ICD-11 Content Model Reference Guide: version for December 2010

February 18, 2011 by

ICD-11 Content Model Reference Guide: version for December 2010

Post #62 Shortlink: http://wp.me/pKrrB-Xj

Update @ 1 March 2011

A more recent version of the Content Model document was uploaded to the ICD Revision site on 22 February.

It can be accessed here on the ICD Revision site:

View Word document

Download Word document

Or opened here on DSM-5 and ICD-11 Watch site: Content Model Reference Guide v January 2011

A revised version of the ICD-11 Content Model Reference Guide was uploaded to the WHO’s ICD Revision Google site in January.  This version of the document, dated 27 January 2011, replaces previous versions on DSM-5 and ICD-11 Watch site and on the ICD Revision Google site.

Content Model Reference Guide December 2010 v.1  27 Jan 2011

A copy of this 57 page document can be viewed on the ICD Revision Google site from this page:

http://sites.google.com/site/icd11revision/home/documents

View Word document

Download Word document

or open here on DSM-5 and ICD-11 Watch site: Content Model Reference Guide December 2010 [v.1]

 

Introductory pages

ICD-11 alpha

World Health Organization, Geneva

Content Model Reference Guide 11th Revision

December 2010

Table of Contents

Page 2

Introduction 3
What is the “Content Model”? 4
Explanations on the Content Model 5
Technical Specifications for the Content Model 7
ICD -11 Alpha Content Model 9

1. ICD Entity Title 9

2. Classification Properties 11

3. Textual Definition(s) 17

4. Terms 21

5. Body Structure Description 24

6. Temporal Properties 27

7. Severity Properties 31

8. Manifestation Properties 33

9. Causal Properties 35

10. Functioning Properties 38

11. Specific Condition Properties 42

12. Treatment Properties 44

13. Diagnostic Criteria 45

Section B 46

Appendices 48
Appendix 1: Body Systems Value Set 48
Appendix 2: Temporal Properties Value Set 49
Appendix 3: Temporal Properties Value Set and explanations 50
Appendix 4: Basic Aetiology Value Set 56
Appendix 5: Grammar Rules for Titles and Synonyms 57

Page 3

Reference Guide on the Content Model of the ICD 11α

Introduction

This Reference Guide is intended to define and explain the Content Model used in the ICD-11 alpha draft in practical terms. It aims to guide users to understand the purposes and parameters of the Content Model.

The Reference Guide also informs users about the technical specifications of each parameter which the designers of the iCAT (the computer platform that is used to fill in the content model: international Collaborative Authoring Tool) took into account in building the software.

Accordingly, information on each parameter is given in two sections:

(1) Explanations
(2) Technical specifications

The purpose of this Reference Guide is to ensure that the Content Model and its different parameters are properly understood.

This document will be periodically updated in response to user needs and evolution of the content model.

Brief introduction to the ICD – International Classification of Diseases

The International Classification of Diseases (ICD) is the global standard to report and categorize diseases in order to compile health information related to deaths, illness and injury. The ICD content includes diseases and a range of health problems including disorders, syndromes, signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury. The ICD is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics.

In ICD there are multiple classification categories which are defined by explicit or implicit parameters such as: codes, titles, definitions and other characteristics. In ICD 11, we aim to formally represent all this classification knowledge in a systematic way. The Content Model serves this purpose.

Page 4

What is the “Content Model”?

The Content Model is a structured framework that defines “a classification unit” in ICD in a standard way in terms of its components that allows computerization.

A “model” is a technical term that refers to a systematic representation of knowledge that underpins any system or structure. Hence, the content model is an organized description of an ICD unit with its different parameters.

In the past, ICD did not explicitly define its “classification units” – in other words diseases were classified without defining “what is a disease?” (There have been efforts to provide some definitions, inclusions, exclusion information, and some coding rules in the instructions and in the index. Some chapters, such as mental health, oncology, or other groups of diseases have been elaborated with diagnostic criteria. All these efforts may be seen as implicit modelling.) In the ICD 11 revision process, deliberate action is being taken to define the ICD categories in a systematic way and represent the classification knowledge to allow processing within computer systems.

To achieve this aim, different ICD categories have been defined by user groups as to what they are. For example, first a disease was defined as follows:

A disease is a set of dysfunction(s) in any of the body systems defined by:

1. Symptomatology: manifestations: known pattern of signs, symptoms and related findings
2. Aetiology: an underlying explanatory mechanism
3. Course and outcome: a distinct pattern of development over time
4. Treatment response: a known pattern of response to interventions
5. Linkage to genetic factors: e.g., genotypes, patterns of gene expression
6. Linkage to interacting environmental factors

Then the key components of this definition have been operationally defined as different parameters which, as a whole, formed the Content Model.

Page 5

Explanations on the Content Model:

A classification unit in ICD is called an “ICD entity”. In other words, any distinct classification rubric is called an Entity. (The term “Entity” is used interchangeably – in the same meaning — with the term “ICD Concept”.

An ICD entity may be:

– A category
– A block
– A chapter

A category (which is the most common reference to an ICD class) may be a disease, disorder or syndrome; sign, symptom or other health problem such as injuries, or a combination of the above. In addition, ICD has also been used to classify “external causes” or “other reasons for encounter” which are different kinds of entities than the diseases. In other words, “Category” refers to the individual classes represented in the ICD-10 printed version.

The Content Model, therefore, allows the various classification categories to be represented more clearly so that users can identify the classification units in a scientific fashion.

The purpose of the content model is to present the knowledge that lies under the definition of an ICD entity. Each ICD entity can be seen from different dimensions. The content model represents each one of these dimensions as a “parameter”. For example, there are currently 13 defined main parameters in the content model to describe a category in ICD.

TABLE 1: The Content Model main parameters

For each category, various parameters are given different values. For example:

Category: Myocardial Infarction

Parameters:                       Value:
Body system                         Cardiovascular system
Body part                              Heart
Signs/symptoms                   Crushing chest pain, etc.
Investigation Findings           ST elevation in ECG

It is not necessary to describe all categories with all parameters. Only parameters that are relevant to the description of the category should be used. In certain instances such as External Causes, only a number of the parameters are valid for the description of these entities.

The full range of different values for a given parameter is predefined using standard terminologies and ontologies. The predefined values constitute a “value set”.

Read full document here: Content Model Reference Guide December 2010 [v.1]

 

Related documents:

Paper:

http://bmir.stanford.edu/file_asset/index.php/1522/BMIR-2010-1405.pdf

A Content Model for the ICD-11 Revision

Samson W. Tu1, Olivier Bodenreider2, Can Çelik3, Christopher G. Chute4, Sam Heard5, Robert Jakob3, Guoquian Jiang4, Sukil Kim6, Eric Miller7, Mark M. Musen1, Jun Nakaya8, Jon Patrick9, Alan Rector10, Guillermo Reynoso11, Jean Marie Rodrigues12, Harold Solbrig4, Kent A Spackman13, Tania Tudorache1, Stefanie Weber14, Tevfik Bedirhan Üstün3

1Stanford Univ., Stanford, CA, USA; 2National Library of Medicine, Bethesda, MD, USA; 3World Health Organization, Geneva, Switzerland; 4Mayo Clinic College of Medicine, Rochester, MN, USA; 5Ocean Informatics, Chatswood, NSW, Australia; 6Catholic Univ. of Korea, Korea; 7Zepheira, Fredricksburg, VA, USA; 8Tokyo Medical and Dental Univ., Tokyo, Japan; 9Univ. of Sydney, Sydney, NSW, Australia; 10Univ. of Manchester, Manchester, UK; 11Buenos Aires, Argentina;12Université de Saint Etienne, Saint Priest en Jarez, France; 13IHTSDO, USA; 14DIMDI – German Institute of Medical Documentation and Information, Köln, Germany

Abstract

The 11th revision of the International Classification of Diseases and Related Health Problems (ICD) will be developed as a collaborative effort supported by Webbased software. A key to this effort is the content model designed to support detailed description of the clinical characteristics of each category, clear relationships to other terminologies and classifications, especially SNOMED-CT, multi-lingual development, and sufficient content so that the adaptations for alternative uses cases for the ICD – particularly the standard backwards compatible hierarchical form – can be generated automatically. The content model forms the basis of an information infrastructure and of a webbased authoring tool for clinical and classification experts to create and curate the content of the new revision.

Filed under iCAT, ICD revision process, ICD-10, ICD-10-CM, ICD-11, ICD-11 Alpha Draft, ICD-11 Beta Draft, ICD-11 consultation, ICD-11 in the media, ICD-11 revision docs, WHO (World Health Organization)

CFS orphaned in the “R” codes in ICD-10-CM

February 13, 2011 by

CFS orphaned in the “R” codes in US specific ICD-10-CM

Post #60 Shortlink: http://wp.me/pKrrB-V4

Current proposals for ICD-10-CM place CFS in Chapter 18, under R53 Malaise and fatigue at R53.82 Chronic fatigue syndrome NOS (Not otherwise specified).

According to a Note to a Recommendation on the CSFSAC webpages:

*DFO Note: The ICD 10-CM is scheduled for implementation on October 1, 2013. In that classification, two mutually exclusive codes exist for chronic fatigue [sic]:

post-viral fatigue syndrome (in the nervous system chapter), and
chronic fatigue syndrome, unspecified (in the signs and symptoms chapter).

HHS has no plans at this time to change this classification in the ICD 10-CM.

Images Copyright 2011 ME agenda  No unauthorized reproduction

 

The revision of ICD-10, ICD-11, is scheduled for implementation in 2015.

Once ICD-10-CM has been adopted, the US does not envisage moving on to ICD-11 (or a “Clinical Modification” adaptation of ICD-11) for many years.

Partial Code Freeze

Although ICD-10-CM is not scheduled for implementation until October 2013, it had been proposed that at some point prior that date codes might be “frozen”.

At the ICD-9-CM Coordination & Maintenance Committee Meeting on Sept. 15, 2010, it was announced that the committee had finalized the decision to implement a partial freeze for both ICD-9-CM codes and ICD-10-CM and ICD-10-PCS codes prior to implementation of ICD-10 on Oct. 1, 2013.

       Partial Code Freeze Announcement

As of October 1, 2011, only limited updates will be instituted into the code sets so that providers, payers, clearinghouses, and health IT vendors will not have to simultaneously keep pace with code updates while also reconfiguring their existing systems for ICD-10-CM/PCS.

So the clock is ticking for CFS and US advocates and patients need to be aware of how little time may be left.

References:

[1] International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Note: The 2011 release of ICD-10-CM is now available. It replaces the December 2010 release:
http://www.cdc.gov/nchs/icd/icd10cm.htm

[2] US “Clinical Modification” ICD-10-CM
This article clarifies any confusion between ICD-10, ICD-11 and the forthcoming US Clinical Modification, ICD-10-CM: http://wp.me/pKrrB-Ka

[3] Chronic Fatigue Syndrome Advisory Committee (CFSAC). The Chronic Fatigue Syndrome Advisory Committee (CFSAC) provides advice and recommendations to the Secretary of Health and Human Services via the Assistant Secretary for Health of the U.S. Minutes of meetings, Recommendations and meeting videocasts:
http://www.hhs.gov/advcomcfs/meetings/index.html

Filed under ICD revision process, ICD-10, ICD-10-CM, ICD-11, ICD-11 Alpha Draft, ICD-11 Beta Draft, ICD-11 consultation, ICD-11 revision docs, WHO (World Health Organization), WHO Collaborating Centre

The clock is ticking for CFS: Partial Code Freeze for ICD-9-CM and ICD-10-CM/PCS Finalized

February 6, 2011 by

The clock is ticking for CFS: Partial Code Freeze for ICD-9-CM and ICD-10-CM/PCS Finalized (US)

Post #59 Shortlink: http://wp.me/pKrrB-Un

The clock is ticking…

The US was authorized by the WHO to develop its own country specific adaptation of the WHO’s now retired ICD-9, called ICD-9-CM, and has been slow to move on to a “Clinical Modification” of ICD-10.

Rather than skip ICD-10 and move straight onto ICD-11 in 2015, the National Center for Health Statistics (NCHS) has been developing a “clinical modification” of ICD-10 called ICD-10-CM. This development process has been in progress for a number of years.

So ICD-10-CM is US specific and it’s scheduled for implementation in October 2013 [1].

The US does not envisage moving on to ICD-11 (or an adaptation of ICD-11) for many years. So although the majority of countries will be implementing ICD-11 in 2015+, the US will sail on with ICD-10-CM.

Several other countries use a modification of ICD-10. Canada is authorized to use its adaptation of ICD-10, ICD-10-CA. According to one source, Canada may not adopt ICD-11 (or an adaptation of ICD-11) until beyond 2018.

ICD-10-CM

The US clinical modification is proposing to retain CFS in the R codes and to classify it at R53.82 in Chapter 18, rather than code CFS in Chapter 6: Diseases of the nervous system, along with ME and PVFS, at G93.3.

“Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.” [2]

For ICD-10-CM, then, PVFS and (B)ME are proposed to be coded thus, in Chapter 6:

Diseases of the nervous system (G00-G99)

Excludes2:

[…]
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

G93 Other disorders of brain

[…]

G93.3 Postviral fatigue syndrome

Benign myalgic encephalomyelitis
Excludes1: chronic fatigue syndrome NOS (R53.82)

which would bring the classification of PVFS and ME for the US in line with existing ICD-10 codes. (Though note that in ICD-10, Chronic fatigue syndrome is indexed to G93.3 in Volume 3: The Alphabetical Index and does not appear in Volume 1: The Tabular list under the G93 parent category.)

Whereas for ICD-10-CM, CFS is proposed to be coded thus, in Chapter 18:

R53: Malaise and fatigue

[…]

R53.82 Chronic fatigue, unspecified

Chronic fatigue syndrome NOS
Excludes1: postviral fatigue syndrome (G93.3)

Retaining CFS in the R codes and coding CFS in Chapter 18 under R53.82 (which specifically excludes G93.3) means that in ICD-10-CM, the coding of the terms CFS, PVFS and ME will be out of step with four classification systems:

1 The International ICD-10, which is used in the majority of countries.

2 The Canadian Clinical Modification ICD-10-CA.

3 The German Clinical Modification ICD-10-GM.

4 The proposals for Chapter 6 of ICD-11 as they stood in the iCAT ICD Revision Platform at November 2010, where CFS is proposed to be classified in Chapter 6: Diseases of the nervous system, with (B)ME specified as an Inclusion to CFS.

(I am informed that “PVFS” is a term little used by the US medical profession.)

 

Schism

This issue is proving divisive because some US patients would prefer to see CFS split from ME in ICD-10-CM. 

But retaining CFS in the R codes and placing it under the R53: Malaise and fatigue parent category may have considerable implications for patients who already have a diagnosis of CFS or who may receive a diagnosis of CFS in the future – for the treatments that are provided, the care packages received and for medical and disability insurance.

So I consider it will hurt patients to have CFS coded under the R chapter, rather than in Chapter 6: Diseases of the nervous system and that coding CFS under “ill-defined conditions” will render CFS and ME patients more vulnerable to the current proposals for the revision of the “Somatoform Disorders” section for DSM-5 [4].

If I were a patient who already had a diagnosis of CFS or might be given diagnosis of CFS in the future, I would feel safer if CFS were coded at G93.3, until the science has got it sorted. For there are no guarantees that US medics will diagnose ME and use the new ME code for billing purposes.

But this is not a new issue. 

US patients organizations, advocates and patients have known about these proposals for several years. The issue has been discussed at meetings of the Chronic Fatigue Syndrome Advisory Committee (CFSAC).

CFSAC provides advice and recommendations to the Secretary of Health and Human Services via the Assistant Secretary for Health of the U.S. Department of Health and Human Services on issues related to chronic fatigue syndrome (CFS). Copies of meeting agendas, minutes, recommendations, some presentations and since 2009, videocasts of entire meeting proceedings, can be accessed from the CFSAC pages. Minutes of meetings go back to September 2003 [3].

The codings issue had been discussed by CFSAC in June 2004 and again in September 2005, when a presentation had been given by the CDC’s Donna Pickett. In 2005, the committee had recommend that CFS be classified under G93.3.

“Recommendation 10: We would encourage the classification of CFS as a ‘Nervous System Disease,’ as worded in the ICD-10 G93.3.” CFSAC Committee Recommendations August 2005

The issue was discussed more recently, at the May 2010 CFSAC meeting. During the last ten minutes of that meeting, Dr Lenny Jason discussed his concerns with the committee that the placement of CFS in ICD-10-CM under the Chapter 18 “R” codes could be problematic. 

CFSAC 10.05.10 Agenda

CFSAC 10.05.10 Minutes

Videocast of CFSAC meeting

The Recommendations for that meeting in relation to the coding of CFS in ICD-10-CM had been:

“CFSAC rejects proposals to classify CFS as a psychiatric condition in U.S. disease classification systems. CFS is a multi-system disease and should be retained in its current classification structure, which is within the “Signs and Symptoms” chapter of the International Classification of Diseases 9-Clinical Modification (ICD 9-CM).*

“*DFO Note: The ICD 10-CM is scheduled for implementation on October 1, 2013. In that classification, two mutually exclusive codes exist for chronic fatigue [sic]:

“post-viral fatigue syndrome (in the nervous system chapter), and
chronic fatigue syndrome, unspecified (in the signs and symptoms chapter).

“HHS has no plans at this time to change this classification in the ICD 10-CM.”

Incidently, amongst the Recommendations of the CFSAC committee for the October 2010 meeting was:

3. Adopt the term “ME/CFS” across HHS programs.

I hope further discussion of ICD-10-CM codings can be pushed back up the agenda for the next CFSAC meeting because a number of issues were left hanging.

 

Code “freezing”

Although ICD-10-CM is not scheduled for implementation until October 2013, it had been proposed that at some point prior that date codes might be “frozen”.

At the ICD-9-CM Coordination & Maintenance Committee Meeting on Sept. 15, 2010, it was announced that the committee had finalized the decision to implement a partial freeze for both ICD-9-CM codes and ICD-10-CM and ICD-10-PCS codes prior to implementation of ICD-10-CM on Oct. 1, 2013.

As of October 1, 2011, only limited updates will be instituted into the code sets so that providers, payers, clearinghouses, and health IT vendors will not have to simultaneously keep pace with code updates while also reconfiguring their existing systems for ICD-10-CM/PCS.

 

So the clock is ticking and US advocates and patients need to be aware of how little time may be left.

A few days ago, I contacted Donna Pickett, Medical Systems Administrator, Classifications and Public Health Data Standards, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC) to enquire whether the proposed date by which ICD-10-CM codings might be “frozen” had been finalized.

Ms Pickett has provided information regarding the freezing of the ICD-9-CM and ICD-10-CM code sets.

She also confirmed that Clinical criteria and diagnostic guidelines will not be included in ICD-10-CM.

(As I have reported before, for ICD-11, diseases and disorders will be defined through multiple parameters according to a common “Content Model” so there will be definitions, clinical descriptions etc and the potential for considerably more textual content than in ICD-10. See: http://wp.me/pKrrB-KK  for screenshots.)

The notice below is also available in PDF format here

There is an associated meeting Agenda Handout which also includes this information and dates of ICD-9-CM and ICD-10-CM meetings: Agenda. ICD-9-CM Coordination and Maintenance Committee. DHSS

Partial Code Freeze for ICD-9-CM and ICD-10 Finalized

The ICD-9-CM Coordination and Maintenance Committee will implement a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes prior to the implementation of ICD-10 on October 1, 2013. There was considerable support for this partial freeze. The partial freeze will be implemented as follows:

• The last regular, annual updates to both ICD-9-CM and ICD-10 code sets will be made on October 1, 2011.

•On October 1, 2012, there will be only limited code updates to both the ICD-9-CM and ICD-10 code sets to capture new technologies and diseases as required by section 503(a) of Pub. L. 108-173.

• On October 1, 2013, there will be only limited code updates to ICD-10 code sets to capture new technologies and diagnoses as required by section 503(a) of Pub. L. 108-173. There will be no updates to ICD-9-CM, as it will no longer be used for reporting.

• On October 1, 2014, regular updates to ICD-10 will begin.

The ICD-9-CM Coordination and Maintenance Committee will continue to meet twice a year during the partial 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 on and after October 1, 2014 once the partial freeze has ended.

Codes discussed at the September 15 – 16, 2010 and March 9 – 10, 2011 ICD-9-CM Coordination and Maintenance Committee meeting will be considered for implementation on October 1, 2011, the last regular updates for ICD-9-CM and ICD-10. Code requests discussed at the September 14 – 15, 2011 and additional meetings during the freeze will be evaluated for either the limited updates to capture new technologies and diseases during the freeze period or for implementation to ICD-10 on October 1, 2014. The public will be actively involved in discussing the merits of any such requests during the period of the partial freeze.

References:

(For history of ICD in the US to 2001, see archive CDC document: A Summary of Chronic Fatigue Syndrome and Its Classification in the International Classification of Diseases. The March 2001 proposals are since superceded as per 2009, 2010 and 2011 proposals.)

[1] International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Note: The 2011 release of ICD-10-CM is now available. It replaces the December 2010 release:
http://www.cdc.gov/nchs/icd/icd10cm.htm

[2] US “Clinical Modification” ICD-10-CM
This article clarifies any confusion between ICD-10, ICD-11 and the forthcoming US Clinical Modification, ICD-10-CM: http://wp.me/pKrrB-Ka

[3] Chronic Fatigue Syndrome Advisory Committee (CFSAC). The Chronic Fatigue Syndrome Advisory Committee (CFSAC) provides advice and recommendations to the Secretary of Health and Human Services via the Assistant Secretary for Health of the U.S. Minutes of meetings, Recommendations and meeting videocasts:
http://www.hhs.gov/advcomcfs/

[4] The most recent proposals of the DSM-5 “Somatic Symptoms Disorders” Work Group plus two key Disorder Description and Rationale PDF documents can be read on the APA’s DSM-5 Development site:
http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

or here on Dx Revision Watch site: http://wp.me/pKrrB-St

Filed under Clinical Modification, DSM-5, DSM-5 draft proposals, iCAT, ICD-10, ICD-10-CM, ICD-11, WHO (World Health Organization)

No publication of an ICD-11 Alpha Draft for public scrutiny

November 19, 2010 by

There will be no publication of an ICD-11 Alpha Draft for public scrutiny

Post #53 Shortlink: http://wp.me/pKrrB-QL

For some time now, I have been trying to establish whether ICD Revision intends to release any form of ICD-11 Alpha Draft for public scrutiny. An Alpha Draft had originally been scheduled for May 2010.

On 6 August, ICD Revision on Facebook had stated:

“The ICD-11 Alpha Drafting process has been ongoing since the first iCamp that was held in Geneva, Switzerland in September 2009. A draft print version will be available in September 2010.”

On 29 September, I asked:

“Clarification would be welcomed on whether an Alpha Draft will be available this month for internal use only or whether it is intended for public viewing, and if for public viewing, in what format(s)?”

which received no response.

On 6 October, I asked, again:

“On 6 August, ICD Revision on Facebook stated that “A draft print version will be available in September 2010”. Other than what can be seen on the iCAT collaborative authoring platform, will ICD Revision please clarify for stakeholders, whether any form of Alpha Draft for ICD-11 is going to be placed in the public domain, when this will now be released, and in what formats?”

On 15 October, ICD Revision on Facebook responded: 

“Indeed a print version is available but as an alpha draft it is not for public consumption. Public draft ( beta draft) was and (is still) targeted for MAY 2011. iCAT authoring platform is not open to public and should be only seen by designated authors. — This is not something opaque. any project of this size and complexity has to pass through stages. In May 2011 more user-friendly software and easy-to-view options will be available…”

At that point, it was in fact the case that both the iCAT authoring platform server and the iCAT demo and training platform had been viewable by the public, although only WHO, ICD Revision Steering Group, ICD Revision IT technicians and Topic Advisory Groups (TAGs) had editing access.

The iCAT production server is at: http://icat.stanford.edu/
The iCAT demo and training platform is at: http://icatdemo.stanford.edu/

In early November, access to viewing the iCAT and the iCAT demo platform was closed to the public. 

Topic Advisory Group (TAG) members now require a password login for both browsing and editing the iCAT or importing data and the public can no longer view the iCAT and the population of ICD Title Categories and Content, at all.

Filed under iCAT, ICD revision process, ICD-10, ICD-11, ICD-11 Alpha Draft, ICD-11 consultation, ICD-11 revision docs, Somatic Symptom Disorder, Somatoform Disorders, WHO (World Health Organization)

The Development, Evolution, and Modifications of ICD-10: Challenges to the International Comparability of Morbidity Data

October 29, 2010 by

The Development, Evolution, and Modifications of ICD-10: Challenges to the International Comparability of Morbidity Data

Post #52 Shortlink: http://wp.me/pKrrB-QX

Keywords
ICD, WHO, morbidity, ICD-10 clinical modifications, administrative data

Medical Care

POST AUTHOR CORRECTIONS, 25 October 2010
doi: 10.1097/MLR.0b013e3181ef9d3e
Original Article: PDF Only

The Development, Evolution, and Modifications of ICD-10: Challenges to the International Comparability of Morbidity Data

Published Ahead-of-Print

Abstract

Background: The United States is about to make a major nationwide transition from ICD-9-CM coding of hospital discharges to ICD-10-CM, a country-specific modification of the World Health Organization’s ICD-10. As this transition occurs, the WHO is already in the midst of developing ICD-11. Given this context, we undertook this review to discuss: (1) the history of the International Classification of Diseases (a core information “building block” for health systems everywhere) from its introduction to the current era of ICD-11 development; (2) differences across country-specific ICD-10 clinical modifications and the challenges that these differences pose to the international comparability of morbidity data; (3) potential strategic approaches to achieving better international ICD-11 comparability.

Literature Review and Discussion: A literature review and stakeholder consultation was carried out. The various ICD-10 clinical modifications (ICD-10-AM [Australia], ICD-10-CA [Canada], ICD-10-GM [Germany], ICD-10-TM [Thailand], ICD-10-CM [United States]) were compared. These ICD-10 modifications differ in their number of codes, chapters, and subcategories. Specific conditions are present in some but not all of the modifications. ICD-11, with a similar structure to ICD-10, will function in an electronic health records environment and also provide disease descriptive characteristics (eg, causal properties, functional impact, and treatment).

Conclusion: The threat to the comparability of international clinical morbidity is growing with the development of many country-specific ICD-10 versions. One solution to this threat is to develop a meta-database including all country-specific modifications to ensure more efficient use of people and resources, decrease omissions and errors but most importantly provide a platform for future ICD updates.

(C) 2010 Lippincott Williams & Wilkins, Inc.

Ed note: The forthcoming US “Clinical Modification”, ICD-10-CM, is country specific; it does not apply outside the US.

Current proposals for the US Clinical Modification ICD-10-CM, which is scheduled for implementation in October  2013, propose classifying Chronic fatigue syndrome in ICD-10-CM Chapter 18 at R53.82.

The proposed U.S. classification ICD-10-CM separates CFS and Postviral fatigue syndrome into mutually exclusive categories. “Chronic fatigue, unspecified | Chronic fatigue syndrome not otherwise specified” appear in Chapter XVII under R53.82.

“Postviral fatigue syndrome | Benign myalgic encephalomyelitis” appear in Chapter VI under G93.3.

The Chronic Fatigue Syndrome Advisory Committee (CFSAC) had previously recommended CFS to be placed under the same neurological code as ME and PVFS, G93.3.

For the most recent ICD-10-CM proposals see:

CDC site: International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) [1]:

http://www.cdc.gov/nchs/icd/icd10cm.htm

The Zipped file for the “2010 ICD-10-CM Tabular List of Diseases & Injuries” is not that easy to locate on the CDC site.

A non Zipped PDF of the most recent proposals can be downloaded here:

http://www.cms.gov/ICD10/12_2010_ICD_10_CM.asp#TopOfPage

http://www.cms.gov/ICD10/Downloads/6_I10tab2010.pdf

Page 325:

G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis
Excludes1: chronic fatigue syndrome NOS (R53.82)

Page 1165:

R53.82 Chronic fatigue, unspecified
Chronic fatigue syndrome NOS
Excludes1: postviral fatigue syndrome (G93.3)

The Canadian Clinical Modification (ICD-10-CA) has all three terms classified in Chapter VI: Diseases of the nervous system at G93.3:

Version 2009 ICD-10-CA Tabular List, Volume 1 PDF (4.9MB):

http://secure.cihi.ca/cihiweb/en/downloads/ICD-10-CA_Vol1_2009.pdf

Other disorders of the nervous system

(G90-99)

[…]

G93 Other disorders of brain

[…]

G93.3 Postviral fatigue syndrome
Includes: Benign myalgic encephalomyelitis
Chronic fatigue syndrome

Excludes: fatigue syndrome NOS (F48.0)

[1] Although this release of ICD-10-CM is now available for public viewing, the codes in ICD-10-CM are not currently valid for any purpose or use.

[2] More information on US “Clinical Modification” ICD-10-CM here, on DSM-5 and ICD-11 Watch site: http://wp.me/pKrrB-Ka

Filed under Clinical Modification, ICD revision process, ICD-10, ICD-10-CM, ICD-11, ICD-11 in the media, WHO (World Health Organization)

Web Protégé: Supporting the Creation of ICD-11 and iCAMP2 YouTubes

October 26, 2010 by

Web Protégé: Supporting the Creation of ICD-11 and iCAMP2 YouTubes

Post #51 Shortlink: http://wp.me/pKrrB-Qv

http://iswc2010.semanticweb.org/pdf/502.pdf

Web Protégé: Supporting the Creation of ICD-11

Sean M. Falconer, Tania Tudorache, Csongor Nyulas, Natalya F. Noy, Mark A. Musen

Stanford Center for Biomedical Informatics Research, Stanford University, US

1 Introduction

The International Classification of Diseases (ICD) is a public global standard that organizes and classifes information about diseases and related health problems [4]. Health offcials use ICD in all United Nations member countries to compile basic health statistics, to monitor health-related spending, and to inform policy makers. In the United States, use of the ICD is also a requirement for all medical billing. ICD has therefore a major impact on many aspects of health care all over the world.

In 2007, the WHO initiated the 11th revision of ICD. Several ambitious goals were set for this version (details in [2]). One such goal is to allow the ICD to become a multi-purpose classification for a much larger number of usages. Previous versions of ICD were strictly classification hierarchies used for statistical purposes. To meet the new revision goals, ICD-11 will use OWL to create a rich formal representation. Another key diference between ICD-11 and previous versions is that the development process of ICD-11 will use a Web-based open process powered by collaboration and social features. That is, similar to Wikipedia, the WHO hopes that a large number of medical experts will contribute to the content of ICD-11.

Our group has been working closely with the WHO to provide the technical support for these ambitious goals. We have created a customized version of Protégé specifcally designed to support the ICD authoring process. In [2], we discuss in detail the use of Semantic Web technologies for the revision of ICD. Our demo will showcase features of the customized Protégé such as content creation and collaboration. For the remainder of this paper, we present the architecture and highlight features of the user interface…

Full document

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iCamp2: 27 September – 1 October 2010

http://sites.google.com/site/icd11revision/home/face-to-face-meetings/icamp2-2010   

The iCamp2 meeting, scheduled for April but postponed due to volcanic ash cloud disruption of air traffic, was held between 27 September – 1 October, in Geneva.   

iCamp2
27 September – 1 October 2010 Geneva, Switzerland WHO Headquarters   

RSG 2010 [Revision Steering Group]
30 September – 1 October 2010 Geneva, Switzerland WHO Headquarters   

The revised Agenda for the meeting can be read here in html on the ICD Revision site.   

Download here as a Word document from the ICD Revision site or open here iCamp2 Agenda September 2010 on DSM-5 and ICD-11 Watch site.   

I will post a link for the minutes, summary or note of this meeting when these are available on the ICD Revision site.

There are two ICD-11 iCamp2 on YouTube   

ICD-11 ICAMP2 Day 5 

WHOICD11’s Channel  | 21  October 2010  |  9.53 mins

iCAMP2 Day 2   

WHOICD11’s Channel  | 29 September 2010  |  7:32 mins    

 

Related information

ICD Revision iCamp2 meeting, new documents and status of the ICD-11 Alpha Draft

Filed under iCAT, ICD on YouTube, ICD revision process, ICD-10, ICD-11, ICD-11 Alpha Draft, ICD-11 revision docs, WHO (World Health Organization), Wikipedia

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