Submission: Objection to proposal to insert DSM-5’s Somatic symptom disorder into ICD-10-CM

November 11, 2013 by

Post #281 Shortlink: http://wp.me/pKrrB-3×1

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

There are just five days is just one day left in which to submit objections to NCHS to the proposal to insert DSM-5’s Somatic symptom disorder into ICD-10-CM.

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

Further information here: Keep SSD out of ICD-10-CM – November 15 deadline for objections

Please let me know if you or your organization or professional body has submitted comment or objections, with a link if your submission is being placed in the public domain.

We need to keep SSD out of ICD-10-CM

Please consider submitting an objection before the November 15 deadline.

If you submitted comment during any of the three DSM-5 public review periods or you are an advocate or clinician signatory to the Institute of Medicine (IOM) definition issue letters campaign please also consider submitting an objection to NCHS.

I have submitted the following:

PDF: Submission NCHS

Text:

To: Ms Donna Pickett, CDC

Re: Comment on proposals, September 18-19, 2013 meeting of the ICD-9-CM Coordination and Maintenance Committee

Diagnostic Agenda, Page 45: Additional Tabular List Inclusion Terms for ICD-10-CM

Add Somatic symptom disorder to ICD-10-CM Tabular List under F45 Somatoform Disorders as inclusion term to F45.1 Undifferentiated somatoform disorder.

Add Somatic symptom disorder to ICD-10-CM Alphabetical Index.

Requestor for proposal: Unspecified

——————————————————–

I am writing to object to the proposed insertion of Somatic symptom disorder into the ICD-10-CM Tabular List and Alphabetical Index.

Somatic symptom disorder is a new construct created by the American Psychiatric Association (APA) for DSM-5.

For DSM-5, the Somatoform Disorders have been dismantled. Four DSM-IV categories: somatization disorder [300.81], some presentations of hypochondriasis [300.7], pain disorder, and undifferentiated somatoform disorder [300.82] are eliminated and replaced with a single new construct, Somatic Symptom Disorder (SSD), cross-walked in DSM-5 to ICD 300.82 (F45.1).

The Somatic Symptom Disorder construct de-emphasizes “medically unexplained” as the central defining feature of this disorder group. The diagnosis does not require that the somatic symptoms are medically unexplained, instead, the focus shifts away from somatic symptoms to emotional, cognitive and behavioral disturbances and “maladaptive” responses: high levels of health anxiety; disproportionate and persistent concerns about the medical seriousness of the symptom(s); or an excessive amount of time and energy devoted to symptoms and health concerns.

Symptoms may or may not be associated with another medical condition: SSD allows for the application of a mental health diagnosis in patients with “established general medical conditions or disorders” like diabetes, heart disease and cancer or presenting with “somatic symptoms of unclear etiology” if the clinician considers the patient otherwise meets the new criteria.

To meet the requirements for DSM-IV Somatization Disorder, a rigorous criteria set needed to be fulfilled: a history of many medically unexplained symptoms before the age of thirty, resulting in treatment sought or psychosocial impairment. And a high diagnostic threshold: a total of eight or more medically unexplained symptoms from four, specified symptom groups, with at least four pain, two gastrointestinal, one psychosexual and one pseudoneurological symptom.

In DSM-5, the requirement for eight symptoms has been dropped to just one or more persistent, non specific, distressing somatic symptoms and the clinician’s perception of “excessive” or “maladaptive” response to the symptom or symptoms.

• These changes for DSM-5 represent a radical restructuring of the DSM-IV Somatoform Disorder categories and a new construct for which much remains to be determined.

On Day Two of the September ICD-9-CM Coordination and Maintenance Committee meeting, Dr Darrel Regier presented and discussed rationales, coding proposals and timings for six new DSM-5 disorders that the APA has proposed for insertion into ICD-10-CM. But the proposal to add the new DSM-5 Somatic symptom disorder and Illness anxiety disorder category terms to ICD-10-CM did not form part of Dr Regier’s presentation on behalf of the APA.

As it is unspecified within the Diagnosis Agenda and during the meeting presentations, it is unclear whether these two proposals are being requested by the APA, by NCHS/CMS, or by other parties or individuals.

• My first concern is that no description of Somatic symptom disorder, no rationale for why this ICD-10-CM change is needed (including clinical relevancy) and no supporting clinical and literature references for the validity of Somatic symptom disorder as a new disorder term were published in the Diagnosis Agenda.

At the public meeting, no presentation had been made on behalf of APA, or by representatives of NCHS or CMS, or by anyone else for the specific proposal to add Somatic symptom disorder as an inclusion term under the ICD-10-CM Somatoform disorders and there was no discussion of this proposal during the course of the meeting [1][2].

There is an expectation that the committees overseeing the development and revision of the draft for the ICD-10-CM will give due consideration to the applicability, clinical utility and reliability of any proposal for the inclusion of a new disorder construct before granting approval for addition to the Tabular List and Index, and that the comments and objections received during the public response period will also be considered.

The lack of rationales and references for supportive evidence provided by the requestors hinders public participation in the response process.

• The absence from both the Diagnosis Agenda document and the meeting presentations of rationales, clinical relevancy and supporting clinical and literature references to enable public scrutiny, consideration and informed responses to this proposal should disqualify SSD from consideration for implementation during a partial code freeze or for consideration for implementation in October 2015.

The burden of proof before introducing any new diagnosis into a classification system is that it has a favourable risk to benefit ratio. This new construct created by the APA for its DSM-5 merits the same level of scrutiny and risk to benefit evaluation as would be expected to be applied to any proposed new disorder/disease under consideration for inclusion in any chapter of ICD, whether this is for the updating of the ICD-10-CM draft, the international ICD-10, the several clinical modifications of ICD-10 or the drafting of ICD-11.

A number of papers have remarked on the paucity of rigorous evidence for the validity, reliability, acceptability, safety and utility of the SSD construct applied to adults and children in diverse clinical settings and across a spectrum of health and allied professionals.

There is no significant body of published research on the epidemiology, clinical characteristics or treatment of the Somatic symptom disorder construct [3][4][5].

In a paper published in the Journal of Psychosomatic Research, September 2013, the SSD work group concedes the lack of clinical evidence for its new construct and acknowledges the “small amount of validity data concerning SSD”; “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” as they go forward [6].

• As an under researched, poorly validated disorder construct, Somatic symptom disorder 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 be rejected for consideration for implementation during a partial code freeze but also rejected for consideration for implementation in October 2015.

Concerns for the looseness of the SSD definition and the ease with which these new criteria can be met have been discussed in a number of published papers and commentaries [7][8][9].

The over-inclusiveness of the SSD diagnosis is borne out by the results of the DSM-5 field trial study reported by the chair of the Somatic symptom disorder work group at the 2012 annual meeting of the American Psychiatric Association.

15% of the ‘diagnosed illness’ study group, comprising patients with cancer or coronary disease, were caught by SSD and would meet the criteria for application of an additional mental disorder diagnosis.

26% of the ‘functional somatic’ study group, patients with irritable bowel syndrome or chronic widespread pain, met the SSD criteria.

SSD has a high false positive rate – capturing 7% of the ‘healthy’ field trial control group.

It is also disturbing that the SSD work group (which included no primary care physicians) appears not to have undertaken any field trials into the safety of application of the SSD criteria in children and adolescents.

NCHS/CMS provides no references for data for the application of SSD in children within the Diagnosis Agenda, although the DSM-5 text clearly indicates APA’s intention that SSD is a diagnosis that may also be applied to children with persistent, distressing somatic symptoms.

Potential implications for the application of a diagnosis of SSD:

I am not persuaded that the new SSD construct and criteria can be safely applied outside the optimal conditions of field trials, in settings where practitioners may not necessarily have adequate time for, or instruction in the administration of diagnostic assessment tools, and where decisions to code or not to code may hang on the arbitrary and subjective perceptions of a wide range of end-users who may lack clinical training in the application of mental disorder criteria.

Misapplication of highly subjective and loose, easily met criteria, especially in busy primary care practice, may result in inappropriate diagnoses of mental disorder and inappropriate medical decision making [10], with considerable implications for patients (see Appendix).

A mental disorder diagnosis of SSD can be applied as a “bolt-on” to any chronic medical diagnosis, eg patients with diabetes, angina, cancer, MS, cardiovascular disease, ME and CFS, IBS, chronic widespread pain (aka fibromyalgia) or to patients with a chronic pain condition or with persistent symptoms of unclear etiology.

Patients with chronic, multiple bodily symptoms due to rare diseases, difficult to diagnoses diseases, or multi-system diseases like Behçet’s disease, which can take several years to arrive at a diagnosis, may be especially vulnerable to missed diagnosis or to misdiagnosis with a mental disorder, which may impede access to further testing, investigations, interventions and effective treatments (and result in increased claims against practitioners for medical negligence).

Patients with chronic fatigue syndrome (CFS), “almost a poster child for medically unexplained symptoms as a diagnosis,” according to SSD work group chair, Joel E Dimsdale, or chronic Lyme disease, Gulf War illness, chemical injury and chemical sensitivity; women with potential symptoms of gynecological disease, like ovarian cancer, already often late-diagnosed, endometriosis or interstitial cystitis, or patients with vague neurological symptoms may be particularly vulnerable to misapplication or misdiagnosis with a mental health disorder under the SSD criteria.

There has been considerable opposition to the introduction of this new, poorly tested construct into the DSM-5 amongst patients, carers, advocates, consumer organizations, mental health practitioners and clinicians and considerable concern for the implications for diverse patient populations that the Somatic Symptom Disorder category will provide a “dustbin diagnosis” for the so-called “functional somatic syndromes,” for those living with chronic pain and for patients with persistent, but as yet undiagnosed, symptoms of disease.

• NCHS/CMS has published no independent field trial data and provided no rationales or clinical and literature references to inform public responses. Given the lack of published evidence for the validity and safety of SSD as a construct in adults and children, there is insufficient basis for the approval of SSD for inclusion within ICD-10-CM and it would be scientifically unsafe, premature and against the public interest to include this new construct within ICD.

The proposal for addition to the ICD-10-CM as an inclusion term during a partial code freeze should be rejected. There should be no implementation in October 2015 as an inclusion term to F45.1 or to any other existing code, or with a unique code created.

Appendix:

Incautious, inept application of criteria resulting in a “bolt-on” psychiatric diagnosis of Somatic symptom disorder could have far-reaching implications for diverse patient populations:

• Application of highly subjective and difficult to measure criteria could potentially result in misdiagnosis with a mental disorder, misapplication of an additional diagnosis of a mental disorder or missed diagnoses through dismissal and failure to investigate new or worsening somatic symptoms.

• Patients with cancer and life threatening diseases may be reluctant to report new symptoms that might be early indicators of recurrence, metastasis or secondary disease for fear of attracting a diagnosis of SSD or of being labelled as “catastrophisers.”

• Application of an additional diagnosis of SSD may have implications for the types of medical investigations, tests and treatments that clinicians are prepared to consider and which insurers are prepared to fund.

• Application of an additional diagnosis of SSD may impact payment of employment, medical and disability insurance and the length of time for which insurers are prepared to pay out. It may negatively influence the perceptions of agencies involved with the assessment and provision of social care, disability adaptations, education and workplace accommodations, and the perceptions of medical staff during hospital admissions and accident and emergency admissions.

• Patients prescribed psychotropic drugs for perceived unreasonable levels of “illness worry” or “excessive preoccupation with symptoms” may be placed at risk of iatrogenic disease or subjected to inappropriate and costly behavioural therapies.

• For multi-system diseases like Multiple Sclerosis, Behçet’s disease or Systemic lupus it can take several years before a diagnosis is arrived at. In the meantime, patients with chronic, multiple somatic symptoms who are still waiting for a diagnosis would be vulnerable.

• The burden of the DSM-5 changes to Somatoform Disorders will fall particularly heavily upon women who are more likely to be casually dismissed when presenting with physical symptoms and more likely to be prescribed inappropriate antidepressants and anti-anxiety medications for them.

• Proposals allow for the application of a diagnosis of SSD to children and where a parent is considered excessively concerned with a child’s symptoms. Families caring for children with any chronic illness may be placed at increased risk of wrongful accusation of “over-involvement” with a child’s symptomatology.

Where a parent is perceived as encouraging maintenance of “sick role behavior” in a child, this may provoke social services investigation or court intervention for removal of a sick child out of the home environment and into foster care or enforced in-patient rehabilitation. This is already happening in families in the U.S. and Europe with a child or young adult with chronic illness, notably with Chronic fatigue syndrome or ME. It may happen more frequently with a diagnosis of a chronic childhood illness + SSD.

Thank you for your consideration.

References:

1. September 18-19, 2013 meeting of the ICD-9-CM Coordination and Maintenance Committee Diagnosis Agenda.

2. September 18-19, 2013 meeting of the ICD-9-CM Coordination and Maintenance Committee Summary of Diagnosis Presentations.

3. DSM-5 Somatic Symptom Disorders Work Group Disorder Descriptions and Justification of Criteria – Somatic Symptoms, pub. May 2011, for second DSM-5 stakeholder review.

4. Robert L. Woolfolk and Lesley A. Allen (2012). Cognitive Behavioral Therapy for Somatoform Disorders, Standard and Innovative Strategies in Cognitive Behavior Therapy, Dr. Irismar Reis De Oliveira (Ed.), ISBN: 978-953-51-0312-7

5. Ghanizadeh A, Firoozabadi A. A review of somatoform disorders in DSM-IV and somatic symptom disorders in proposed DSM-V. Psychiatr Danub. 2012 Dec;24(4):353-8.

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

7. Frances A. The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill. BMJ. 2013 Mar 18;346:f1580. doi: 10.1136/bmj.f1580.

8. Frances A. DSM-5 Somatic Symptom Disorder. J Nerv Ment Dis. 2013 Jun;201(6):530-1. doi: 10.1097/NMD.0b013e318294827c.

9. Frances A, Chapman S. DSM-5 somatic symptom disorder mislabels medical illness as mental disorder. Aust N Z J Psychiatry. 2013 May;47(5):483-4. doi: 10.1177/0004867413484525.

10. Dimsdale JE. Medically unexplained symptoms: a treacherous foundation for somatoform disorders? Psychiatr Clin North Am 2011;34:511-3.

Interest:

Carer/advocate for young adult with long-term medical condition. Owner of website Dx Revision Watch, Monitoring the revision of DSM-5 and ICD-11. Co-author, journal papers and commentaries on the SSD construct (with Professor Allen Frances).

[End of submission]

Filed under Allen Frances, Darrel Regier, DSM-5, Functional Somatic Syndrome (FSS), ICD-10-CM, ICD-11, MUS, Myalgic encephalomyelitis, Somatic Symptom Disorder, Somatoform Disorders Tagged with , , , , , , , , ,

Which new DSM-5 disorders proposed for inserting into ICD-10-CM are already added to the ICD-11 Beta draft?

November 6, 2013 by

Post #280 Shortlink: http://wp.me/pKrrB-3vs

Update to ICD-11 Beta draft at February 3, 2014:

Since my update on January 3, in the ICD-11 Beta draft, Hypochondriasis (illness anxiety disorder) has since been reverted to Hypochondriasis with illness anxiety disorder listed, instead, as an Inclusion term to Hypochondriasis.

Hypochondriasis was subsequently assigned to three parents:

Bodily distress disorders, and psychological and behavioural factors associated with disorders or diseases classified elsewhere; Obsessive-compulsive and related disorders;
Anxiety and fear-related disorders;

At February 3, Hypochondriasis has been removed from parent Bodily distress disorders and is currently assigned dual parentage under:

Obsessive-compulsive and related disorders;
Anxiety and fear-related disorders

Foundation View:

hppt://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f675329566

Joint Linearization for Mortality and Morbidity Statistics View:

http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f675329566

The Definition for Hypochondriasis currently displaying in the Beta draft appears to be the legacy Definition, unrevised from ICD-10.

Update to ICD-11 Beta draft at January 3, 2014:

Revision to ICD-11 Beta draft: In the report below, I stated:

ICD-11 public version Beta draft: Illness anxiety disorder is proposed to be dual coded as Hypochondriasis (illness anxiety disorder) under primary parent, Obsessive-compulsive and related disorders and also coded under Bodily distress disorders, and psychological and behavioural factors associated with disorders or diseases classified elsewhere and assigned a unique code.

As the ICD-11 Beta drafting platform now stands, at January 3, 2014, the DSM-5 term “(illness anxiety disorder)” has been removed from the “Hypochondriasis (illness anxiety disorder)” disorder name and the term reverted to Hypochondriasis.

The term “illness anxiety disorder” is now displaying as listed under “Synonyms” to Hypochondriasis in the ICD-11 Beta Foundation View, and listed under “All Index Terms” in the Morbidity Linearization View.

As previously posted on November 6, 2013:

In the previous four posts, I have documented the September 18-19, 2013 meeting of the ICD-9-CM Coordination and Maintenance Committee and reported on American Psychiatric Association (APA) proposals for inserting a number of new DSM-5 terms into the forthcoming US specific ICD-10-CM.

I also set out how public and professional stakeholders can submit comment or objections on any of the proposals requested at this meeting before the November 15 deadline.

At the September meeting, Darrel Regier, MD, APA Director of Research, presented six diagnoses that are new to DSM-5 for inclusion within ICD-10-CM, with proposals for assigning unique new codes to these disorders for October 2015 [1].

Some of the DSM-5 disorders, below, presented for consideration for inclusion in ICD-10-CM are already entered into the ICD-11 Beta drafting platform and in some cases, entered into the draft over a year or more ago.*

*Caveat: The ICD-11 Beta draft is not approved by WHO or WHA. The Beta draft is a work in progress over the next two to three years. The Beta draft is updated on a daily basis: parent terms, category terms, sorting codes and descriptive content are subject to change as chapter reorganization progresses. This post reflects the Beta draft as it stood on November 6, 2013. ICD-11 Beta Draft Caveats

Binge eating disorder (BED)

(Rationale: Page 32, Diagnosis Agenda: Page 6, Diagnosis Presentations Summary)

Proposal for ICD-10-CM for October 1, 2014: add Binge eating disorder (BED) as an inclusion term to F50.8 Other eating disorders.

Proposal for ICD-10-CM for October 1, 2015: that a unique new code is created for F50.81 Binge eating disorder.

ICD-11 public version Beta draft: Binge eating disorder currently proposed to be coded under Feeding and eating disorders and assigned a unique ICD-11 code. No ICD-11 Definition or other “Content Model” descriptive parameters have yet been populated for Binge eating disorder.

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Gender Identity Disorder in Adolescence and Adulthood

(Rationale: Page 34, Page 6, Diagnosis Presentations Summary)

Proposal for ICD-10-CM for October 1, 2014: that ICD-10-CM change the code for Gender identity disorder in adolescents and adulthood to F64.0 and that “gender dysphoria in adolescents and adults” is added as an inclusion term for this entry.

ICD10CM5

Source: September 2013 Diagnosis Agenda, Page 34

[See Page 34 of Diagnosis Agenda for discussion of proposed coding changes.]

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Disruptive mood dysregulation disorder (DMDD)

(Rationale: Page 35, Diagnosis Agenda; Page 6, Diagnosis Presentations Summary)

Proposal for ICD-10-CM for October 1, 2014: add Disruptive mood dysregulation disorder (DMDD) as an inclusion term under F34.8: Other persistent mood [affective] disorders.

Proposal for ICD-10-CM for October 1, 2015: that unique new codes are created at F34.81 Disruptive mood dysregulation disorder and F34.89 Other specified persistent mood disorders.

ICD-11 public version Beta draft: Disruptive mood dysregulation disorder (DMDD) is not currently listed.

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Social (Pragmatic) Communication Disorder

(Rationale: Page 37, Diagnosis Agenda; Page 6, Diagnosis Presentations Summary)

Proposal for ICD-10-CM for October 1, 2014: add Social (Pragmatic) Communication Disorder as an inclusion term under F80.89 Other developmental disorders of speech and language.

Proposal for ICD-10-CM for October 1, 2015: that a unique new code is created at F80.82 Social pragmatic communication disorder.

Excludes1: Asperger’s syndrome (F84.5)

Autistic disorder (F84.0)

ICD-11 public version Beta draft: Social (Pragmatic) Communication Disorder is not currently listed.

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Hoarding disorder

(Rationale: Page 39, Diagnosis Agenda; Page 7, Diagnosis Presentations Summary)

Proposal for ICD-10-CM for October 1, 2014: add Hoarding disorder as an inclusion term to F42 Obsessive Compulsive Disorder.

Proposal for ICD-10-CM for October 1, 2015: that a unique new code is created at F42 for F42.2 for Obsessive Compulsive Disorder and F42.3 for Hoarding Disorder in future revisions. (Ms. Pickett stated that new code proposal starting at F42.2 is due to F42.0 and F42.1 deactivation by WHO.)

F42 Obsessive compulsive disorder

New code F42.2 Mixed obsessional thoughts and acts
New code F42.3 Hoarding disorder
New code F42.8 Other obsessive compulsive disorder
New code F42.9 Obsessive-compulsive disorder, unspecified

ICD-11 public version Beta draft: Hoarding disorder currently proposed to be coded under parent Obsessive-compulsive and related disorders and assigned a unique code. No ICD-11 Definition or other “Content Model” descriptive parameters have yet been populated for Hoarding disorder.

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Excoriation (skin picking) disorder

(APA Rationale: Page 41, Diagnosis Agenda, Page 7, Diagnosis Presentations Summary)

Proposal for ICD-10-CM for October 1, 2014: add Excoriation (skin-picking) disorder as an inclusion term to L98.1 Factitial dermatitis (Dermatology section).

Proposal for ICD-10-CM for October 1, 2015: that a unique new code is created at F42 for F42.4 Excoriation (skin-picking) disorder.

Excludes1: Factitial dermatitis (L98.1)

Other specified behavioral and emotional disorders with onset usually occurring in early childhood and adolescence (F98.8)

ICD-11 public version Beta draft: Excoriation disorder (skin-picking disorder) currently proposed to be coded under Obsessive-compulsive and related disorders under parent Body-focused repetitive behaviour disorders and assigned a unique code. No ICD-11 Definition or other “Content Model” descriptive parameters have yet been populated for Excoriation (skin-picking) disorder.

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Premenstrual dysphoric disorder (PMDD)

(APA Rationale: Page 43, Diagnosis Agenda; Page 7, Diagnosis Presentations Summary)

APA considers that placing PMDD outside the recurrent depressive disorder category is less than optimal for differentiating it from ICD-10-CM N94.3 Premenstrual Tension Syndrome, which is generally less severe than PMDD, and does not require psychiatric treatment. If an alternative code in the F32 series is possible, APA would prefer to modify the code in that section in future revisions.

Proposal for ICD-10-CM for October 1, 2014: add Premenstrual dysphoric disorder as an inclusion term to N94.3 Premenstrual tension syndrome (Chapter 15 Diseases of the genitourinary system).

Proposal for ICD-10-CM for October 1, 2015: that a unique new code is created under Chapter 5 F32.8 Other depressive episodes.

New code F32.81 Premenstrual dysphoric disorder

Excludes1: premenstrual tension syndrome (N94.3)

ICD-11 public version Beta draft: Premenstrual dysphoric disorder (PMDD) currently proposed to be dual coded under Chapter 15 Diseases of the genitourinary system > Premenstrual tension syndrome and also coded under Chapter 5 Depressive disorders and assigned a unique code. A draft ICD-11 Definition has been populated for PMDD but no other ICD-11 “Content Model” descriptive parameters have been populated.

——————————

Somatic symptom disorder and Illness anxiety disorder

ICD10CM 4

Source: September 2013 Diagnosis Agenda, Page 45

Somatic symptom disorder:

(No rationale provided: Page 45, Diagnosis Agenda) Requester unspecified

Proposal for ICD-10-CM: add Somatic symptom disorder under F45 Somatoform Disorders as inclusion term to F45.1 Undifferentiated somatoform disorder.

ICD-11 public version Beta draft: There is no Somatic symptom disorder in the ICD-11 Beta draft either as a unique new ICD-11 entity code or as an inclusion term or Synonym to an existing ICD-11 code.

For ICD-11 Core version: the current proposal for the F45 Somatoform disorders is for a proposed new construct, Bodily distress disorder, to replace a number of existing ICD-10 categories under Bodily distress disorders, and psychological and behavioural factors associated with disorders or diseases classified elsewhere. Two specifiers: Bodily distress disorder and Severe Bodily distress disorder have yet to be defined or characterized within the Beta draft and no “Content Model” parameters have yet been populated. ICD-11 plans to field test this proposed new ICD-11 construct.

The Definition for Bodily distress disorders, and psychological and behavioural factors associated with disorders or diseases classified elsewhere currently displaying in the Beta draft appears to be the legacy Somatoform disorders Definition imported from ICD-10 and does not reflect any proposed structural reorganization or construct revision for the ICD Somatoform disorders categories.

——————————

Illness anxiety disorder

(No rationale provided: Page 45, Diagnosis Agenda) Requester unspecified

Proposal for ICD-10-CM: add Illness anxiety disorder under F45 Somatoform disorders as inclusion term to F45.21 Hypochondriasis.

ICD-11 public version Beta draft: Illness anxiety disorder is proposed to be dual coded as Hypochondriasis (illness anxiety disorder) under primary parent, Obsessive-compulsive and related disorders and also coded under Bodily distress disorders, and psychological and behavioural factors associated with disorders or diseases classified elsewhere and assigned a unique code.

The Definition for Hypochondriasis (illness anxiety disorder) currently displaying in the Beta draft appears to be the legacy Definition imported from ICD-10 and does not reflect any proposed structural reorganization or construct revision for the ICD Somatoform disorders categories.

Submitting comments

If you have comments or objections to any of the proposals requested at the September ICD-9-CM C & M Committee meeting, the deadline for submissions is November 15, by email, to Donna Pickett: nchsicd9CM@cdc.gov

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References for key documents:

1. Article: ICD Codes for Some DSM-5 Diagnoses Updated, Mark Moran, Psychiatric News, October 07, 2013:
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleID=1750103

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

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

September meeting Summary of Diagnosis Presentations PDF file [PDF – 347 KB]:
http://www.cdc.gov/nchs/data/icd/icd_summary_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. September 19, 2013 Meeting Day Two: ICD-9-CM Coordination and Maintenance Committee Meeting Part 4 videocast:
http://www.youtube.com/watch?v=G-pYdKyr_NE

5. ICD-11 Beta drafting platform (public version):
http://apps.who.int/classifications/icd11/browse/f/en

Filed under American Psychiatric Association (APA), CDC, CMS, Criticism of DSM-V, DSM-5, DSM-5, ICD-10-CM, ICD-10-PCS, ICD-11, Somatic Symptom Disorder, WHO (World Health Organization) Tagged with , , , , , , , , ,

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

November 5, 2013 by

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

Filed under American Psychiatric Association (APA), CDC, CMS, Criticism of DSM-V, DSM-5, DSM-5, ICD-10-CM, ICD-10-PCS, ICD-11, Somatic Symptom Disorder, WHO (World Health Organization) Tagged with , , , , , , , , ,

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

November 1, 2013 by

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.

+++
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.

+++
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.

+++
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.

Filed under American Psychiatric Association (APA), Bodily Distress Disorders, CMS, Criticism of DSM-V, DSM-5, Diagnostic classification, DSM-5, ICD-10-CM, ICD-11, Somatic Symptom Disorder, Somatoform Disorders Tagged with , , , , , , , , ,

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

October 10, 2013 by

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]

+++

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


+++
Part 2 1:27 hours duration

Procedure presentations with public comment


+++
Part 3 59 minutes duration

Diagnosis presentations with public comment

+++
Videocast for September 19, 2013 | Day Two

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

Diagnosis presentations with public comment

+++
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.)

Filed under American Psychiatric Association (APA), CDC, CMS, Criticism of DSM-V, DSM-5, DSM-5, ICD-10-CM, ICD-10-PCS, ICD-11, Somatic Symptom Disorder, WHO (World Health Organization) Tagged with , , , , , , , , ,

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

October 8, 2013 by

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.)

+++

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

Filed under American Psychiatric Association (APA), CDC, CMS, Criticism of DSM-V, DSM-5, DSM-5, ICD-10-CM, ICD-10-PCS, ICD-11, Somatic Symptom Disorder, WHO (World Health Organization) Tagged with , , , , , , , , ,

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