September ’13 meeting Summary document posted: ICD-9-CM Coordination and Maintenance Committee

Post #279 Shortlink: http://wp.me/pKrrB-3w6

The Summary of Diagnosis Presentations for the September 2013 meeting of the ICD-9-CM Coordination and Maintenance Committee has now been posted on the CDC website.

Deadline for receipt of public comments: November 15, 2013

Comments on the proposals presented at the September meeting should be sent to this email address: nchsicd9CM@cdc.gov

The Summary document and Diagnosis Agenda document can be downloaded here:

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

Summary and Proposals

September 18-19, 2013

Summary Adobe PDF file [PDF – 93 KB] Click link for PDF document   Summary Sept 18-19 2013

http://www.cdc.gov/nchs/data/icd/icd_summary_sept_181913.pdf

Proposals Adobe PDF file [PDF – 347 KB] Click link for PDF document   Topic packet Sept 18-19 2013

http://www.cdc.gov/nchs/data/icd/icd_topic_packet_sept_181913.pdf

According to the instructions for requesters, proposals for a new code should include:

• Description of the code(s)/change(s) being requested

• Rationale for why the new code/change is needed (including clinical relevancy)

• Supporting clinical references and literature should also be submitted.

Proposals should be consistent with the structure and conventions of the classification.

For the proposals to insert Somatic symptom disorder (SSD) and Illness anxiety disorder into ICD-10-CM as inclusion terms under existing F45 Somatoform disorders codes (as listed on Page 45 of the Diagnostic Agenda/Proposals document), no descriptions, no rationales and no supporting clinical references and literature were set out in the Diagnostic Agenda/Proposals document nor presented at the September meeting.

The requesters for each of these additional 17 insertions/changes listed under “Additional Tabular List Inclusion Terms for ICD-10-CM” remain unclear.

If you have comments or objections to the proposed insertion of Somatic symptom disorder (SSD) or in relation to any of the proposals requested via the September ICD-9-CM C & M Committee meeting, please have your submissions in, via email, to Donna Pickett nchsicd9CM@cdc.gov by November 15.

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Related posts:

Keep SSD out of ICD-10-CM – November 15 deadline for objections: http://wp.me/pKrrB-3vK

Videos and meeting materials: September 18–19 ICD-9-CM Coordination and Maintenance Committee meeting: http://wp.me/pKrrB-3tV

APA petitions CMS for additions to ICD-10-CM: Deadline for public comment and objections November 15: http://wp.me/pKrrB-3tq

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References for key documents and screenshots:

1. Article: ICD Codes for Some DSM-5 Diagnoses Updated, Mark Moran, Psychiatric News, October 07, 2013:
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleID=1757346

2. ICD-9-CM/PCS Coordination and Maintenance Committee Meeting September 18-19, 2013:
http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

September meeting Proposals document [PDF – 342 KB]:
http://www.cdc.gov/nchs/data/icd/icd_topic_packet_sept_181913.pdf

3. ICD-9-CM/PCS Coordination and Maintenance Committee Meeting Sept 18-19, 2013 meeting materials and four YouTubes of proceedings:
http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials-Items/2013-09-18-MeetingMaterials.html

4. YouTube Videos from September 18, 2013 Meeting Day One

ICD-9-CM Coordination and Maintenance Committee Meeting (Morning Session) Part 1
http://www.youtube.com/watch?v=Ut3DmV88Dmc

ICD-9-CM Coordination and Maintenance Committee Meeting (Morning Session) Part 2
http://www.youtube.com/watch?v=CAE190sM5AQ

ICD-9-CM Coordination and Maintenance Committee Meeting (Afternoon Session) Part 3
http://www.youtube.com/watch?v=QQOFadq2x6U

September 19, 2013 Meeting Day Two

ICD-9-CM Coordination and Maintenance Committee Meeting Part 4
http://www.youtube.com/watch?v=G-pYdKyr_NE

Keep SSD out of ICD-10-CM – November 15 deadline for objections

Post #278 Shortlink: http://wp.me/pKrrB-3vK

Update: My submission on behalf of Dx Revision Watch can be read here.

The American Psychiatric Association (APA) has proposed the following DSM-5 disorders for inclusion in the forthcoming ICD-10-CM (Pages 32-44, September 2013 Diagnosis Agenda):

Binge eating disorder (BED);
Disruptive mood dysregulation disorder (DMDD);
Social (pragmatic) communication disorder;
Hoarding disorder;
Excoriation (skin picking) disorder;
Premenstrual dysphoric disorder (PMDD)

Additionally, APA has petitioned for revisions to the ICD-10-CM listing for gender dysphoria in adolescents and adults, which is not a new disorder.

On Page 45 and 46 of the Agenda, under Additional Tabular List Inclusion Terms for ICD-10-CM a number of other additions and changes to specific Chapter 5 F codes are being proposed, including the insertion of Somatic symptom disorder (SSD) and Illness anxiety disorder.

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A final reminder of the deadline for comments and objections in relation to Somatic symptom disorder

Q: When do objections need to be in by and where should they be sent?

A: Submit objections via email by November 15 to Donna Pickett, CDC: nchsicd9CM@cdc.gov

Q: Can anyone submit objections?

A: Yes. And from as many patient, professional and advocacy groups as possible, particularly from the U.S. but also international objections. Although this concerns potential changes to the draft of the U.S. specific ICD-10-CM there may be implications for ICD-11.

Q: What is being proposed?

A: The American Psychiatric Association has requested 6 new DSM-5 disorders for consideration for inclusion in the forthcoming ICD-10-CM via the September 18-19, 2013 ICD-9-CM Coordination and Maintenance Committee meeting.

APA’s rationales for these requested additions, the coding proposals and timings are set out on Pages 32 thru 44 of the September meeting Diagnosis Agenda.

But on Pages 45-46, under “Additional Tabular List Inclusion Terms for ICD-10-CM”, a further 17 proposals and changes are listed for consideration for addition to the Mental and behavioral disorders F codes.

These include the addition of the new DSM-5 categories, Somatic symptom disorder (SSD) and Illness anxiety disorder, as inclusion terms, under the ICD-10-CM Somatoform disorders section, thus:

ICD10CM 4

Source: September 2013 Diagnosis Agenda, Page 45

The Diagnosis Agenda can be downloaded here: http://www.cdc.gov/nchs/data/icd/icd_topic_packet_sept_181913.pdf

Q: Is “Somatic symptom disorder” being proposed to replace several existing ICD-10-CM Somatoform disorders categories and is a unique new code proposed to be assigned to SSD?

A: No, not in the proposal as it stands in the Diagnosis Agenda document.

The proposal is to add SSD as an inclusion term under F45.1 Undifferentiated somatoform disorder. This is the ICD-10-CM code to which SSD is cross-walked in the DSM-5.

Illness anxiety disorder is being proposed as an inclusion term under F45.21 Hypochondriasis. This is the ICD-10-CM code to which Illness anxiety disorder is cross-walked in the DSM-5.

Q: What should I include in my objection?

A: Responders are being asked by NCHS/CMS to consider the following: Whether you agree with a proposal, disagree (and why), or have an alternative proposal to suggest.

Responders are also being asked to comment on the timing of those proposals that are being requested for approval for October 2014: Does a specific proposal for a new or changed Index entry and Tabular List entry meet the criteria for consideration for implementation during a partial code freeze [6] or should consideration for approval be deferred to October 2015?

And separately, and where applicable, comment on the creation of a specific new code for the condition effective from October 1, 2015. (This is not applicable in the case of SSD or Illness anxiety disorder.)

• Since no timing has been specified for the proposed insertion of the requests on Pages 45-46, I suggest stating that as a poorly validated disorder construct, SSD does not meet NCHS/CMS criteria for “new diseases/new technology procedures, and any minor revisions to correct reported errors in these classifications” and should not be considered for approval during a partial code freeze.

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On Day Two of the meeting, APA’s Darrel Regier presented 7 proposals for additions or changes, discussed APA’s rationales for each of these requests, in turn, and fielded any resulting questions or comments from the floor or from the meeting chairpersons.

Rationales, references, specific coding proposals for addition as inclusion terms in October 2014 (and subsequent code modifications in those cases where a unique new ICD code is proposed to be created for the term effective from October 2015) are also set out in the Agenda document (from Page 32).

But there was no presentation on behalf of APA, or by representatives of NCHS or CMS, or by anyone else for the specific proposal to add Somatic symptom disorder (SSD) and Illness anxiety disorder as inclusion terms under the ICD-10-CM Somatoform disorders.

No rationales for their inclusion or references to scientific evidence to support the validity of these new DSM-5 constructs have been published in the Diagnosis Agenda and there was no discussion of these two proposals during the course of the meeting.

The requesters of the proposals set out on Pages 45-46 are not identified, so it is unclear whether these “Additional Tabular List Inclusion Terms” are being proposed by APA or by NCHS/CMS.

• I suggest you comment in submissions on the absence from both the Agenda document and the meeting presentations of rationales and references to enable proper public scrutiny, consideration and informed responses to the proposed inclusion of these two terms.

All that was said about the list of proposals on Pages 45-46 was the following, after Dr Regier had wrapped up his own presentation and handed the podium back to the Co-Chair:

[Unofficial transcription from videocast] Donna Pickett (CDC):

“…And just to complete the package, there are other Tabular List proposals that appear on Page 45 and 46 that we would also invite your comments on. And again, with some of the terminology changes that Dr Regier has described the intent here is to make sure that if those terms are being used, that they do have a home somewhere within ICD-10-CM to facilitate people looking these up. So we invite comments. We’re showing the Tabular List proposed changes; however, there obviously would be associated Alphabetic Index changes with that which we didn’t show just to keep the package a little bit smaller.”

• You might also consider quoting the APA’s disturbing DSM-5 field trial data (see March 2013 BMJ commentary by Prof Allen Frances for data).

• Or quote the SSD work group’s recognition of the shaky foundations and lack of scientific robustness for its new DSM-5 construct:

In its recent paper: Somatic Symptom Disorder: An important change in DSM, the SSD work group acknowledges the “small amount of validity data concerning SSD” and that much “remains to be determined” about the utility and reliability of the specific SSD criteria and its thresholds when applied in busy, general clinical practice, and there are “vital questions that must be answered.” [7]

• There is no body of published research on the epidemiology, clinical characteristics or treatment of the APA’s Somatic symptom disorder construct.

• There is a paucity of rigorous evidence for the validity, safety, reliability, acceptability and utility of the SSD construct when applied to adults and children in diverse clinical settings and across a spectrum of health and allied professionals.

• NCHS/CMS has insufficient scientific basis for the approval of SSD as a valid new disorder construct for inclusion within ICD; has published no independent field trial data and provided no rationale to inform public responses.

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Why is it important to submit objections?

If SSD is inserted as an inclusion term to an existing code in ICD-10-CM this may leverage the future replacement of several existing ICD-10-CM Somatoform disorders categories with the SSD construct, to more closely mirror DSM-5.

Inserting SSD as an inclusion term into ICD-10-CM may make it easier for ICD-11 to justify its proposal for a Bodily distress disorder to replace several existing ICD-10 Somatoform disorders categories. Though BDD may not mirror SSD exactly, it is anticipated to incorporate SSD’s characteristics and thereby facilitate harmonization between ICD-11 and DSM-5 disorder terminology.

As set out many times during the three DSM-5 stakeholder reviews and in several papers published earlier this year with Prof Allen Frances, DSM-5 SSD has highly subjective and loose, easily met criteria.

A mental health diagnosis of SSD can be applied as a “bolt-on” to any chronic medical diagnosis – to patients with cancer, diabetes, heart disease, MS, angina, ME and CFS, IBS, FM, chronic pain conditions. It can be applied to adults and children (or to the caregivers of children with chronic illnesses).

SSD may become the dustbin diagnosis into which those with persistent, “medically unexplained” somatic (bodily) symptoms will be shovelled. Patients with rare or hard to diagnose illnesses may find themselves mislabelled with SSD.

Implications for the potential impact on patients for an additional diagnosis of SSD are set out (about half way down the page) in my report Somatic Symptom Disorder could capture millions more under mental health diagnosis and in copies of submissions to the three DSM-5 stakeholder review periods, collated on this site.

Also in Mary Dimmock’s 2012 SSD Call to Action materials.

There is a now a copy of the 20 March, 2013 BMJ commentary “The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill” by Prof Allen Frances (with Suzy Chapman) on the NAPPS Skills (Northern Association for Persistent Physical Symptoms) site (Vincent Deary’s group) in this PDF.

If you’ve not already done so, please get an objection in before November 15.

And please alert all contacts, advocates, patient groups and professionals to the November 15 deadline and the need for input and objections.

Further information:

1 Crazy Like Us: How the U.S. Exports Its Models of Illness – DSM-5 is Americanizing the world’s understanding of the mind Christopher Lane, Ph.D. in Side Effects, October 9, 2013

2. Dx Revision Watch: APA petitions CMS for additions to ICD-10-CM: Deadline for public comment and objections November 15: http://wp.me/pKrrB-3tq

3. Dx Revision Watch: Videos and meeting materials: September 18- 19 ICD-9-CM Coordination and Maintenance Committee meeting: http://wp.me/pKrrB-3tV

4. Article: ICD Codes for Some DSM-5 Diagnoses Updated, Mark Moran, Psychiatric News, October 07, 2013:

http://psychnews.psychiatryonline.org/newsarticle.aspx?articleID=1757346

5. ICD-9-CM/PCS Coordination and Maintenance Committee Meeting September 18-19, 2013

September C & M meeting Diagnosis Agenda Proposals PDF document [PDF – 342 KB]

http://www.cdc.gov/nchs/data/icd/icd_topic_packet_sept_181913.pdf

6. Partial Freeze of Revisions to ICD-9-CM and ICD-10-CM/PCS

7. Somatic Symptom Disorder: An important change in DSM. Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, Lee S, Irwin MR, Levenson J. J Psychosom Res. 2013 Sep;75(3):223-8. Epub 2013 Jul 25.

Videos and meeting materials: September 18–19 ICD-9-CM Coordination and Maintenance Committee meeting

Post #277 Shortlink: http://wp.me/pKrrB-3tV

Update: Crazy Like Us: How the U.S. Exports Its Models of Illness – DSM-5 is Americanizing the world’s understanding of the mind by Christopher Lane, Ph.D. in Side Effects, October 9, 2013

This report relates to proposals submitted via the September ICD-9-CM/PCS Coordination and Maintenance Committee meeting for the inclusion of additional codes to the forthcoming US specific ICD-10-CM.

The twice yearly ICD-9-CM Coordination and Maintenance Committee meetings provide a public forum to discuss proposed code changes to ICD-9-CM and the ICD-10-CM/PCS. Next year, the committee, which is co-chaired by CMS and CDC, will be renamed to the ICD-10-CM Coordination and Maintenance Committee.

ICD-10-CM/PCS is scheduled for implementation in October 2014 and currently subject to partial code freeze.

The meeting scheduled on September 18, 2013 was devoted to both diagnosis and procedure code topics. The second day of the meeting, September 19, continued discussions related to diagnosis code topics.

Below are links for key meeting materials, four videocasts, and agenda item listings for the diagnosis proposals presented on Day Two (videocast Part 4). This includes the presentation of proposals by American Psychiatric Association (APA) Director of Research, Darrel Regier, MD, for insertion of new DSM-5 diagnoses into the ICD-10-CM.

Meeting materials:

From CDC website: ICD-9-CM Coordination and Maintenance Committee webpage:

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

September 18-19, 2013 meeting Proposals (Timeline, Agenda for Diagnosis Proposals) [PDF – 342 KB]

From CMS.gov website:

September 18-19, 2013 meeting materials page

September 18, 2013 Agenda (Timeline, Agenda for ICD-10-PCS Topics, Procedure presentations) [PDF, 326KB]

September 18, 2013 Meeting Materials [ZIP, 4MB]

Download Zip file from CMS.gov meeting materials page | 4MB Zip file unpacks to:

PDF Presenter Slides: Cerapedics ICD-9 9 18 2013 FINAL [712KB]

PDF Presenter Slides: Respicardia ICD-9 Sept 18 FINAL [670KB]

PDF CMS/CDC Meeting Slides: September-ICD9CM-slides [3033KB]

PDF Text version of CMS/CDC Meeting slides: 508-Compliant-Version-of-September-ICD9CM-slides [282KB]

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Videocasts for September 18, 2013 | Day One

Pat Brooks (CMS) Co-Chairperson
9:00 AM – 12:30 PM ICD-10-PCS Procedure presentations with public comment
12:30 PM – 1:30 PM Lunch break
1:30 PM – 5:00 PM Diagnosis presentations with public comment

Part 1 1:43 hours duration

Procedure presentations with public comment


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Part 2 1:27 hours duration

Procedure presentations with public comment


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Part 3 59 minutes duration

Diagnosis presentations with public comment

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Videocast for September 19, 2013 | Day Two

Donna Pickett (CDC) Co-Chairperson
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Part 4 1:42 hours duration

Diagnosis presentations with public comment

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Diagnosis proposals

4:58 mins in: Presenter Lizabeth (Beth) Fisher (CDC) [on behalf of requestor: The American Society of Anesthesiologists]

Page 47 Diagnosis Agenda: Unintended awareness under general anesthesia

Comment from floor: Robert Adams reads out written statement.

13:56 mins in: DSM-5 and ICD-10-CM Discussions on mental health conditions and harmonization with ICD-10-CM.

Presenter: Darrel Regier, MD (Director of Research, APA; served as DSM-5 Task Force Vice-Chair)

Preamble about DSM and DSM-5.

Page 32 Diagnosis Agenda: Binge eating disorder

No questions or comments from the floor or by phone link.

29 mins in: Page 34 Diagnosis Agenda: Gender identity disorder in adolescence and adulthood

No questions or comments from the floor or by phone link.

37 mins in: Page 35 Diagnosis Agenda: Disruptive mood dysregulation disorder (DMDD)

No questions or comments from the floor or by phone link.

45 mins in: Page 37 Diagnosis Agenda: Social (pragmatic) communication disorder

No questions or comments from the floor or by phone link.

54 mins in: Page 39 Diagnosis Agenda: Hoarding disorder

No questions or comments from the floor or by phone link.

1hr:1 min in: Page 41 Diagnosis Agenda: Excoriation (skin picking) disorder

Some questions raised by DP on behalf of other and comment from the floor.

1hr:14 mins in: Page 43 Diagnosis Agenda: Premenstrual dysphoric disorder (PMDD)

Question raised by DP regarding PMDD and Excludes.
No questions or comments from the floor or by phone link.

Dr Regier concludes his presentation and hands podium back to Donna Pickett (CDC).

1hr:22 mins in: Page 45-46 Diagnosis Agenda: Additional Tabular List Inclusion Terms for ICD-10-CM

See screenshots at end of Post #276 for Diagnosis Agenda Pages 45-46.

[Unofficial transcription from videocast]

Donna Pickett (CDC): “…And just to complete the package, there are other Tabular List proposals that appear on Page 45 and 46 that we would also invite your comments on. And again, with some of the terminology changes that Dr Regier has described the intent here is to make sure that if those terms are being used, that they do have a home somewhere within ICD-10-CM to facilitate people looking these up. So we invite comments. We’re showing the Tabular List proposed changes; however, there obviously would be associated Alphabetic Index changes with that which we didn’t show just to keep the package a little bit smaller…”

No questions or comments from the floor or by phone link on any of the proposed inclusion terms listed on Pages 45 and 46 under “Additional Tabular List Inclusion Terms for ICD-10-CM”.

Donna Picket moves on to next set of proposals and turns podium over to Beth Fisher (CDC).

1hr:23 mins in: Page 49 Diagnosis Agenda: Intracranial injury (TBI)

Comment from floor at 1hr:32 mins: Luana Ciccarelli from the American Academy of Neurology. Comment from Sue Bowman read out by Beth Fisher.

1hr:34 mins in: Page 53 Diagnosis Agenda: Placenta Previa vs Low Lying Placenta

Presenter Lizabeth (Beth) Fisher (CDC) on behalf of requestor: The American Congress of Obstetricians and Gynecologists (ACOG).

No questions or comments from the floor or by phone link.

This concluded the diagnosis portion of the presentations.

Note that Agenda items from Page 53 onwards were tabled for presentation and discussion in earlier in the meeting proceedings.

1hr:40 mins in: Donna Pickett (CDC) brings meeting to a close.

[Unofficial transcription from videocast]

Donna Pickett (CDC): “…November 15…is in the Topic Package for receipt of comments on all of the proposals. That is the deadline, but we’d love to have them sooner as this does have implications in terms of what does become part of an addenda or not, and that would be specific to the inclusion terms in the Tabular List and Alphabetical Index because, again, unless the proposal meets the criteria established for the partial freeze, no new codes are being entertained except for the ones that were requested. We invite your comments on that as well…”

Submitting public comment:

The deadline for receipt of public and professional stakeholder comment on any of the proposed ICD-10-CM/PCS code revisions discussed at the September 18-19, 2013 ICD-9-CM Coordination and Maintenance Committee meeting is November 15.

Comments should be sent to the following dedicated NCHS/CMS email addresses:

Procedure comments by email to Pat Brooks, CMS: patricia.brooks2@cms.hss.gov

Diagnosis comments by email to Donna Pickett, CDC: nchsicd9CM@cdc.gov

(Full contact details for submission of written comments/objections to NCHS/CMS on Page 8 of the Proposals/Diagnosis Agenda PDF. Electronic submissions are much preferred in order to ensure timely receipt.)

APA petitions CMS for additions to ICD-10-CM: Deadline for public comment and objections November 15

Post #276 Shortlink: http://wp.me/pKrrB-3tq

Information in this report relates to American Psychiatric Association (APA) proposals, submitted via the September ICD-9-CM/PCS Coordination and Maintenance Committee Meeting, for the inclusion of a number of additions to the forthcoming US specific ICD-10-CM.

ICD-9-CM is the official system of assigning codes to medical diagnoses in the United States. Next year, ICD-9-CM will be replaced by ICD-10-CM, scheduled for implementation on October 1, 2014.

The DSM is widely used by CMS contractors, federal and state agencies and medical insurers to indicate eligibility for provision of services.

Since the official codes required in the United States for records and reimbursement purposes are ICD-CM codes, DSM diagnoses are cross-walked to the closest approximation of ICD-CM codes to classify diagnoses for insurance claims, research, data capture and other public health purposes.

APA petitions ICD-9-CM Coordination and Maintenance Committee:

The ICD-9-CM and ICD-10-CM coding systems are subject to annual revisions by NCHS and CMS via public review meetings held twice a year (in March and September), followed by brief public comment periods.

October 1, 2011 saw the last major update of ICD-10-CM/PCS until October 1, 2015. Between October 1, 2011 and October 1, 2015 revisions to ICD-10-CM/PCS will be for new diseases/new technology procedures, and any minor revisions to correct reported errors in these classifications. Regular (at least annual) updates to ICD-10-CM/PCS will resume on October 1, 2015.

The ICD-9-CM Coordination and Maintenance Committee will continue to meet twice a year during this partial code freeze. At these meetings, the public will be asked to comment on whether or not requests for new diagnosis or procedure codes should be created based on the criteria of the need to capture a new technology or disease. Any code requests that do not meet the criteria will be evaluated for implementation within ICD-10-CM on and after October 1, 2015 once the partial code freeze has ended.

At last month’s Coordination and Maintenance Committee meeting, APA presented seven diagnoses that are new to DSM-5, along with proposals for new codes for addition to the ICD-10-CM [1]. APA states that the new codes, if approved [by NCHS/CMS], would probably not be added to ICD-10-CM until 2015.

Yesterday, APA published an article in Psychiatric News (the PR organ of the APA), listing the additions and changes proposed by APA via the September meeting (about two thirds into the article):

ICD Codes for Some DSM-5 Diagnoses Updated, Mark Moran, Psychiatric News, October 07, 2013 DOI: 10.1176/appi.pn.2013.10b30

The following disorders were proposed by APA for inclusion in ICD-10-CM (Pages 32-44, Diagnosis Agenda).

Dr Regier’s presentation starts on Day Two of the meeting, video Part 4, 13:50 mins in from start and concludes after PMDD.

Binge eating disorder (BED);
Disruptive mood dysregulation disorder (DMDD);
Social (pragmatic) communication disorder;
Hoarding disorder;
Excoriation (skin picking) disorder;
Premenstrual dysphoric disorder (PMDD)

Additionally, the APA has petitioned for revisions to the ICD-10-CM listing for gender dysphoria in adolescents and adults, which is not a new disorder. Dr Regier’s presentation concluded with recommendations for PMDD.

Edit: On Page 45 and 46 of the Agenda, under Additional Tabular List Inclusion Terms for ICD-10-CM a number of other changes to specific Chapter 5 F codes are proposed, including the addition to the ICD-10-CM Chapter 5 codes of the new DSM disorders:

Somatic symptom disorder (proposed as Inclusion term to F45.1 Undifferentiated somatoform disorder)

Illness anxiety disorder (proposed as Inclusion term to F45.21 Hypochondriasis)

None of these 16 proposed additional inclusion terms to the ICD-10-CM Mental and behavioural disorders (Chapter 5) F codes, as listed on Pages 45-46, were presented or discussed by Dr Regier on behalf of the APA but presented briefly and en masse by Donna Pickett.

I have pasted screenshots from the Agenda at the end of this report [Ref 5].

Ms Pickett introduced this section of the Agenda on Day Two, video Part 4, 1 hour 22 mins in from start.

Diagnosis Agenda Item Page 45-46: “Additional Tabular List Inclusion Terms for ICD-10-CM”

Co-Chair Donna Pickett: “…And just to complete the package, there are other Tabular List proposals that appear on Page 45 and 46 that we would also invite your comments on. And again, as with some of the terminology changes that Dr Regier has described the intent here is to make sure that if those terms are being used, that they do have a home somewhere within ICD-10-CM to facilitate people looking these up. So we invite comments. We’re showing the Tabular List proposed changes. However, there obviously would be associated Alphabetic Index changes with that which we didn’t show [in the Agenda] just to keep the package a little bit smaller.”

With no discussion taking place on rationales for individual proposals and no comments or questions being received from the floor or by phone link, Ms Pickett moved swiftly forward to introduce the next Agenda item.

Since these proposals are unattributed in the Agenda, the provenance of these additional 16 code change requests is unclear (that is, whether the requestors are CMS/CDC, Collaborating Centre for the WHO-FIC in North America, WHO ICD-10 Update Committee, WHO ICD-11 Revision, APA or other petitioners).

If the addition of new DSM-5 disorders Somatic symptom disorder and Illness anxiety disorder had been proposed by the APA, it is unclear why these were not included within Dr Regier’s presentation for discussion.

Blink and you might have missed the proposal to incorporate Somatic symptom disorder and Illness anxiety disorder into ICD-10-CM – so little time and attention being devoted to this section of the Agenda.

Note that Hypochondriasis (Illness anxiety disorder) is proposed to be included in the ICD-11 Beta draft under dual parents Obsessive-compulsive and related disorders and Bodily distress disorders, and psychological and behavioural factors associated with disorders or diseases classified elsewhere.

Full proposals from APA and other petitioners can be read in the ICD-9-CM/PCS Coordination and Maintenance Committee Meeting Sept 18–19, 2013: Proposals document at:

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

(Diagnosis Agenda) Proposals document [PDF – 342 KB]:

http://www.cdc.gov/nchs/data/icd/icd_topic_packet_sept_181913.pdf

A Summary report of the Procedure part of the September 18–19, 2013 ICD-9-CM Coordination and Maintenance Committee meeting is not yet available. This is expected to be posted on the CMS webpage in October, at:

http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials.html

and also on the CDC’s website page for the meetings.

Other Meeting materials (Agenda, Proposals and four YouTubes of the two-day September meeting proceedings) are now available from this page [3]:

http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials-Items/2013-09-18-MeetingMaterials.html

There is an ICD-9-CM and ICD-10-CM/PCS revisions Timeline set out on pages 3 thru 7 of the Proposals PDF [2].

Submitting public comment:

The deadline for receipt of public and professional stakeholder comment on any of the proposed ICD-10-CM/PCS code revisions discussed at the September 18-19, 2013 ICD-9-CM Coordination and Maintenance Committee meeting is November 15, 2013.

Comments should be sent to the following NCHS email addresses:

Procedure comments by email to Pat Brooks, CMS: patricia.brooks2@cms.hss.gov

Diagnosis comments by email to Donna Pickett, CDC: nchsicd9CM@cdc.gov

Full contact details for submission of comments/objections to NCHS/CMS are on page 8 of the Proposals PDF. The meeting co-chairs state that electronic submissions are greatly preferred over snail mail in order to ensure timely receipt.

Responders are asked to consider the following:

Whether you agree with a proposal, disagree (and why), or have an alternative proposal to suggest.

But also to comment on the timing of those proposals that are being requested for approval for October 2014.

Does a proposal for a new or changed Index entry and Tabular List entry meet the criteria for implementation in Oct 2014 during a partial code freeze or should consideration for inclusion be deferred to Oct 2015 implementation? And separately, comment on the creation of a specific new code for the condition effective from October 1, 2015.

I shall post reminders before the November 15, 2013 deadline date and also a copy of the September meeting Summary document, once this is available. (Posting of the Summary document may be delayed due to the government shut-down and you may prefer to review the YouTubes of the meeting proceedings rather than wait for the Summary document to appear.)

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References for key documents and screenshots:

1. Article: ICD Codes for Some DSM-5 Diagnoses Updated, Mark Moran, Psychiatric News, October 07, 2013:
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleID=1757346

2. ICD-9-CM/PCS Coordination and Maintenance Committee Meeting September 18-19, 2013:
http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

September meeting Proposals document [PDF – 342 KB]:
http://www.cdc.gov/nchs/data/icd9/icd9cm_proposals_91819.pdf

3. ICD-9-CM/PCS Coordination and Maintenance Committee Meeting Sept 18-19, 2013 meeting materials and four YouTubes of proceedings:
http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials-Items/2013-09-18-MeetingMaterials.html

4. YouTube Videos from September 18, 2013 Meeting Day One

ICD-9-CM Coordination and Maintenance Committee Meeting (Morning Session) Part 1
http://www.youtube.com/watch?v=Ut3DmV88Dmc

ICD-9-CM Coordination and Maintenance Committee Meeting (Morning Session) Part 2
http://www.youtube.com/watch?v=CAE190sM5AQ

ICD-9-CM Coordination and Maintenance Committee Meeting (Afternoon Session) Part 3
http://www.youtube.com/watch?v=QQOFadq2x6U

September 19, 2013 Meeting Day Two

ICD-9-CM Coordination and Maintenance Committee Meeting Part 4
http://www.youtube.com/watch?v=G-pYdKyr_NE

5. Pages 45-46, Diagnosis Agenda:

ICD10CM 1

ICD10CM 2

ICD10CM 3

ICD-10-CM Release for 2014 now available

Post #270 Shortlink: http://wp.me/pKrrB-3iT

ICD-10-CM Release for 2014 now available

Prior to implementation, the codes in ICD-10-CM are not valid for any purpose or use.

The World Health Organization’s (WHO) International Classification of Diseases (ICD-10) was published in 1992 and is used in over a hundred countries worldwide.

A number of countries have been authorized by WHO to develop “Clinical Modifications” – adaptations of ICD-10 for country specific use. These differ in the number of chapters, codes and subcategories. Specific conditions are present in some adaptations but not all clinical modifications [1]. All modifications to the ICD-10 must conform to WHO conventions for ICD.

Canada uses an adaptation called ICD-10-CA, Australia uses ICD-10-AM, Germany uses ICD-10-GM and Thailand uses ICD-10-TM.

The U.S. lags behind most of the rest of the world and is still using a Clinical Modification of the WHO’s long since retired, ICD-9.

A U.S. specific adaptation of ICD-10 has been under development for a considerable length of time but is scheduled for implementation on October 1, 2014.

Transition to ICD-10-CM is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA).

Implementation schedules for Large Practices; Small and Medium Practices; Small Hospitals and Payers can be found on the CMS website, here: Implementation Timelines.

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2014 release of ICD-10-CM

The 2014 release of ICD-10-CM is now available from the CDC website. It replaces the July 2012 release.

Prior to the implementation date of October 1, 2014, the codes in ICD-10-CM are not valid for any purpose or use.

The ICD-10-CM code set is currently subject to partial code freeze. For information on the code freeze see Partial Freeze of Revisions to ICD-9-CM and ICD-10-CM/PCS.

October 1, 2011 was the last major update of ICD-10-CM/PCS until October 1, 2015. Between October 1, 2011 and October 1, 2015, revisions to ICD-10-CM/PCS will be for new diseases/new technology procedures or minor revisions to correct any reported errors in these classifications. Regular (at least annual) updates to ICD-10-CM/PCS will resume on October 1, 2015.

Information on the ICD-9-CM and ICD-10-CM/PCS update and revision processes and the public NCHS/CDC Coordination and Maintenance Committee meetings can be found on this CDC page: Coordination and Maintenance Committee.

Downloading the ICD-10-CM code sets

The ICD-10-CM Preface, Guidelines, Tabular List, Index and associated documentation can be downloaded from this page: http://www.cdc.gov/nchs/icd/icd10cm.htm#10update.

The PDF of the Preface is in a single PDF file here: ICD-10-CM Preface 2014

The PDF of the Guidelines is in a single PDF file here: ICD-10-CM Guidelines

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To access the PDFs for the ICD-10-CM Tabular List and Index, the files need extracting from Zip files from this link:

ICD-10-CM List of codes and Descriptions (updated 7/3/2013)

( ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2014/ )

Select this file, below, on the CDC site and open it. It is a large file of over 15MB so you will need to allow sufficient time for it to fully load:

06/19/2013 08:28AM 15,223,965 ICD10CM_FY2014_Full_PDF.zip

It will unpack these five PDF files, which can be opened and viewed in situ or saved:

ICD10CM_FY2014_Full_PDF_DIndex  4,222 KB  [ICD-10-CM INDEX TO DISEASES and INJURIES]

or open unzipped PDF on Dx Revision Watch: ICD-10-CM 2014 Full Index

ICD10CM_FY2014_Full_PDF_EIndex   [401 KB]  [ICD-10-CM External Cause of Injuries Index]

ICD10CM_FY2014_Full_PDF_TableOfDrugs   [2,193 KB]

ICD10CM_FY2014_Full_PDF_TableOfNeoplasms   [646 KB]

ICD10CM_FY2014_Full_PDF_Tabular   [7, 398 KB]  [ICD-10-CM TABULAR LIST of DISEASES and INJURIES]

or open unzipped PDF on Dx Revision Watch: ICD-10-CM Tabular List

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For five PDF files of Addenda go to this page:

ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2014/

and select this file:

06/19/2013 08:28AM 582,584 ICD10CM_FY2014_Addenda.zip

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Comparison between classifications and codings in ICD-10-CM and ICD-10

The WHO’s ICD-10 Volume 1 The Tabular List isn’t made available as a PDF file but can be accessed on a searchable electronic browser platform here: ICD-10 Version: 2010.

The Tabular List for ICD-10 contains more textual descriptions for the categories in Chapter V (the mental and behavioural disorders chapter) than other chapters in ICD-10.

There are also two “speciality” volumes for ICD-10 Chapter V for Clinical descriptions and diagnostic guidelines (known as the “Blue Book”) and Diagnostic criteria for research (known as the “Green Book”).

The U.S. specific ICD-10-CM will not contain this depth of textual content within its Chapter 5.

CDC’s, Donna Picket, has confirmed that CMS/CDC does not plan to adapt the “Blue Book” specifically for U.S. use in conjunction with Chapter 5 of ICD-10-CM [2]. Nor are there plans for an official CMS/CDC crosswalk between ICD-10-CM’s Chapter 5 classifications and codes and those in ICD-10 Chapter V [3].

In the U.S., since 2003, the ICD-9-CM diagnostic codes have been mandated for third-party billing and reporting by HIPAA for all electronic transactions for billing and reimbursement. Following implementation on October 1, 2014, the ICD-10-CM codes sets will become mandatory.

This also applies to the coding of mental and behavioural disorders. APA’s DSM-IV disorder diagnoses are crosswalked to ICD-9-CM codes, or their nearest equivalent, for billing and reimbursement.

The DSM-5, published in May this year, includes the crosswalk codes for both the existing ICD-9-CM and the forthcoming ICD-10-CM codes.

For comparison between

ICD-10-CM Chapter 5 Mental, Behavioral and Neurodevelopmental disorders (F01-F99)

and ICD-10 Chapter V Mental and behavioural disorders (F00-F99) see the ICD-10 online browser or

The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines (The “Blue Book”)

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References and further resources

1. The development, evolution, and modifications of ICD-10: challenges to the international comparability of morbidity data. Jetté N, Quan H, Hemmelgarn B, Drosler S, Maass C, Moskal L, Paoin W, Sundararajan V, Gao S, Jakob R, Ustün B, Ghali WA; IMECCHI Investigators. Med Care. 2010 Dec;48(12):1105-10. doi: 10.1097/MLR.0b013e3181ef9d3e [PMID: 20978452].

The development, evolution and modifications of ICD-10: challenges to the international comparability of morbidity data: Nathalie Jetté MD, November 2009, Slide Presentation [5 MB].

2. Personal communication.

3. Personal communication.

4. Information for providers, payers and vendors on transition to ICD-10-CM can be found here on the CMS website.

5. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services: ICD-10-CM/PCS MYTHS AND FACTS ICN 902143, April 2013.

6. American Psychological Association: Nine frequently asked questions about DSM-5 and ICD-10-CM, APA Practice staff answer questions about billing, determining diagnoses and more related to the two diagnostic classification systems. Practice Update, May 16, 2013.

7. American Psychiatric Association: Insurance Implications of DSM-5

8. AAPC What is ICD-9-CM?

ICD-11 Round up: April #1

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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