

The International Reaction to DSM-5

Allen Frances, MD | April 23, 2013

For WPA/WHO survey of global usage of ICD-10 v DSM-5 see Presentation slides: Slides 17 and 18:
Revising the ICD Definition of Intellectual Disability: Implications and Recommendations March 19, 2013
Data from 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. Free full paper

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Huffington Post Allen Frances MD
Allen Frances MD, Professor Emeritus, Duke University | April 21, 2013

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Slide presentation David J Kupfer

Psychiatry Update – American College of Physicians | March 2, 2013

www.acponline.org/about_acp/chapters/va/13mtg/kupfer_psychiatryupdate.pptx

File Format: Microsoft Powerpoint .pptx

(Emerging options for DSM-5 Primary Care Version from Slide 18)

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Psychiatric News | April 19, 2013
Volume 48 Number 8 page 5-5
10.1176/appi.pn.2013.4b14
American Psychiatric Association

Professional News

Gambling Disorder to Be Included in Addictions Chapter

Mark Moran | April 19, 2013

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Full paper PDF:

www.luc.edu/law/media/law/students/publications/llj/pdfs/hass.pdf

Could the American Psychiatric Association Cause You Headaches? The Dangerous Interaction between the DSM-5 and Employment Law

Douglas A. Hass | March 9, 2013

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Scientific American

New DSM-5 Ignores Biology of Mental Illness

The latest edition of psychiatry’s standard guidebook neglects the biology of mental illness. New research may change that

Ferris Jabr | April 2013

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UK Times

First, the good news: you’re not having a nervous breakdown

John Naish | April 16, 2013

Behind a paywall

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11th hour call: “Mislabeling Medical Illness As Mental Disorder” by Allen J. Frances, MD.

11th hour call: “Mislabeling Medical Illness As Mental Disorder” by Allen J. Frances, MD.

Post #217 Shortlink: http://wp.me/pKrrB-2AL

Image Copyright Dx Revision Watch 2012On December 8, Allen J. Frances, MD, blogged at Psychology Today on our shared concerns for the new DSM-5 category – Somatic Symptom Disorder. Dr Frances was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus, Duke.

One in six people suffering from cancer, heart and other serious diseases risks being saddled with a psychiatric diagnosis if they are considered to be “excessively” worried about their illness or spending more time on the internet researching their symptoms than the American Psychiatric Association (APA) thinks good for them.

But many illness groups – particularly the so-called “functional somatic syndromes” – stand to be captured by these new criteria and assigned an additional mental health diagnosis, or placed at risk of misdiagnosis.

The DSM-5 manual texts are still being finalized and the Somatic Symptom Disorder Work Group has been asked to reconsider its criteria and tighten them up before the next edition of DSM is sent to the publishers.

Please demonstrate to the APA and the Somatic Symptom Disorder Work Group the level of concern amongst clinicians and allied health professionals, patients, caregivers and advocacy organizations by visiting Dr Frances’ blog post and leaving a comment. You can read the commentary at the link, below.

If you share our concerns that these catch-all criteria will see thousands more patients tagged with a mental health label please forward the link to your colleagues and contacts and post on Twitter, blogs and social media platforms.

Thank you,

Suzy Chapman for Dx Revision Watch

Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake

Psychology Today, DSM5 in Distress, Allen Frances, MD, December 8, 2012

Additional commentary

Oak Park Behavioral Medicine, Mind Your Body blog

Moving in the Wrong Direction

Dr Tiffany Taft, Ph.D., Northwestern University, December 13, 2012

IBS Impact IBS Impact blog

Proposed DSM-5 Criteria May Unfairly Label Physical Conditions as Psychological Disorders

The most recent proposals for new category “J 00 Somatic Symptom Disorder”

Ed: Proposals, criteria and rationales, as posted for the third stakeholder review and comment period, in May 2012, were removed from the DSM-5 Development website on November 15, 2012 and placed behind a non public log in. Criteria as they had stood for the third draft can no longer be viewed but are set out on Slide 9 in this presentation, which note, does not include the three, optional Severity Specifiers that were included in the third iteration.

Note that the requirement for “at least two from the B type criteria” was reduced to “at least one from the B type criteria” between the second and third set of draft proposals.

IASP and the Classification of Pain in ICD-11  Prof. Dr. Winfried Rief, University of Marburg,

Slide 9

Related material

Somatic Symptom Disorder could capture millions more under mental health diagnosis

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals

Bloomberg: How Many Billions a Year Will the DSM-5 Cost? Allen Frances, MD

Bloomberg: How Many Billions a Year Will the DSM-5 Cost? Allen Frances, MD

Post #216 Shortlink: http://wp.me/pKrrB-2Av

Update: Additional recent articles on DSM-5 development:

Healio Psychiatric Annals > Practice Management > News

DSM-5: a ‘living document’ that may impact practice, patients health

December 21, 2012

Bloomberg

How Many Billions a Year Will the DSM-5 Cost?

Illustration by Pete Gamlen

Allen Frances, MD | December 20, 2012

Further responses to the commentary on DSM-5 Somatic Symptom Disorder by Allen Frances and Suzy Chapman published last week on Psychology Today, Huffington Post and Education Update:

IBS Impact blog

Proposed DSM-5 Criteria May Unfairly Label Physical Conditions as Psychological Disorders

“Recently in the IBS and chronic illness community, several professionals and self-advocates have begun expressing concern about proposed changes in the Diagnostic and Statistical Manual for Mental Disorders, commonly known as the DSM…The DSM is revised periodically and the 5th edition is expected to be released in 2013. While there are many controversial proposed changes, one that has received relatively little attention in the mainstream media is particularly alarming in its potential implications for people with chronic illnesses, especially ones that are still scientifically poorly understood, like irritable bowel syndrome or commonly overlapping conditions like fibromyalgia, chronic fatigue syndrome and interstitial cystitis among others…”

Mind Your Body

Moving in the Wrong Direction

Dr Tiffany Taft, Ph.D., Northwestern University | December 13, 2012

“…Rather than repeating what’s in store in DSM 5, this article provides an excellent summary of the proposed changes. It’s really worth taking the time to read, whether you have diabetes, irritable bowel syndrome, lupus, or fibromyalgia. The bottom line is, regardless of the etiology of your chronic illness you are a candidate for the Somatic Symptom Disorder (SDD) diagnosis. If you’re a parent caregiver, your reactions to your child’s illness may be deemed pathological as well…”

The Reporting on Health Member Blog

DSM 5 – Misdiagnosing or Mislabeling of Medical Diseases

Kate Benson | December 19, 2012

Related material

Somatic Symptom Disorder could capture millions more under mental health diagnosis

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals

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

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

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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)

Trouble with timelines (2) Might APA hold back DSM-5 in response to an October 2014 ICD-10-CM compliance date?

Trouble with timelines (2): Might APA hold back publication of DSM-5 in response to a firm October 2014 ICD-10-CM compliance date?

Post #200 Shortlink: http://wp.me/pKrrB-2sW

Update at August 17: Commentary on DSM-5 from One Boring Old Man: didn’t need to happen…

Update at August 16: Commentary on DSM-5 from One Boring Old Man: all quiet on the western front…

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In Trouble with timelines (1): DSM-5, ICD-10-CM, ICD-11 and ICD-11-CM, on August 10, I wrote

With no changes to the published Timeline and no intimation of further delays, I’m assuming DSM-5 remains on target.

But it’s not necessarily a given that DSM-5 will be on the bookshelves for May 2013.

Roger Peele, M.D., D.L.F.A.P.A, has been a member of the DSM-5 Task Force since 2006. From 2007- 2010, Dr Peele was APA Trustee-At-Large; since 2010, Secretary to the APA Board of Trustees.

Dr Peele maintains a website at http://rogerpeele.com/index.asp providing clinical information for Montgomery County clinicians, resources for County residents and listing some of the initiatives taken relative to the American Psychiatric Association:

http://rogerpeele.com/

Writing just a few days after HHS Secretary’s announcement of intent to postpone the compliance date for adoption of ICD-10-CM/PCS codes sets for a further year, to October 1, 2014, Dr Peele informed his readers that the proposal to delay the compliance deadline

“…reduces some of the pressures to publish DSM-5 in 2013.”

In his post of February 23, Dr Peele goes on to say that a more certain answer was expected on February 28, but that remarks at the previous day’s American College of Psychiatrists meeting suggested the timing of DSM-5 for early 2013 was still on.

This suggests to me that if HHS decides not to take forward its proposal to delay ICD-10-CM compliance until October 1, 2014 but to stick with the original compliance date of October 1, 2013, that APA will still want to get its manual out several months ahead of the ICD-10-CM compliance deadline.

In order to meet a publication date of May 2013, APA says the final manual text will need to be with the publishers by December, this year. So unless HHS announces a decision within the next few weeks, APA isn’t going to have very much time left in which to dither over potentially shifting publication to 2014.

ICD-10-CM will be freely available online and is already accessible for pre implementation viewing. It’s the policy of WHO, Geneva, to make print versions of ICD publications globally available at reasonable cost. Although ICD-10-CM has been developed by US committees for US specific use, it’s not expected that print versions of ICD-10-CM will be as expensive as DSM-5.

DSM manuals are expensive; they are a commercial product generating substantial income for the APA’s publishing arm. APA will be looking to maximize sales and publication revenue and retain market share with this forthcoming edition.

There are already groups and petitions calling for the boycotting of DSM-5 in favour of using Chapter 5 of ICD-10-CM, when its code sets are operationalized.

So if ICD-10-CM is to be adopted by October 1, 2013, I cannot see APA and American Psychiatric Publishing not aiming to steal a march.

If, on the other hand, HHS were to announce shortly a firm rule that compliance for ICD-10-CM is being pushed back to October 2014, if DSM-5 Task Force and work groups are struggling to finalize the manual or having problems obtaining approval for some of their more contentious proposals from the various panels that are scrutinizing the near final draft, then delaying publication of DSM-5 to late 2013 or spring 2014 would provide APA with a window in which to complete its manual but still push it out ahead of ICD-10-CM.

Its PR firm can sell a publication delay to end-users as the APA’s taking the opportunity of postponement of ICD-10-CM compliance to allow more time for evaluation of DSM-5 field trial results, refinement of criteria or honing disorder description texts, and that a delay will better facilitate harmonization efforts with ICD-10-CM and ICD-11.

(ICD-10-CM is a modification of the WHO’s ICD-10 and has closer correspondence with DSM-IV than with DSM-5. Since 2003, ICD-9-CM diagnostic codes have been mandated by HIPAA for all electronic reporting and transactions for third-party billing and reimbursement and DSM-5 codes will need to be crosswalked to ICD-9-CM codes, for the remaining life of the ICD-9-CM. DSM-5 codes will also need to be convertible to ICD-10-CM codes for all electronic transactions.)

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 drafting timelines for the three systems now so out of whack and a partial code freeze on ICD-10-CM, and with ICD-11 still at the Beta drafting stage, I can no longer be bothered to attempt to unscramble how alignment of the three systems [or best fit where no corresponding category exists] is going to dovetail, in practice, pre and post publication, or what the implications might be for the medical billing and coding industry, for clinicians and for patients.

Dr Peele then says

“Since ICD-11-CM is due in 2016, it may become appealing to the Feds to skip ICD-10-CM, and wait until 2016”

ICD-11-CM due in 2016?

Not so. It is the WHO’s ICD-11 that is aiming for readiness by 2016.

A misconception on the part of Dr Peele or wishful thinking?

It might suit the interests of APA and American Psychiatric Publishing, financially and politically, if ICD-10-CM were to be thrown overboard and instead, the US skip to a Clinical Modification of ICD-11, two or three years after a copy of its shiny new DSM-5 is sitting on every psychiatrist’s desk.

But that is not going to happen in 2016.

There is strong federal opposition, in any case, against leapfrogging over ICD-10-CM to a US modification of ICD-11:

Federal Register, January 16, 2009:

…We [ICD-9-CM Coordination and Maintenance Committee] discussed waiting to adopt the ICD-11 code set in the August 22, 2008 proposed rule (73 FR 49805)…

…However, work cannot begin on developing the necessary U.S. clinical modification to the ICD–11 diagnosis codes or the ICD–11 companion procedure codes until ICD–11 is officially released. Development and testing of a clinical modification to ICD–11 to make it usable in the United States will take an estimated additional 5 to 6 years. 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.

The suggestion that we wait and adopt ICD–11 instead of ICD–10–CM and ICD–10–PCS does not consider that the alpha-numeric structural format of ICD–11 is based on that of ICD–10, making a transition directly from ICD–9 to ICD–11 more complex and potentially more costly. Nor would waiting until we could adopt ICD–11 in place of the adopted standards address the more pressing problem of running out of space in ICD–9–CM Volume 3 to accommodate new procedure codes…

And from a more recent Federal Register document:

Federal Register, April 17, 2012:

3. Option 3: Forgo ICD-10 and Wait for ICD-11

…The option of foregoing a transition from ICD-9 to ICD-10, and instead waiting for ICD-11, was another alternative that was considered. This option was eliminated from consideration because the World Health Organization, which creates the basic version of the medical code set from which all countries create their own specialized versions, is not expected to release the basic ICD-11 medical code set until 2015 at the earliest.

From the time of that release, subject matter experts state that the transition from ICD-9 directly to ICD-11 would be more difficult for industry and it would take anywhere from 5 to 7 years for the United States to develop its own ICD-11 CM and ICD-11-PCS versions.

 

From an interview with Christopher Chute, MD, Making the Case for the ICD-10 Compliance Delay April 4, 2012, by Gabriel Perna for Healthcare Informatics:

“…Chute is also adamant that there is no possible reason or possibility that the U.S. could just skip over ICD-10 right into ICD-11. Even with his ties to ICD-11, Chute says there it’s not realistic, nor is it plausible, to have seven-to-nine more years of ICD-9 codes, while the medical industry waits for the World Health Organization to finish drafting ICD-11 and then waits for the U.S. to adapt it for its own use.”

A recent article in the JOURNAL OF AHIMA/July 2012/Volume 83, Number 7 in response to Chute et al [1] suggests the earliest the US could move onto a CM of ICD-11 might be 2025, or 13 years from now.

So, if HHS were to announce, soonish, a final rule for an October 1, 2014 ICD-10-CM compliance date, it’s not totally out of the question, in my view, that APA (who might be struggling to complete the manual for December) may extend its publication date for a second time.

 

References

1] There are important reasons for delaying implementation of the new ICD-10 coding system. Chute CG, Huff SM, Ferguson JA, Walker JM, Halamka JD. Health Aff (Millwood). 2012 Apr;31(4):836-42. Epub 2012 Mar 21 http://www.ncbi.nlm.nih.gov/pubmed/22442180  (Abstract free; Subscription or payment required for full text)

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