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

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

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

Deadline for receipt of public comments: November 15, 2013

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

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

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

Summary and Proposals

September 18-19, 2013

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

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

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

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

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

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

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

• Supporting clinical references and literature should also be submitted.

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

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

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

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

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Related posts:

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

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

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

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References for key documents and screenshots:

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

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

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

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

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

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

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

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

September 19, 2013 Meeting Day Two

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

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

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

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

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

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

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

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

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

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

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

Q: Can anyone submit objections?

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

Q: What is being proposed?

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

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

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

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

ICD10CM 4

Source: September 2013 Diagnosis Agenda, Page 45

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

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

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

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

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

Q: What should I include in my objection?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Why is it important to submit objections?

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

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

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

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

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

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

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

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

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

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

Further information:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Meeting materials:

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

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

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

From CMS.gov website:

September 18-19, 2013 meeting materials page

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

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

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

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

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

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

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

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Videocasts for September 18, 2013 | Day One

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

Part 1 1:43 hours duration

Procedure presentations with public comment


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Part 2 1:27 hours duration

Procedure presentations with public comment


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Part 3 59 minutes duration

Diagnosis presentations with public comment

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Videocast for September 19, 2013 | Day Two

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

Diagnosis presentations with public comment

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Diagnosis proposals

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

Page 47 Diagnosis Agenda: Unintended awareness under general anesthesia

Comment from floor: Robert Adams reads out written statement.

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

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

Preamble about DSM and DSM-5.

Page 32 Diagnosis Agenda: Binge eating disorder

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

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

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

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

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

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

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

54 mins in: Page 39 Diagnosis Agenda: Hoarding disorder

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

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

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

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

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

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

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

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

[Unofficial transcription from videocast]

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

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

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

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

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

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

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

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

This concluded the diagnosis portion of the presentations.

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

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

[Unofficial transcription from videocast]

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

Submitting public comment:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Submitting public comment:

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

Comments should be sent to the following NCHS email addresses:

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

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

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

Responders are asked to consider the following:

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

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

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

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

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References for key documents and screenshots:

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

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

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

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

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

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

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

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

September 19, 2013 Meeting Day Two

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

5. Pages 45-46, Diagnosis Agenda:

ICD10CM 1

ICD10CM 2

ICD10CM 3

DSM-5 Somatic Symptoms Disorders work group publishes SSD field trial data

Post #272 Shortlink: http://wp.me/pKrrB-3ke

Update: Somatic Symptom Disorder: An important change in DSM. is now published in the September 2013 issue, J Psychosom Res. A subscription or payment is required to access this paper.

http://www.ncbi.nlm.nih.gov/pubmed/23972410

J Psychosom Res. 2013 Sep;75(3):223-8. Epub 2013 Jul 25.
Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, Lee S, Irwin MR, Levenson J.

DSM-5 Somatic Symptoms Disorders work group publishes SSD field trial data…behind a paywall

Reports on the findings of the DSM-5 field trials have been slow to emerge.

Kappa results trickled out in dribs and drabs; work group chairs presented limited field trial data at the APA’s 2012 Annual Meeting. There remains a paucity of information on field trial study protocols, patient selection, field test results and analysis.

This is of particular concern where radical changes to DSM-IV definitions and criteria were introduced into DSM-5 and are now out there in the field.

A good example is the new DSM-5 “Somatic Symptom Disorder” category, where there is no substantial body of evidence for the reliability, validity, prevalence, safety, acceptability and clinical utility of the implementation of this new disorder construct – though that did not stop them barrelling it through to the final draft.

In its paper, the SSD Work Group 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 that there are “vital questions that must be answered” as they go forward.

They don’t sound any too confident about what they’ve barrelled through; but neither do they seem overly concerned.

With remarkable insouciance, SSD Work Group Chair, Joel E Dimsdale, told ABC journalist, Susan Donaldson James, “…If it doesn’t work, we’ll fix it in the DSM-5.1 or DSM-6.” (ABC News, February 27, 2013).

Cavia15The implementation of SSD in the DSM-5 is a Beta trial; the public – adults and children – unwitting guinea pigs.

Members of the DSM-5 Somatic Symptoms Disorders Work Group have just published a report – Somatic Symptom Disorder: An important change in DSM.

APA owns the output of the DSM-5 work groups but this report isn’t posted on the APA’s DSM-5 Development site or on the Field Trials or DSM-5 Resources pages.

It’s being published (currently In Press) in the Journal of Psychosomatic Research, for which DSM-5 SSD Work Group member, James Levenson, is a Co-Editor and for which SSD Work Group member, Francis Creed, a past Editor.

Unless you are a subscriber to JPS or have institution access you will need to cough up $30 to access this paper.

DSM-5 Task Force’s Regier and Kupfer have been banging on for years about how transparent the development process for this most recent iteration of the DSM has been. Yet reports on field trial findings and analysis of studies cited in support of the introduction of radical new constructs for DSM are stuffed behind paywalls.

Why are DSM-5 work group reports not being published on the DSM-5 Development website or other APA platforms or published in journals under Creative Commons Licenses, for ease of public accessibility, professional and consumer stakeholder scrutiny and discussion, and for accountability?

The development of ICD-11 is also being promoted by WHO’s Bedirhan Üstün as an open and transparent process.

But emerging proposals from the two working groups charged with making recommendations for revision of ICD-10′s Somatoform Disorders (the Primary Care Consultation Group, chaired by Prof Sir David Goldberg and the WHO Expert Working Group on Somatic Distress and Dissociative Disorders, chaired by Prof Oje Gureje) were also published, last year, in subscription journals and subject to those journals’ respective copyright restrictions [1] [2].

1. Lam TP et al. Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Fam Pract. 2013 Feb;30(1):76-87. [Abstract: PMID:22843638]
2. Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry 2012;24:556-67. [Abstract: PMID: 23244611]

Why are ICD-11 working group progress reports on emerging proposals for potential new ICD disorders and focus group study reports not being published on platforms accessible, without payment, to all classes of ICD stakeholder?

The SSD Work Group paper is authored by Joel E Dimsdale (Chair), Francis Creed, Javier Escobar, Michael Sharpe, Lawson Wulsin, Arthur Barsky, Sing Lee, Michael R. Irwin and James Levenson.

[Although not a member of the SSD Work Group, Javier Escobar is Task Force liaison to the SSD work group and works closely with the group. Francis J Keefe (not included in the paper’s authors) is a member of the SSD Work Group. Nancy Frasure-Smith (not included in the paper’s authors) served as a member of the Work Group from 2007-2011 and was not replaced following withdrawal.]

The paper describes the DSM-5 Work Group’s rationale for the new SSD diagnosis (which replaces four DSM-IV categories); defines the construct, discusses field trial kappa data (inter-rater reliability), presents limited data for validity of SSD, clinical utility and potential prevalence rates, and briefly discusses tasks for future research, education and clinical practice.

http://www.jpsychores.com/

July 2013, Vol. 75, No. 1

In Press

Somatic Symptom Disorder: An important change in DSM

29 July 2013

Joel E. Dimsdale, Francis Creed, Javier Escobar, Michael Sharpe, Lawson Wulsin, Arthur Barsky, Sing Lee, Michael R. Irwin, James Levenson

Received 4 April 2013; received in revised form 27 June 2013; accepted 29 June 2013. published online 29 July 2013.

Corrected Proof

doi:10.1016/j.jpsychores.2013.06.033

Abstract: http://www.jpsychores.com/article/S0022-3999(13)00265-1/abstract [Free]

Full text: http://www.jpsychores.com/article/S0022-3999(13)00265-1/fulltext  [Paywall]

References: http://www.jpsychores.com/article/PIIS0022399913002651/references  [Paywall]


Commentaries on Somatic Symptom Disorder in recent journal papers

In the June 2013 edition of Journal of Nervous and Mental Disorders, Allen Frances, MD, who chaired the Task Force for DSM-IV, discusses his concerns for the loosely defined DSM-5 category, Somatic Symptom Disorder, sets out his suggestions for revising the criteria prior to finalization, as presented to the SSD Work Group chair, in December 2012, and advises clinicians against using the new SSD diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/23719325

DSM-5 Somatic Symptom Disorder.

Frances A.

Department of Psychiatry, Duke University, Durham, NC.

J Nerv Ment Dis. 2013 Jun;201(6):530-1. doi: 10.1097/NMD.0b013e318294827c. No abstract available.

PMID: 23719325

+++

Commentary by Allen Frances, MD, and Suzy Chapman in the May 2012 issue of Australian and New Zealand Journal of Psychiatry. The paper discusses the over-inclusive DSM-5 Somatic Symptom Disorder criteria and the potential implications for diverse patient groups. The paper concludes by advising clinicians not to use the new SSD diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/23653063

DSM-5 somatic symptom disorder mislabels medical illness as mental disorder.

Allen Frances¹, Suzy Chapman²

1 Department of Psychiatry, Duke University 2 DxRevisionWatch.com

Aust N Z J Psychiatry. 2013 May;47(5):483-4. doi: 10.1177/0004867413484525. No abstract available.

PMID: 23653063

+++

The April 22, 2013 edition of Current Biology published a feature article on DSM-5 by science writer, Michael Gross, Ph.D. The article includes quotes from Allen Frances, MD, and Suzy Chapman on potential implications for patients for the application of the new DSM-5 Somatic Symptom Disorder. The article includes concerns for the influence of Somatic Symptom Disorder on proposals for a new ICD category – Bodily Distress Disorder – being field tested for ICD-11.

Current Biology 22 April, 2013 Volume 23, Issue 8

Copyright 2013 All rights reserved. Current Biology, Volume  23, Issue  8, R295-R298, 22 April 2013

doi:10.1016/j.cub.2013.04.009

Feature

Has the manual gone mental?

Michael Gross

Full text: http://www.cell.com/current-biology/fulltext/S0960-9822(13)00417-X

PDF: http://download.cell.com/current-biology/pdf/PIIS096098221300417X.pdf

+++

In a BMJ opinion piece, published March 2013, Allen Frances, MD, opposes the new Somatic Symptom Disorder, discusses lack of specificity, data from the field trials, and advises clinicians to ignore this new category.

http://www.ncbi.nlm.nih.gov/pubmed/23511949

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill.

Frances A.

Allen Frances, chair of the DSM-IV task force

BMJ. 2013 Mar 18;346:f1580. doi: 10.1136/bmj.f1580. No abstract available.

PMID: 23511949

[PubMed – indexed for MEDLINE]

+++
Somatic Symptom Disorder is also included in Saving Normal: An Insider’s Revolt Against Out-Of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (pp. 193-6): Allen Frances, William Morrow & Company (May 2013).

Also Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (Chapter 16): Allen Frances, Guilford Press (June 2013).

+++

Further reading

APA Somatic Symptom Disorder Fact Sheet APA DSM-5 Resources

Somatic Chapter Drops Centrality Of Unexplained Medical Symptoms Psychiatric News, Mark Moran, March 1, 2013

Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care David J Kupfer, MD, Chair, DSM-5 Task Force, defends the SSD construct, Huffington Post, February 8, 2013

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill Allen Frances, MD, BMJ 2013;346:f1580 BMJ Press Release

Somatic Symptom Disorder could capture millions more under mental health diagnosis Suzy Chapman, May 26, 2012

Mislabeling Medical Illness As Mental Disorder Allen Frances, MD, Psychology Today, DSM 5 in Distress, December 8, 2012

Why Did DSM 5 Botch Somatic Symptom Disorder? Allen Frances, MD, Psychology Today, Saving Normal, February 6, 2013

New Psych Disorder Could Mislabel Sick as Mentally Ill Susan Donaldson James, ABC News, February 27, 2013

Dimsdale JE. Medically unexplained symptoms: a treacherous foundation for somatoform disorders? Psychiatr Clin North Am 2011;34:511-3. [PMID: 21889675]

DSM-5 released: professional and campaigning reaction: Round up #7

Post #262 Shortlink: http://wp.me/pKrrB-3cF

DSM-5 released: professional and campaigning reaction: Round up #7

A considerable amount of media coverage and commentary on DSM-5 has been published since posting Round up #6, on May 24. Occupied with other matters, I shall likely not catch-up. The world will continue to turn.

Here, though, are some recent commentaries from psychiatry and psychology professionals; a report from Prof Sir Simon Wessely on last week’s Institute of Psychiatry’s two day DSM-5 Conference; below that, new Online Assessment Measures documents from the APA’s DSM-5 Resource pages, including Somatic Symptom assessment instruments for 6-17 year olds, and a clarification from CMS on HIPAA and the status of the DSM-5 code sets.

Via Patrick Landman

Pédopsychiatre, Psychiatre, Président d’Initiative Pour une Clinique du Sujet Stop-Dsm, Psychanalyste Membre d’Espace Analytiquea

A statement written and signed by prominent French psychiatrists in response to recent comments by APA President-Elect, Jeffrey Lieberman, was issued, yesterday:

Full text on the STOP-DSM campaign website:

To oppose the DSM-5 is not to oppose psychiatry

Recently, some of the DSM-5 supporters have been trying to portray the opposition against the fifth edition of this manual of the American Psychiatric Association as an opposition to psychiatry and a form of antipsychiatry. This political argument aims to discredit the movement and to subsume it in its entirety, including its numerous variations, under a single label, one that can easily be identified and connected with a certain history, the sixties. Such specious rhetoric allows its authors not to have to respond to serious and well-documented arguments of the DSM-5 critics. In reality, its many opponents from Europe, Australia, South America and even the United States include a great number of psychiatrists, clinical psychologists, social workers and other mental health practitioners… Read on


Report on the website of South London and Maudsely NHS Foundation Trust from Prof Sir Simon Wessely on the Institute of Psychiatry’s recent DSM-5 Conference.

Prof Wessely is Head of the Department of Psychological Medicine and Vice Dean, Institute of Psychiatry, King’s College London. 

DSM-5 at the IoP

Monday June 10, 2013

The latest and fifth version of the Diagnostic and Statistical Manual of the American Psychiatric Association (APA), invariably known as the DSM, was published on 18 May 2013. To mark the occasion, we hosted an international conference at the Institute of Psychiatry from 3-4 June. This was the first such meeting since the launch and the first platform for Professor David Kupfer, Chair of Psychiatry at the Western Psychiatric Institute in Pittsburgh, but more importantly for us, the man who has directed the compilation and development of DSM-5, and who is justly regarded as its architect…

…I used the somatoform disorders as an example of where “DSM feared to tread”. The latest attempt to come up with something that is both empirically rigorous but also suitable for real world use in this particular area represents a small step forward, at least in simplifying an area of previous mind numbing complexity, but I suggested, was unlikely to represent real progress. This is because the DSM (and for that matter the ICD) are both diagnostic systems that are written by psychiatrists but which in this area need to be used by physicians, who ignore them, and concern patients who don’t like them, often fiercely so… Full Text


Essay by Sarah Kamens MA on the Dx Summit platform

DSM-5′s Somatic Symptom Disorder: From Medical Enigma to Psychiatric Sphinx

Sarah Kamens is a Ph.D. candidate in clinical psychology at Fordham University and in media & communications at the European Graduate School (EGS). Her work focuses on diagnostic discourse and sociopolitics in the psy disciplines.


Spiked Review of Books

‘This manual is, frankly, a disaster for children’

Christopher Lane talks to spiked about the new edition of the bible of psychiatry – ‘a legal document facilitating the medication of millions’.

by Helene Guldberg


http://www.psychiatry.org/dsm5

DSM-5 Online Assessment Measures

APA is inviting clinicians and researchers to provide feedback on the instruments’ usefulness in characterizing patient status and improving patient care. There are a large number of documents that can be downloaded from the link above, including:

For Adults

LEVEL 2–Somatic Symptom–Adult (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

For Parents of Children Ages 6–17

LEVEL 2—Somatic Symptom—Parent/Guardian of Child Age 6-17 (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

For Children Ages 11–17

LEVEL 2—Somatic Symptom—Parent/Guardian of Child Age 11-17 (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

Clinician-Rated

Clinician-Rated Severity of Somatic Symptom Disorder


Finally, a note on the FAQ pages of the CMS.gov website which clarifies the non official status of DSM-5 code sets:

Frequently Asked Questions

(FAQ1817)

[Q] In current practice by the mental health field, many clinicians use the DSM-IV in diagnosing mental disorders. As of May 19, 2013, the DSM-5 was released. Can these clinicians continue current practice and use the DSM-IV and DSM-5 diagnostic criteria?

[A] Yes. The Introductory material to the DSM-IV and DSM-5 code set indicates that the DSM-IV and DSM-5 are “compatible” with the ICD-9-CM diagnosis codes. The updated DSM-5 codes are crosswalked to both ICD-9-CM and ICD-10-CM. As of October 1, 2014, the ICD-10-CM code set is the HIPAA adopted standard and required for reporting diagnosis for dates of service on and after October 1, 2014.

Neither the DSM-IV nor DSM-5 is a HIPAA adopted code set and may not be used in HIPAA standard transactions. It is expected that clinicians may continue to base their diagnostic decisions on the DSM-IV/DSM-5 criteria, and, if so, to crosswalk those decisions to the appropriate ICD-9-CM and, as of October 1, 2014, ICD-10 CM codes. In addition, it is still perfectly permissible for providers and others to use the DSM-IV and DSM-5 codes, descriptors and diagnostic criteria for other purposes, including medical records, quality assessment, medical review, consultation and patient communications.

Dates when the DSM-IV may no longer be used by mental health providers will be determined by the maintainer of the DSM-IV/DSM-5 code set, the American Psychiatric Association, http://www.dsm5.org

(FAQ1817)

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