Update to addition of Disorder of nervous system parent for Chronic fatigue syndrome and terms under Synonyms in SNOMED CT

October 5, 2018 by

Post #345 Shortlink: https://wp.me/pKrrB-4uk

In Post #342 (August 1, 2018), I confirmed that the addition of parent: Disorder of nervous system to Chronic fatigue syndrome was implemented for the July 31, 2018 release of the SNOMED CT International Edition.

The SNOMED CT Concept term for Chronic fatigue syndrome is SCTID 52702003 Chronic fatigue syndrome (disorder). Benign myalgic encephalomyelitis; and Myalgic encephalomyelitis are included in a list of terms under Synonyms.

SCTID: 52702003 Chronic fatigue syndrome (disorder) and the terms listed under Synonyms are now located under supertype SCTID: 118940003 Disorder of nervous system (disorder). This change to the International Edition is being incorporated into the national editions, as they release their next updates. These are released on a staggered schedule.

The rationale for requesting this additional supertype for Chronic fatigue syndrome and the terms listed under Synonyms is set out in this August 2018 document:

PDF: Statement on SNOMED CT and Chronic fatigue syndrome

Note that prior to July 2015, Postviral fatigue syndrome had been listed under Children to SCTID: 52702003 Chronic fatigue syndrome.

But for the July 2015 release, Postviral fatigue syndrome was removed from under SCTID: 52702003 Chronic fatigue syndrome and relocated under supertype: Post-viral disorder under: Post-infectious disorder and assigned the Concept code: SCTID: 51771007.

(A change that had not been requested by the Countess of Mar during her 2014-2015 engagement with SNOMED CT terminology managers for the removal of the Mental disorder parent. Provision of the rationale for relocating Postviral fatigue syndrome was not pursued by Forward-ME.)

Incorporation of addition of supertype Disorder of nervous system into national editions

SNOMED CT U.S. Edition incorporated the change for its September 01, 2018 release:

 

SNOMED CT Belgium Edition incorporated the change for its September 15, 2018 release:

 

SNOMED CT Danish Edition incorporated the change for its September 30, 2018 release:

 

SNOMED CT Netherlands Edition incorporated the change for its September 30, 2018 release:

Note on inclusion of “neurasthenie” in the Netherlands Edition: SNOMED CT International Edition and national editions used to include a Concept term SCTID: 192439005 Neurasthenia. This Concept was retired (Inactivated) a number of years ago. However, the Netherlands Edition retained the term “neurasthenie” under the list of Synonym terms. “Neurasthenie” is designated as an “Acceptable” term in the Netherlands Dutch language reference set (open “Details” tab to view Netherlands reference sets).

Details tab:

A Netherlands advocate has contacted Pim Volkert (Terminology Co-ordinator, Nictiz, and lead for the Netherlands SNOMED CT National Release Centre) with a request and rationales for consideration of the removal of the “neurasthenie” term, for consistency with the SNOMED CT International Edition and with the WHO’s ICD-10, which has an exclusion for G93.3 under F48.0 Neurasthenia. This request has been considered and accepted. I am advised that removal of the “neurasthenie” term is anticipated to be implemented for the March 2019 release of the Netherlands Edition.

 

SNOMED CT UK Edition incorporated the change for its October 01, 2018 release:

(Public browser hosted by NHS Digital. Browser can also be accessed from the landing page of the SNOMED CT International browser platform.)

Note: the UK Edition has three severity specifier options listed under “Children” that are specific to the UK Edition.

These are assigned the discrete codes: SCTID: 377181000000104 Mild chronic fatigue syndrome; SCTID: 377171000000101 Moderate chronic fatigue syndrome; and SCTID: 377161000000108 Severe chronic fatigue syndrome.

It has yet to be established from NHS Digital in which year these severity specifier options were added to the UK Edition, to what extent they are used, and by what means clinicians would determine which of the severities to apply.

The UK Edition includes the terms Myalgic encephalitis and Myalgic encephalopathy.

 

Updated to add screenshot of Canadian Edition

SNOMED CT Canadian Edition incorporated the change for its October 30, 2018 release:

 

Updated to add screenshot of Swedish Edition

SNOMED CT Swedish Edition incorporated the change for its November 30, 2018 release:

Note: the Swedish Edition includes a separately coded for Concept term:

SCTID: 55941000052101 | kronisk trötthet | [Chronic fatigue (finding)].

This is marked with the Swedish flag symbol to denote that this SNOMED CT Concept term is exclusive to the Swedish Edition. It can be viewed here:

 

Updated to add screenshot of Argentinian Edition

SNOMED CT Argentinian Edition incorporated the change for its November 30, 2018 release:

 

Updated to add screenshot of Australian Edition

The January 31, 2019 release of the Australian Edition has incorporated the change:

 

If your country is a member of SNOMED International but does not have a publicly accessible browser hosted on the International Edition platform or hosted on its own platform, please refer to your country’s SNOMED CT National Release Centre website for the release schedule.

Media:

GP system updated to reflect M.E. as neurological, Action for M.E., August 01, 2018

NHS to update classification system to reflect that M.E. is neurological disease, ME Association, August 06, 2018

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Filed under Chronic fatigue syndrome, Disorder of nervous system, Forward-ME, ICD-11, ICD-11 MMS 2018, Myalgic encephalomyelitis, Nervous system disease, neurological disorder, SNOMED CT, WHO (World Health Organization) Tagged with , , , , , , , , ,

Chronic fatigue syndrome classified under Neurological disorder in SNOMED CT International Edition

August 1, 2018 by

Post #342 Shortlink: https://wp.me/pKrrB-4pK

SNOMED CT is a standardized electronic terminology system for recording and sharing symptoms, diagnoses, clinical findings, procedures etc. in primary and secondary care and across other health care settings.

Since April 2018, SNOMED CT UK Edition has been the mandatory terminology system for use in NHS primary care, replacing the Read Code (CTV3) terminology which is now retired. SNOMED CT UK Edition is scheduled for adoption across all NHS clinical settings by 2020.

In SNOMED CT terminology system, disease and disorder terms are not arranged in chapters, as they are in ICD-10 and ICD-11. Instead, terms are arranged within a hierarchical relationship of parent and children concepts (or supertypes and subtypes).

The SNOMED CT Concept term for Chronic fatigue syndrome is SCTID 52702003 Chronic fatigue syndrome (disorder). Benign myalgic encephalomyelitis; and Myalgic encephalomyelitis are included as Synonym terms.

Chronic fatigue syndrome has historically been located under the Parent Concept: Multisystem disorder.

Multisystem disorder Parent retired for January 2018 release

In 2017, SNOMED CT terminology managers decided that the Multisystem disorder concept term was not sufficiently specific for the purposes of their system and the term was inactivated (retired) for the January 2018 release.

There had been 90 Children terms under SCTID: 281867008 Multisystem disorder (disorder) and the retirement of this parent concept had implications for all of these 90 terms — not just for Chronic fatigue syndrome and its Synonym terms.

Many of these 90 Children terms were assigned under a more specific parent but a few, including Chronic fatigue syndrome, had no new parent assigned to them.

This presented an opportunity to request a more specific parent for Chronic fatigue syndrome.

In February 2018, a formal request and rationale for adding the supertype: Disorder of nervous system was submitted.

Chronic fatigue syndrome classified under Neurological disorder for July 2018 release

Following a peer review process, the addition of the parent: Disorder of nervous system for Chronic fatigue syndrome was provisionally approved for implementation in the next release, which has been finalized and published.

SCTID: 52702003 Chronic fatigue syndrome (disorder) is now classified under supertype SCTID: 118940003 Disorder of nervous system (disorder) in the July 2018 release of the SNOMED CT International Edition.

This change will be incorporated into the next update of the U.S. Edition (in September 2018), the UK Edition (in October 2018) and other National Editions, as they release their next updates.

Download a copy of the full report

PDF: Statement on SNOMED CT and Chronic fatigue syndrome

 

SNOMED CT International Edition Release for July 2018 (v20180731) was published on the public SNOMED CT browser on July 31, 2018

Media:

GP system updated to reflect M.E. as neurological, Action for M.E., August 01, 2018

NHS to update classification system to reflect that M.E. is neurological disease, ME Association, August 06, 2018

Filed under Chronic fatigue syndrome, Disorder of nervous system, Forward-ME, ICD-11, ICD-11 MMS 2018, Myalgic encephalomyelitis, Nervous system disease, neurological disorder, SNOMED CT, WHO (World Health Organization) Tagged with , , , , , , , , ,

Proposals for the classification of Chronic pain in ICD-11: Part 2

August 22, 2015 by

Post #326 Shortlink: http://wp.me/pKrrB-48Y

Click here for Part 1

Note: Since these proposed changes for Fibromyalgia were published on the ICD-11 Beta draft, in 2015, not a single comment has been posted via the ICD-11 Comment or Proposals mechanisms from stakeholder patient organizations, the clinicians who advise them, allied health professionals or disability lawyers.

Part 2: Fibromyalgia

On May 5, 2015, the ICD-11 Beta draft category, Fibromyalgia, was deleted from the Diseases of the musculoskeletal system and connective tissue chapter and relocated under Symptoms, signs, clinical forms, and abnormal clinical and laboratory findings, not elsewhere classified (currently numbered Chapter 21 in the Beta draft).*

*Source: Fibromyalgia Change History, 05 May 2015

For ICD-11, Fibromyalgia is proposed to be listed under the Symptoms, signs chapter, under a proposed new parent category called Multi-site primary chronic pains syndromes, under new parent class, Chronic primary pain, under new parent class, Chronic pain.

No rationale for a proposed change of chapter location and parent class was recorded in the Change History at the time of the edit.

See Part 1 and the June 2015 paper A classification of chronic pain for ICD-11. Rolf-Detlef Treede, Winfried Rief et al for the IASP working group’s proposals for locating irritable bowel syndrome; chronic nonspecific back pain; chronic pelvic pain; chronic widespread pain, fibromyalgia, and potentially some other conditions where chronic pain is a feature, under proposed new disorder category, Chronic primary pain.

Some of the categories listed under the new Chronic pain parent are proposed to be secondary parented (cross-referenced) to other chapters. But it is unclear from the proposals, whether Fibromyalgia is intended to be secondary parented to the Diseases of the musculoskeletal system and connective tissue chapter or to Diseases of the nervous system, or whether some disorders categorized under Chronic primary pain disorder would have no secondary parent chapter association beyond the Symptoms, signs chapter.

ICD-11 Beta Foundation Component

In the ICD-11 Foundation Component (where all ICD-11 entities are listed), Fibromyalgia is listed under Chronic pain > Primary chronic pain > Multi-site primary chronic pains syndromes, and assigned a Definition and other Content Model descriptors**.

View the Beta draft Foundation Component here: Fibromyalgia

**The current Beta draft Definitions for Fibromyalgia do not appear to have been revised from how the text had stood prior to its chapter relocation in May 2015.

(The likely source for the text entered into the Definition and Long Definition fields is this Orphanet page, apparently last updated in May 2007, but which appends links to more recent criteria and practice guidelines.)

 

From the ICD-11 Beta draft Foundation Component (accessed August 20, 2015):

Fibromyalgia

Fibro2208152


But in the Joint Linearization for Mortality and Morbidity Statistics (JLMMS), Fibromyalgia is not proposed to be listed with a discrete code assigned but rolled up as an Inclusion term under MAOE.112 Multi-site primary chronic pains syndromes.

View the Beta draft JLMMS linearization here: Fibromyalgia

FibroJMMLS1

This screenshot shows the hover text for Inclusion term, Fibromyalgia, in the JMMLS linearization:

Fibro as inlcusion term3

ICD-11 Beta drafting platform, public version: Joint Linearization for Mortality and Morbidity Statistics. Accessed August 20, 2015.

I am not a stakeholder or advocate for Fibromyalgia or for any of the several terms proposed to be categorized under the Primary chronic pain/Chronic primary pain parent term.

Consideration of the implications for aggregating Fibromyalgia, chronic widespread pain, irritable bowel syndrome, chronic nonspecific back pain, chronic pelvic pain and some other conditions where chronic pain is a predominate feature, under a new term in the Symptoms, signs chapter, on data collection, research, commissioning of services, access to treatments, reimbursement etc. is beyond the scope of this report.

But I urge stakeholder patient organizations, the clinicians who advise them, allied health professionals, occupational therapists and disability lawyers to scrutinize the IASP Task Force paper, the Beta draft rationale and proposals documents, proposed definitions and other descriptive content and to register with the Beta draft to submit comments and make formal suggestions for improvements via the Proposal Mechanism, (supported with references, where possible).

There is a considerable amount of psychosomatics in the Detailed Proposals document for Primary chronic pain. There is disorder description and criteria overlap with ICD-11’s proposed Bodily distress disorder; with DSM-5 Somatic symptom disorder “Predominate pain” specifier; with Somatoform pain disorder and the German ICD-10-GM: F45.41: Chronic pain disorder with somatic and psychological factors – a classification which Prof Winfried Rief was instrumental in getting inserted into the German ICD-10-GM, in 2009.

Prof Winfried Rief slide presentation:

Back in 2012, Chronic pain Task Force co-chair, Prof Winfried Rief, had presented tentative ideas for potential frameworks for a new ICD-11 chapter or section for pain conditions:

2012 SIP Symposium Workshop presentation: IASP and the Classification of Pain in ICD-11

Note in Slides #12-15, a number of the so-called, functional somatic syndromes, and in Slide #15, “Chronic Fatigue Syndrome, Neurasthenia” [sic], had been floated by Prof Rief, in 2012, as potential partners in any proposed new chapter or section for chronic pain.

Key documents for scrutiny by patient organizations, clinicians and advocates

A classification of chronic pain for ICD-11 Treede R, Rief W, et al, June 2015

Detailed Rationale/proposals/criteria documents:

Chronic pain 2015-May-26 Antonia Barke

Chronic primary pain 2015-June-29 Antonia Barke

Chronic visceral pain 2015-May-26 Antonia Barke

Chronic musculoskeletal pain 2015-May-26 Antonia Barke

Current ICD-11 Beta draft location Foundation Component listing for Irritable bowel syndrome

ICD-11 Beta draft Foundation Component listing for Fibromyalgia

ICD-11 Beta draft JLMMS listing for Fibromyalgia [rolled up as Inclusion in Multi-site primary chronic pains syndromes]

Click here for Part 1

 

Further reading

Medscape article: Chronic Pain Syndrome, Manish K Singh, MD; Chief Editor: Stephen Kishner, MD, MHA, updated July 15 2015

The Changing Nature of Fibromyalgia. Frederick Wolfe and Brian Walitt

Caveats: The ICD-11 Beta drafting platform is not a static document: it is a work in progress, subject to daily edits and revisions, to field test evaluation and to approval by ICD Revision Steering Group and WHO classification experts. Not all new proposals may survive ICD-11 field testing. Chapter numbering, codes and sorting labels currently assigned to ICD categories may change as chapters and parent/child hierarchies continue to be reorganized. The public version of the Beta draft is incomplete: not all Content Model parameters display or have been populated; definitions may be absent, awaiting revision or subject to further revision. The draft may contain errors and category omissions.
For some categories, detailed proposals/rationales/criteria are being posted by Topic Advisory Groups (TAGs) and can be viewed via the Proposals Mechanism, for which registration is required. Additional proposals/suggestions for modifications submitted by work groups or stakeholders which are awaiting review and decisions may also be found via the Proposals Mechanism.

Filed under Chronic pain, Chronic pelvic pain, Chronic primary pain, Chronic widespread pain, Diagnostic classification, Fibromyalgia, Functional Somatic Syndrome (FSS), IASP, ICD-11 Beta Draft, Irritable bowel syndrome Tagged with , , , , , , , , ,

Proposals for the classification of Chronic pain in ICD-11: Part 1

August 22, 2015 by

Post #325 Shortlink: http://wp.me/pKrrB-488

Part 1

In 2013, the International Association for the Study of Pain (IASP) launched a working group tasked with developing proposals for the classification of chronic pain within ICD-11, for application in primary care, low-resource environments and clinical settings for specialized pain management.

The Classification of Chronic Pain Task Force is working under the auspices of WHO/ICD Revision. The group is co-chaired by IASP President, Prof. Dr. med. Rolf-Detlef Treede, and Winfried Rief PhD, Professor of Clinical Psychology and Psychotherapy, University of Marburg.

The working group held its first meeting in March 2013. At that point, the potential for creating a new Pain chapter  in ICD-11 was reportedly under consideration (Organizing Principles, Classifying pain for healthcare, Carol Cruzan Morton, April 2013).

But the concept of a dedicated pain chapter for ICD-11 appears to have been set aside in preference to expanding the existing Chronic pain classification within the Symptoms, signs, clinical forms, and abnormal clinical and laboratory findings, not elsewhere classified chapter (currently numbered Chapter 21 in the Beta draft).

Under this new Chronic pain disorder section, “…diagnoses in which pain is either the sole or a leading complaint of the patient will be listed.”

Additionally, chronic pain conditions considered neglected in previous ICD versions, for example, chronic cancer pain, chronic neuropathic pain and chronic visceral pain, will be represented under Chronic pain with their own codes.

A simplified version of the proposed framework for use by primary care practitioners was expected to undergo field testing in several countries. A more detailed specialty ICD-11 linearization for use by pain specialists is also envisaged.

 

What are the most recent proposals from the IASP Chronic Pain Task Force?

In March 2015, the IASP working group published a paper setting out proposals and rationales for the structure of a new Chronic pain section and the disorders classified within it.

Initially, the paper was behind a paywall, but was published under Open Access in June 2015. You can read the paper in html and PDF format here:

A classification of chronic pain for ICD-11. Rolf-Detlef Treede, Winfried Rief et al
Pain. 2015 Jun; 156(6): 1003-7. Published online 2015 Mar 14. PMCID: PMC4450869

Under the proposed framework, chronic pain will be defined as pain that persists or recurs for more than three months.

There are optional specifiers for each diagnosis for recording evidence of psychosocial factors and pain severity. Pain severity can be graded on the basis of pain intensity, pain-related distress, and functional impairment.

“Detailed Explanation of the Proposal” texts for Chronic pain and its 7 child categories have been uploaded to the ICD-11 Beta draft Proposals Mechanism on behalf of the working group.

These are important texts setting out detailed proposals, rationales and criteria and are open for review, comment and suggestions for changes, for which registration with the Beta draft is required. There are links for these texts below but for ease of reference, I am including selected of these texts in .doc format.

Proposed disorder categories

The new ICD section for Chronic pain is proposed to comprise the most common clinically relevant disorders, divided into 7 groups (Fig. 1, Treede et al, 2015).

 

Chapter 21: Symptoms, signs, clinical forms, and abnormal clinical and laboratory findings, not elsewhere classified 

General symptoms, findings and clinical forms

General symptoms

(…)

Pain

Chronic pain [Detailed Proposals] [.doc document]

Update: Proposals for Chronic pain replaced with [Detailed Proposals] Antonia Barke 17.09.15

2.1. Chronic primary pain [Detailed Proposals] [.doc document]

Subclass: Mono-site primary chronic pains syndromes [Detailed proposals not available]

Subclass: Multi-site primary chronic pains syndromes [Detailed proposals not available]

  Fibromyalgia [Detailed proposals not available]

2.2. Chronic cancer pain [Detailed Proposals]

2.3. Chronic postsurgical and posttraumatic pain [Detailed Proposals]

2.4. Chronic neuropathic pain [Detailed Proposals]

2.5. Chronic headache and orofacial pain [Detailed Proposals]

2.6. Chronic visceral pain [Detailed Proposals] [.doc document]

2.7. Chronic musculoskeletal pain [Detailed Proposals] [.doc document]

 

According to its Detailed Proposals text, Chronic primary pain is proposed to be primary parented under Chronic pain and secondary parented to Diseases of the nervous system.

Other chronic pain disorders are proposed to be primary parented under Chronic pain and secondary parented to Neoplasms, Diseases of the nervous system, Diseases of the respiratory system, Diseases of the digestive system, Diseases of the musculoskeletal system and connective tissue or Diseases of the genitourinary system, according to body system.

The “Appendix Structure of the chapter on chronic pain” (page 4 of the Treede et al paper) sets out a complex hierarchy of subclasses.

It’s not evident whether all or selected of these additional subclasses are intended to be added under the disorder categories that are currently displaying in the Beta draft, or whether additional subclasses would be reserved for use in a specialist linearization for chronic pain.

The Treede et al paper describes Chronic primary pain as:

2.1. Chronic primary pain
Chronic primary pain is pain in 1 or more anatomic regions that persists or recurs for longer than 3 months and is associated with significant emotional distress or significant functional disability (interference with activities of daily life and participation in social roles) and that cannot be better explained by another chronic pain condition. This is a new phenomenological definition, created because the etiology is unknown for many forms of chronic pain. Common conditions such as, eg, back pain that is neither identified as musculoskeletal or neuropathic pain, chronic widespread pain, fibromyalgia, and irritable bowel syndrome will be found in this section and biological findings contributing to the pain problem may or may not be present. The term “primary pain” was chosen in close liaison with the ICD-11 revision committee, who felt this was the most widely acceptable term, in particular, from a nonspecialist perspective.

and (under 2.7. Chronic musculoskeletal pain):

…Well-described apparent musculoskeletal conditions for which the causes are incompletely understood, such as nonspecific back pain or chronic widespread pain, will be included in the section on chronic primary pain.

 

Under two new terms: Mono-site primary chronic pains syndromes and Multi-site primary chronic pains syndromes the IASP working group proposes to locate irritable bowel syndrome; chronic nonspecific back pain; chronic pelvic pain; chronic widespread pain; fibromyalgia, and potentially some other conditions where chronic pain is a feature.

This “new phenomenological definition” appears to be an umbrella diagnosis for a number of the so-called, “functional somatic syndromes.”

There is a considerable amount of psychosomatics in the Detailed Proposals document for Primary chronic pain.

It is unclear whether the intention is to add discrete categories for irritable bowel syndrome; chronic nonspecific back pain; chronic widespread pain, and other diagnoses proposed to be aggregated under the Chronic primary pain term. But at the time of compiling this report, Fibromyalgia is the only term to have been inserted.

In the ICD-11 Beta draft, Irritable bowel syndrome remains at its current location in Diseases of the digestive system chapter, under Irritable bowel syndrome and certain specified functional bowel disorders.

It is therefore unclear whether the ICD-11 Revision Steering Group and the IASP working group have reached consensus over the proposed relocation of Irritable bowel syndrome to the Symptoms, signs chapter, under a new Chronic primary pain parent.

I have requested clarification of current intentions for Irritable bowel syndrome via the Proposal Mechanism comments facility but have received no response.

 

Proposed new ICD-11 categories

These are the disorder categories as currently entered into the ICD-11 Beta drafting platform under parent class: Pain > Chronic pain for the Foundation Component:

Chapter: Symptoms, signs, clinical forms, and abnormal clinical and laboratory findings, not elsewhere classified

Chronic pain 2 20.08.15

ICD-11 Beta drafting platform, public version: Foundation Component. Accessed August 20, 2015.

A note about discrepancies in terminology between ICD-11 Beta draft and the Treede et al paper: The term, Primary chronic pain, as entered into the Beta draft, is proposed to be amended to Chronic primary pain, in line with the classification structure set out in Table: Appendix Structure of the chapter on chronic pain on page 4 of the Treede et al paper.

The Beta draft’s Mono-site primary chronic pains syndromes and Multi-site primary chronic pains syndromes are termed Localized chronic primary pain (including nonspecific back pain, chronic pelvic pain) and Widespread chronic primary pain (including fibromyalgia syndrome) in the Treede et al paper.

(I have also enquired whether the Mono- and Multi-site primary chronic pains syndromes terms are to be amended to Mono- and Multi-site chronic primary pain syndromes but have received no response.)

If you are a stakeholder in any of the terms proposed to be classified under this new Symptoms, signs chapter section, please scrutinize the IASP Task Force paper and the Detailed Proposals documents and bring these proposals to the attention of your patient organizations.

 

The G93.3 legacy terms: Postviral fatigue syndrome; Benign myalgic encephalomyelitis; Chronic fatigue syndrome

I have no documentary evidence of intention to locate any of the ICD-10 G93.3 legacy terms under this proposed Symptoms, signs chapter Chronic pain > Chronic primary pain section.

WHO’s, Dr Robert Jakob, told me in June 2015 that he expects TAG Neurology to release proposals and rationales for the classification of the G93.3 legacy terms in September or December, latest. See summary of discussions with WHO personnel, June 19, 2015 http://wp.me/pKrrB-46A

Update: Since no proposals and rationales for the ICD-10 G93.3 legacy terms were released in September or December 2015, I contacted ICD’s Dr Robert Jakob. I was told on February 2, 2016 that “[ICD-11 Revsion is] still working on the extensive review and the conclusions.”

Click here for Part 2 Fibromyalgia

 

Caveats: The ICD-11 Beta drafting platform is not a static document: it is a work in progress, subject to daily edits and revisions, to field test evaluation and to approval by ICD Revision Steering Group and WHO classification experts. Not all new proposals may survive ICD-11 field testing. Chapter numbering, codes and sorting labels currently assigned to ICD categories may change as chapters and parent/child hierarchies continue to be reorganized. The public version of the Beta draft is incomplete: not all Content Model parameters display or have been populated; definitions may be absent, awaiting revision or subject to further revision. The draft may contain errors and category omissions.
For some categories, detailed proposals/rationales/criteria are being posted by Topic Advisory Groups (TAGs) and can be viewed via the Proposals Mechanism, for which registration is required. Additional proposals/suggestions for modifications submitted by work groups or stakeholders which are awaiting review and decisions may also be found via the Proposals Mechanism.
 

Filed under Chronic fatigue syndrome, Chronic pain, Chronic pelvic pain, Chronic primary pain, Chronic widespread pain, Diagnostic classification, Fibromyalgia, Functional Somatic Syndrome (FSS), IASP, ICD-11 Beta Draft, Irritable bowel syndrome Tagged with , , , , , , , , ,

HHS issue Final Rule: ICD-10-CM compliance deadline set for October 1, 2015

July 31, 2014 by

Post #314 Shortlink: http://wp.me/pKrrB-3ZI

CMS Press Release:  Final Rule July 31, 2014

Coding industry and professional body reaction

ICD-10 Testing: Final rule overshadows CMS testing plans

ICD10 Watch | Carl Natale | August 2, 2014

+++
Debunking Myths and Misperceptions of ICD-10 – Journal of AHIMA illustrates why it’s time for 10

AHIMA | News Release | July 30, 2014

+++
DHHS final rule on ICD-10 delay ready for publication

ICD10Watch | Carl Natale | July 31, 2014

+++
CMS Confirms ICD-10 Deadline

Health Leaders Media | Michelle Leppert | August 1, 2014

+++
ICD-10 Final Rule Released, October 2015 Official Compliance Deadline

Journal of AHIMA | Mary Butler | July 31, 2014

+++
ICD-10 Final Rule Stirs Angst, Apprehension

ICD10 Monitor | Chuck Buck | August 1, 2014

+++
(From June 12, 2014)

SNOMED, ICD-11 Not Feasible Alternatives to ICD-10-CM/PCS Implementation

AHIMA | Sue Bowman | June 12, 2014

“For the US, [2017] is the beginning, not the end, of the process toward adoption of ICD-11.”

+++
Resources

Federal Register: HHS ICD-10-CM Compliance FINAL RULE

[PDF] DEPARTMENT OF HEALTH AND HUMAN SERVICES, Office of the Secretary
45 CFR Part 162 [CMS-0043-F] RIN 0938-AS31
Administrative Simplification: Change to the Compliance Date for the International Classification of Diseases, 10th Revision (ICD–10–CM and ICD-10-PCS) Medical Data Code Sets

CMS Press Release:  Final Rule July 31, 2014

CMS NEWS

FOR IMMEDIATE RELEASE    Contact: CMS Media Relations

July 31, 2014                                   (202) 690-6145 or press@cms.hhs.gov

 

Deadline for ICD-10 allows health care industry ample time to prepare for change

Deadline set for October 1, 2015

The U.S. Department of Health and Human Services (HHS) issued a rule today finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.

The ICD-10 codes on a claim are used to classify diagnoses and procedures on claims submitted to Medicare and private insurance payers. By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patient’s care across providers and over time. ICD-10 improves quality measurement and reporting, facilitates the detection and prevention of fraud, waste, and abuse, and leads to greater accuracy of reimbursement for medical services. The code set’s granularity will improve data capture and analytics of public health surveillance and reporting, national quality reporting, research and data analysis, and provide detailed data to enhance health care delivery. Health care providers and specialty groups in the United States provided extensive input into the development of ICD-10, which includes more detailed codes for the conditions they treat and reflects advances in medicine and medical technology.

“ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” said Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid Services (CMS). “For patients under the care of multiple providers, ICD-10 can help promote care coordination.”

Using ICD-10, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM. Moreover, the level of detail that is provided for by ICD-10 means researchers and public health officials can better track diseases and health outcomes. ICD-10 reflects improved diagnosis of chronic illness and identifies underlying causes, complications of disease, and conditions that contribute to the complexity of a disease. Additionally, ICD-10 captures the severity and stage of diseases such as chronic kidney disease, diabetes, and asthma.

The previous revision, ICD-9-CM, contains outdated, obsolete terms that are inconsistent with current medical practice, new technology and preventive services.

ICD-10 represents a significant change that impacts the entire health care community. As such, much of the industry has already invested resources toward the implementation of ICD-10. CMS has implemented a comprehensive testing approach, including end-to-end testing in 2015, to help ensure providers are ready. While many providers, including physicians, hospitals, and health plans, have completed the necessary system changes to transition to ICD-10, the time offered by Congress and this rule ensure all providers are ready.

For additional information about ICD-10, please visit: http://www.cms.gov/ICD10

###

 

Filed under CDC, Clinical Modification, CMS, ICD-10-CM, ICD-10-CM compliance, ICD-10-PCS, NCHS, Somatic Symptom Disorder, WHO (World Health Organization) Tagged with , , , , , , , , ,

National Institute of Mental Health (NIMH) to ditch the DSM

May 3, 2013 by

National Institute of Mental Health (NIMH) to ditch the DSM

Post #241 Shortlink: http://wp.me/pKrrB-2UL

An edited version of the post published on May 3

DSM5NIMH to ditch DSM

Earlier this week, in a blog dated April 29, Thomas Insel, National Institute of Mental Health’s Director, quietly drove another nail into the coffin of DSM-5.

NIMH, part funders of the 13 DSM-5 Research Planning Conferences held between 2004 and 2008 and the monographs that resulted out of them, announced that NIMH “will be re-orienting its research away from DSM categories.”

I don’t have figures for how much funding NIMH has sunk into the development of DSM-5.

This announcement comes just three weeks before the American Psychiatric Association launches its next edition of the Diagnostic and Statistical Manual of Mental Disorders, with a clutch of spin off publications scheduled for release in May and September.

APA has yet to issue a statement or comment in the press.

At the end of this post are links to the NIMH Research Domain Criteria (RDoC) posted in 2011, and a commentary by James Phillips, MD, for Psychiatric Times, from April 2011: “DSM-5 and the NIMH Research Domain Criteria Project.”

You can read Thomas Insel’s announcement in full, below, followed by a round up of media coverage.

Additional coverage and commentary is being added, as it comes in, below the NIMH announcement in the pale blue box.

Most recently added: Dr Tad; Neurocritic BlogSpot

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On April 24, in Mental health: On the spectrum, Nature had reported:

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

“…The APA claims that the final version of DSM-5 is a significant advance on the previous edition and that it uses a combination of category and dimensional diagnoses. The previously separate categories of substance abuse and substance dependence are merged into the new diagnosis of substance-use disorder. Asperger’s syndrome is bundled together with a handful of related conditions into the new category called autism-spectrum disorder; and OCD, compulsive hair-pulling and other similar disorders are grouped together in an obsessive–compulsive and related disorders category. These last two changes, Regier says, should help research scientists who want to look at links between conditions. “That probably won’t make much difference to treatment but it should facilitate research into common vulnerabilities,” he says.

“The Research Domain Criteria project is the biggest of these research efforts. Last year, the NIMH approved seven studies, worth a combined US$5 million, for inclusion in the project — and, Cuthbert says, the initiative “will represent an increasing proportion of the NIMH’s translational-research portfolio in years to come”. The goal is to find new dimensional variables and assess their clinical value, information that could feed into a future DSM.

“One of the NIMH-funded projects, led by Jerzy Bodurka at the Laureate Institute for Brain Research in Tulsa, Oklahoma, is examining anhedonia, the inability to take pleasure from activities such as exercise, sex or socializing. It is found in many mental illnesses, including depression and schizophrenia.

“Bodurka’s group is studying the idea that dysfunctional brain circuits trigger the release of inflammatory cytokines and that these drive anhedonia by suppressing motivation and pleasure. The scientists plan to probe these links using analyses of gene expression and brain scans. In theory, if this or other mechanisms of anhedonia could be identified, patients could be tested for them and treated, whether they have a DSM diagnosis or not.

“One of the big challenges, Cuthbert says, is to get the drug regulators on board with the idea that the DSM categories are not the only way to prove the efficacy of a medicine. Early talks about the principle have been positive, he says. And there are precedents: “Pain is not a disorder and yet the FDA gives licences for anti-pain drugs,” Cuthbert says.

“Going back to the drawing board makes sense for the scientists, but where does it leave DSM-5? On the question of dimensionality, most outsiders see it as largely the same as DSM-IV. Kupfer and Regier say that much of the work on dimensionality that did not make the final cut is included in the section of the manual intended to provoke further discussion and research. DSM-5 is intended to be a “living document” that can be updated online much more frequently than in the past, Kupfer adds. That’s the reason for the suffix switch from V to 5; what comes out next month is really DSM-5.0. Once the evidence base strengthens, he says, perhaps as a direct result of the NIMH project, dimensional approaches can be included in a DSM-5.1 or DSM-5.2…”

National Institute of Mental Health (NIMH) announcement

Transforming Diagnosis

By Thomas Insel on April 29, 2013

Thomas R. Insel, M.D., is Director of the National Institute of Mental Health (NIMH).

“…Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system…”

“…That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system….”

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Dr Tad Blog

Paradigms lost: NIMH, McGorry & DSM-5’s failure

Dr Tad | May 4, 2013

Neurocritic Blogspot

RDoC Dimensional Approach for Research vs. DSM-5 for Diagnosis

Neurocritic | May 5, 2013

Article in Romanian

DESCOPERĂ

Cea mai importantă ştiinţă a minţii umane, psihiatria, se transformă în urma unei decizii importante

Article in French

Psychomédia

Le National Institute of Mental Health (NIMH) américain se distance du DSM-5 de l’American Psychiatric Association

Soumis par Gestion le 3 mai 2013

“Le National Institute of Mental Health (NIMH) américain réoriente ses recherches en se distançant du DSM, le Diagnostic and Statistical Manual of Mental Disorders, dont la cinquième édition sera lancée par l’American Psychiatric Association le 22 mai, explique son directeur, Thomas Insel, dans un billet publié le 29 avril…”

Article in Turkish

Psikiyatristler DSM tanı kriterlerini terk ediyor!

Dünyadaki en büyük ruh sağlığı araştırma kurumlarından ABD Ulusal Sağlık Kurumu (NIMH), psikiyatrik rahatsızlıkların semptomlara bağlı olarak belirlenmesine dayanan tanı yöntemini terk ediyor.

Pazar, 05 Mayıs 2013

Scientific American John Horgan Blog

Psychiatry in Crisis! Mental Health Director Rejects Psychiatric “Bible” and Replaces With… Nothing

“NIMH director Insel doesn’t mention it, but I bet his DSM decision is related to the big new Brain Initiative, to which Obama has pledged $100 million next year.”

John Horgan | May 4, 2013

Psychology Today
Side Effects | Christopher Lane Ph.D.

The NIMH Withdraws Support for DSM-5
The latest development is a humiliating blow to the APA.

Christopher Lane, Ph.D. | May 4, 2013

Government Health IT

NIMH moving beyond DSM

Anthony Brino, Associate Editor | May 3, 2013

1 Boring Old Man

old news…

1 Boring Old Man | May 3, 2013

Previously posted

Mindhacks blog

National Institute of Mental Health abandoning the DSM

“In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.

In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.

This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.

As a result the NIMH will now be preferentially funding research that does not stick to DSM categories…”

New Scientist

Psychiatry divided as mental health ‘bible’ denounced

Andy Coghlan and Sara Reardon | May 3, 2013

“The world’s biggest mental health research institute is abandoning the new version of psychiatry’s “bible” – the Diagnostic and Statistical Manual of Mental Disorders, questioning its validity and stating that “patients with mental disorders deserve better”. This bombshell comes just weeks before the publication of the fifth revision of the manual, called DSM-5…”

“…We cannot succeed if we use DSM categories as the gold standard,” says Insel. “That is why NIMH will be reorienting its research away from DSM categories,” says Insel. Prominent psychiatrists contacted by New Scientist broadly support Insel’s bold initiative. However, they say that given the time it will take to realise Insel’s vision, diagnosis and treatment will continue to be based on symptoms.

“Insel is aware that what he is suggesting will take time – probably at least a decade, but sees it as the first step towards delivering the “precision medicine” that he says has transformed cancer diagnosis and treatment. “It’s potentially game-changing, but needs to be based on underlying science that is reliable,” says Simon Wessely of the Institute of Psychiatry at King’s College London. “It’s for the future, rather than for now, but anything that improves understanding of the etiology and genetics of disease is going to be better [than symptom-based diagnosis].”

New Scientist opinion piece

One manual shouldn’t dictate US mental health research

“The new edition of the DSM “bible” is so flawed that the US National Institute of Mental Health is right to abandon it, says Allen Frances”

Allen Frances, MD | May 3, 2013

@AllenFrancesMD on Twitter

@AllenFrancesMD: @dxrevisionwatch Hype alert. The NIMH dx approach is a necessary, but guarantees nothing in the future and offers nothing in the present.

The Verge

Federal institute for mental health abandons controversial ‘bible’ of psychiatry

Katie Drummond | May 3, 2013

“In a surprising move, the US government institute responsible for overseeing mental health research is distancing itself from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM has, for several decades, been perceived as the “bible” that delegates how psychiatric illnesses are defined, diagnosed, and treated.”

“The National Institute of Mental Health (NIMH) — which funds more research into mental illness than any other agency in the world — this week announced a plan to re-orient its investigations “away from DSM categories.” The move comes mere weeks before the publication of the DSM-5, an update to the manual that’s been mired in controversy because of several contentious changes to existing diagnostic criteria…”

CBS News

National Institute of Mental Health no longer will use DSM diagnoses in studies

Stephanie Pappas | Livescience.com | May 3, 2013

Pharmalive

NIMH Director Says The Bible Of Psychiatry Lacks Validity

Ed Silverman | May 3, 2013

MIT Technology Review

NIMH Will Drop Widely Used Psychiatry Manual

Susan Young | May 3, 2013

Science 2.0

NIMH Delivers A Kill Shot To DSM-5

By Hank Campbell | May 3, 2013

Pacific Standard [Not on NIMH announcement]

Psychiatry’s Contested Bible: How the New DSM Treats Addiction

The 1,000-page psychiatrists’ Big Book will redefine addiction. Critics are already demanding a boycott.

Michael Dhar | May 3, 2013

Drug Rehab [Not on NIMH announcement]

Somatic Symptom Disorder

drugrehab in Mental Health | April 30, 2013

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Related material

DSM-5 and the NIMH Research Domain Criteria Project  Psychiatric Times, James Phillips, MD, April 13, 2011

NIMH Research Domain Criteria (RDoC)  Draft 3.1: June, 2011

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Filed under Allen Frances, American Psychiatric Association (APA), Bereavement, Criticism of DSM-V, DSM-5, David Kupfer, DSM revision process, DSM-5, DSM-5 in the media, DSM-V, NIMH Tagged with , , , , , , , , , ,

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