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IAPT requests addition of DSM-5's Somatic symptom disorder (SSD) to SNOMED CT for use in Data Set v2.0 to replace "MUS - not otherwise specified"

Discussion in 'PsychoSocial ME/CFS Research' started by Dx Revision Watch, Feb 15, 2020.

  1. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    This post and the following ones have been moved from this thread.

    https://digital.nhs.uk/data-and-inf...to-the-iapt-data-set-v2.0---from-1-april-2020

    Submitting IAPT v2.0 data

    Version 2.0 of the IAPT Data Set has received approval from the Data Coordination Board for collection from 1 April 2020. All organisations that provide NHS funded IAPT services in England must submit data. This page explains the data you need to submit and how.


    A Data Provision Notice (DPN) will be published before version 2.0 of the data set (April 2020) goes live. This means that all providers of NHS-funded IAPT services are required under Section 259 (5) of the Health and Social Care Act 2012 to provide the data set as specified by NHS Digital within the DPN.

    How to implement the IAPT data set v2.0
    Refer to the implementation guidance available from the DCB1520 information standard webpage. Section 3.5 contains a step-by-step guide for new and existing users.

    What data is required from 1 April 2020
    The Requirements Specification, available from the DCB1520 information standard webpage, defines the scope of the data set, what is required from providers and how NHS Digital will assess that a provider has complied with submitting the data to meet this legal requirement.

    Future version – IAPT Data Set v2.0 – DCB1520 A18md 14/2019
    Version 2.0 of the IAPT Data Set has received approval from the Data Coordination Board for collection from 1 April 2020.

    The ISN and formal standard documentation for IAPT v2.0 is published on the DCB1520 webpage.

    Update – 30 October 2019
    A corrigendum has been published on the DCB1520 webpage to provide notice of corrections to version 2.0 of the Improving Access to Psychological Therapies (IAPT) Data Set. The corrections relate to:

    • inclusion of an Integrated IAPT-LTC indicator
    • correction to an error in the format listed for a data item
    • amendment to group notes for IDS004EmpStatus
    • amendment to UID for a data item
    The updated Technical Output Specification, Data Model, System Conformance Checklist and SNOMED mapping documents, have been updated and published below that reflect these changes.

    Document Current version Last updated
    IAPT v2.0 Technical Output Specification 2.0.18 13 December 2019
    IAPT v2.0 Data Model 2.0.15 18 October 2019
    IAPT v2.0 User Guidance 1.1 13 December 2019
    Mapping guidance from v1.5 to v2.0 1.0 4 September 2019
    IAPT v2.0 SNOMED CT mapping 3.0 13 December 2019
    IAPT v2.0 System Conformance Checklist 2.0.13 29 October 2019

    Pilot data guidance

    Version 2.0 now contains all of the necessary data requirements for the Employment Advisers and integrated health pilots collections, so these requirements will no longer be detailed in separate specifications.
     
    Last edited by a moderator: Feb 18, 2020
  2. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    PDF: IAPT v2.0 User Guidance 1.1 13 December 2019

    Page 40: 5.2.15 IDS602 Long Term Physical Health Condition
    "To carry details of any Long Term Physical Health Conditions for a patient, which are stated by the patient or recorded in medical notes. These do not necessarily have to have been diagnosed by the organisation submitting the data.

    One occurrence of this group is permitted for each Long Term Physical Health Condition.

    General Table Guidance

    Please see the definition of a Long Term Physical Health Condition in the NHS Data Model and Dictionary.

    Page 41: 5.2.16 IDS603 Presenting Complaints
    "Access to comprehensive information around presenting complaints is fundamental to successful IAPT outcome reporting and service planning. The IAPT Manual provides a coding framework for the range of conditions suitable for treatment within IAPT services, including relevant ICD-10 coding."

    Page 45 Appendix 1.1 List of accepted Assessment Tools for submission within IAPT
    "Please note: This list will remain under development and assessment tools may be added as and when identified as a requirement for submission through the IAPT Data Set."

    Page 48: Long Term Conditions
    "Submitters must now be using SNOMED CT to record long term conditions as specified in the IDS603 Long Term Condition table. Mappings to the SNOMED codes are detailed within the Terminology Mapping Guidance document accessible on the IAPT webpage."

    Presenting Complaints
    "Table IDS603 Presenting Complaints allows the use of terminologies such as ICD 10 and SNOMED CT for the recording of problem descriptors and medically unexplained symptoms. Please see section 5.2.16 Presenting Complaints for further details and the Terminology Mapping Guidance document available from the IAPT webpage."

    ------------------

    https://digital.nhs.uk/data-and-inf...ng-access-to-psychological-therapies-data-set

    Version 2.0 Update – Data collection from 1 April 2020

    An update to the data set (version 2.0) will go live in April 2020 to collect additional information, such as:
    • internet enabled therapies: information around the delivery of these emerging models of therapy
    • long term physical health conditions and medically unexplained symptoms: bringing in the pilot data items into the core data set
    • additional employment items: to better understand employment outcomes and the provision of employment support
    • languages: to further understand patient demographics
    • care personnel qualifications: to support a richer picture of the IAPT workforce and enable better planning
    --------------

    In document:

    Mapping guidance from v1.5 to v2.0 1.0 4 September 2019

    https://digital.nhs.uk/binaries/con...-docs/iapt_v1.5_to_v2.0_mapping_guidance.xlsx

    Single line:

    "Amendment to the mapping for MUS-Other and replacement of MUS terminology within the document."

    But can't see anything other than this single line
    .

    ------------------------------

    As some of you will already be aware from my reports in the ICD-11 and other classifications thread, the UK Edition of SNOMED CT has an existing UK specific code SCTID: 887761000000101 Medically unexplained symptoms which is currently mapped to ICD-10 R68.8 Other specified general symptoms and signs.

    What relevance this SNOMED CT code might have in future is currently unclear.
     
    Last edited: Feb 21, 2020
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  3. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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  4. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Apologies if this draft document had already been posted in another thread:

    https://nhs-digital.citizenspace.co...ecification_DRAFT_FOR_PUBLIC_CONSULTATION.pdf

    Improving Access to Psychological Therapies (IAPT) Data Set v2.0 Change Specification

    Draft for Public Consultation

    This document is provided in DRAFT format for review as part of the Public Consultation. References throughout the document, such as to wider documentation, may not be accurate at this stage.
     
    Last edited: Feb 24, 2020
  5. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    In this document:

    https://www.rcpsych.ac.uk/docs/defa...cmh-iapt-ltc-full-implementation-guidance.pdf

    National Collaborating Centre for Mental Health. The Improving Access to Psychological Therapies (IAPT) Pathway for People with Long-term Physical Health Conditions and Medically Unexplained Symptoms. Full implementation guidance. London: National Collaborating Centre for Mental Health. 2018.

    Page 2:

    "Amended 17 January 2019:

    ‘Chronic pain’ has been categorised as a ‘long-term condition’ where relevant."​


    and in the table on Page 12, "chronic pain" has been inserted (which isn't included in the table I posted above).


    Table 1: Key terms used in this guidance Definition used in this guidance

    Depression and anxiety disorders
    Depression and a range of anxiety disorders (including generalised anxiety disorders, social anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive disorder, specific phobias, post-traumatic stress disorder, health anxiety and mixed depression and anxiety)

    Long-term physical health conditions (LTCs) A range of long-term physical health conditions such as cardiovascular disease, chronic obstructive pulmonary disease, diabetes, chronic pain and musculoskeletal disorders

    Medically unexplained symptoms (MUS) Persistent and distressing bodily symptoms characterised by functional disability that cannot wholly be explained by a known physical pathological cause; psychological processes are often involved in the presentation of MUS. Examples include chronic fatigue syndrome and irritable bowel syndrome
     
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  6. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    File:

    IAPT v2.0 SNOMED CT mapping 3.0 13 December 2019


    Big caveats:


    these proposals below may have changed between the posting of these files on the IAPT webpage and the finalising of Data Set v2.0 for release in April 2020;

    re the "TBC" entry: any request for the addition of the (DSM-5) term "Somatic symptom disorder" to SNOMED CT UK Edition may have been rejected;

    there is no term or code for "Somatic symptom disorder" in ICD-10 Version: 2016 or ICD-10 Version: 2019;

    in ICD-11, Somatic symptom disorder has been inserted under Synomyms to Bodily distress disorder. It is not a specified inclusion term to BDD and does not take the BDD 6C20 code. Instead it is coded to a "Residual code" (6C20.Z Bodily distress disorder, unspecified).

    The notes underneath this image are extracts from what I have posted on David Tuller's blog.


    [​IMG]


    Edited to insert screenshot for comparison with the Table above:

    Web page for draft consultation documents:

    https://nhs-digital.citizenspace.com/data-set-development-service/iapt-data-set-v2/


    IAPT v2.0 Terminology Requirements 113.1 KB (PDF document)

    [​IMG]

    Note the draft for consultation (IAPT v2.0 Terminology Requirements 113.1 KB) had proposed mapping:

    12 MUS - not otherwise specified > F49.9 Somatoform disorder, unspecified

    whereas the most recent version (IAPT v2.0 SNOMED CT mapping 3.0 13 December 2019) has:

    12 MUS - not otherwise specified > TBC* > Somatic symptom disorder

    with the note:

    * A new code for Somatic Symptom Disorder has been requested for authoring in the April SNOMED CT release. The mapping file will be republished when this code is available for use.

    ------------------------------

    Notes:

    1 Somatic symptom disorder is not an ICD-10 code. It is a DSM-5 disorder which replaced most of the DSM-IV Somatoform disorders categories. The DSM-5 is developed and owned by the American Psychiatric Association. The DSM-5 Manual is not much used in the UK and is not mandated for use by NHS Digital.

    There is currently no Concept code for Somatic symptom disorder in the SNOMED CT International Edition. It is not included in the SNOMED CT U.S. Edition nor in any of the other SNOMED CT national editions.

    2 There has been no Somatic symptom disorder added to the final update for ICD-10 (Version: 2019); so currently, there is no ICD-10 Somatic symptom disorder code, per se, available to IAPT.

    3 The DSM-5's Somatic symptom disorder is not inclusive solely of "medically unexplained". It can also be applied to symptoms associated with general medical conditions and the so-called speciality "Functional somatic syndromes".

    4 For NHS England, ICD-10 is the mandatory classification system; SNOMED CT UK Edition is the mandatory terminology system.

    5 From April 2018, SNOMED CT UK Edition absorbed and replaced the Read (CTv3) primary care terminology system. SNOMED CT UK Edition is already implemented for NHS England as the mandatory terminology system for primary care settings and is planned to be adopted across all secondary care and mental health settings from this year.

    It doesn’t replace ICD-10, but is used "at the point of care" to record terminology codes for findings, diagnoses, procedures etc. for entering into the patient’s electronic medical record.

    Whereas ICD-10 is used after the contact with the patient for recording data for NHS England statistics, planning commissioning, monitoring outcomes etc.

    6 SNOMED CT International Edition releases two updates per year (January 31 and July 31). The various national editions are also updated twice yearly, but on a staggered schedule.

    Normally, the national editions absorb all the changes to the latest International release. But national editions are also permitted to add terms which are exclusive to their own extensions; for example, the UK edition has a SNOMED CT SCTID Concept code for "Medically unexplained symptoms" as well as a Concept code that all other editions include for the term, "Medically unexplained symptom".

    So it is feasible for the SNOMED CT UK Edition to consider requests for insertion of codes that aren’t listed in the International Edition or to decide not to absorb a change. (For example, until last year, the Netherlands Edition had retained the term "Neurastenie" under Synonyms to CVS long after all the other editions had retired all of the several "Neurasthenia" related Concept codes.)

    7 The July 2017 Release for SNOMED CT International Edition included an undefined "Bodily distress disorder" term. It was clarified by SNOMED International that the SNOMED CT Concept: Bodily distress disorder had been added by the team working on the SNOMED CT and ICD-11 MMS Mapping Project as an exact match for the ICD-11 term, Bodily distress disorder – to which it has been cross mapped.

    This addition of BDD was absorbed by all the various national editions, including the UK edition. But it is an ICD-11 term and BDD is not included in ICD-10.

    8 In the SNOMED CT UK Edition - ICD-10 classification map, Bodily distress disorder is mapped to ICD-10’s F45.9 Somatoform disorder, unspecified.

    9 If the addition of a Concept code for "Somatic symptom disorder" has been requested and approved for insertion in the SNOMED CT UK Edition April release, that edition would have a Concept code for both Bodily distress disorder (an ICD-11 disorder) but also Somatic symptom disorder (very similar conceptually to BDD, but for which the criteria set and disorder description texts are the intellectual property of the American Psychiatric Association).

    10 If SSD has been added to the SNOMED CT UK Edition for its April 2020 release, it may have been too late for inclusion in the most recent version of the SNOMED CT UK Edition to ICD-10 cross map tables (the schedules for release dates and release of maps have been disrupted this year, according the an NHS Digital Newsletter).

    But an addition to SNOMED CT would still likely need a code map to an existing ICD-10 code – possibly F45.1 Undifferentiated somatoform disorder or F45.9 Somatoform disorder, unspecified (to which ICD-11's BDD is mapped).



    So if that is what is still intended – it’s a dog’s breakfast.

    It will be several years before NHS England migrates from ICD-10 to ICD-11. It would be confusing to be using the DSM-5 term "Somatic symptom disorder" for a few years, then switch to BDD, when ICD-11 has been rolled-out in England.

    Note that I have obtained exclusions under BDD for PVFS; BME; and CFS but there are no exclusions in DSM-5 under SSD for these terms.
     
    Last edited: Feb 17, 2020
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  7. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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  8. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    NHS Digital Newsletter

    https://hscic.kahootz.com/connect.t...RL=/connect.ti/t_c_home/viewblog?blogid=50136

    Terminology & Classifications News

    Update to 2019-20 release schedule for SNOMED CT UK Edition maps to ICD-10 and OPCS-4

    Published: January 2020



    Dear colleague,

    The next release of SNOMED CT to ICD-10 and OPCS-4 maps will be on 01 April 2020.

    The development of and migration to a new terminology tooling platform as well as the subsequent deferment in 2019 of taking the SNOMED International releases for January 2019 and July 2019 has resulted in compressed timelines for mapping.

    The impact of this is that prioritisation has been given to new UK SNOMED CT content including the update of existing maps to reflect any changes as a result of the new codes in OPCS-4.9. This means only a minimum number of new international concepts will be mapped to the classifications before the map editing freeze date.

    We apologise for the alteration to our normal service.

    For further information or queries please contact information.standards@nhs.net

    Kind regards

    Terminology & Classifications Delivery Service
     
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  9. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    NHS Digital Newsletter:


    This delay in absorbing the changes in the SNOMED CT International Edition's January 2019 and July 2019 releases might well account for why the SNOMED CT UK Edition has yet to absorb the restructuring of the 84229001 |Fatigue (finding) parent and its Children.


    (This restructuring affected a number of existing SNOMED CT Concept terms, during the course of which it also resulted in a decision by SNOMED classification managers to assign the additional Fatigue parent to Chronic fatigue syndrome for the July 2019 release.

    Prior to this, CFS had had parent: Disorder of nervous system (disorder), which had been obtained, in 2018, for implementation in the July 31, 2018 release.)

    All the other national editions have already absorbed the addition of the Fatigue parent to 52702003 |Chronic fatigue syndrome (disorder)|

    which I reported on last year.

    See SNOMED CT International browser for the current listing of CFS and the terms under Synonyms:

    https://browser.ihtsdotools.org/?pe...edition=MAIN/2020-01-31&release=&languages=en


    The Fatigue parent (or "Supertype") is described thus:

    Fatigue (finding)

    SCTID: 84229001

    84229001 | Fatigue (finding) |

    en Weariness
    en Fatigue (finding)
    en Fatigue
    en Fatigue refers to a lack of energy, and it may be either acute or chronic. Fatigue may result from exertion, stress, and a wide variety of underlying medical conditions, including infections, malignancies, autoimmune disorders, anxiety, and depression. It may also be an adverse effect of medical treatments such as chemotherapy. Depending on the underlying cause, fatigue may or may not be relieved by rest.

    -----------------------------------------

    Obviously, it was preferable not to have CFS under two parents - and certainly not under the 84229001 |Fatigue (finding) parent (which in ICD-10 and ICD-11 has exclusions for the G93.3 terms).

    This is an issue that still needs sorting with SNOMED CT.

    I cannot confirm at the moment whether Forward-ME has taken this up with SNOMED CT and if so, what the outcome was. (Forward-ME had been informed, indirectly, by me, on October 01, last year, about this change and the need for reopening a dialogue with SNOMED CT managers.)

    It's not an issue I am prepared to take up myself, as I am still trying to retire and I was supposed to be retired last year and then early this year.

    This change for CFS in SNOMED CT, is now in all the national editions (apart from UK) which includes:

    Argentina, Australia, Belgium, Canada, Denmark, Estonia, Ireland, Netherlands, Norway, Sweden, United States, Uruguay.
     
    Last edited: Feb 16, 2020
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  10. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Consultation documents:

    https://nhs-digital.citizenspace.co...ecification_DRAFT_FOR_PUBLIC_CONSULTATION.pdf

    Improving Access to Psychological Therapies (IAPT) Data Set v2.0 Change Specification

    Draft for Public Consultation

    This document is provided in DRAFT format for review as part of the Public Consultation. References throughout the document, such as to wider documentation, may not be accurate at this stage.

    There are more documents relating to the public consultation here:


    Web page for consultation details:

    https://nhs-digital.citizenspace.com/data-set-development-service/iapt-data-set-v2/

    Improving Access to Psychological Therapies (IAPT) v2.0 Data Set Consultation Questionnaire

    Closed 6 Jun 2019
    Opened 9 May 2019

    Feedback Updated 24 Oct 2019

    We Asked

    We asked for feedback on our proposals for the Improving Access to Psychological Therapies (IAPT) Data Set Version 2.0, particularly with regard to the alignment with the Mental Health Services Data Set (MHSDS) and the increased use of clinical terminology within the data set.

    You Said

    (…)

    [If you scroll right down to the end of page (including down to the text on a grey ground) there are links for more documents, including “IAPT v2.0 Public Consultation Summary Report”]

    Related
    IAPT v2.0 Draft Data Set Specification 1.3 MB (Office Excel 2007 XML workbook)
    IAPT v2.0 Draft Change Specification 787.8 KB (PDF document)
    IAPT v2.0 Draft Data Model 81.5 KB (PDF document)
    IAPT v2.0 Terminology Requirements 113.1 KB (PDF document)
    IAPT v2.0 Public Consultation Questionnaire 154.5 KB (Office Word 2007 XML document)
    IAPT v2.0 Burden Survey 132.6 KB (Office Word 2007 XML document)
    IAPT v2.0 Public Consultation Summary Report 149.9 KB (PDF document)

    Improving Access to Psychological Therapies Data Set
    ISB 1520: Improving Access to Psychological Therapies Data Set
    Improving Access to Psychological Therapies Data Set Reports
     
    Last edited: Feb 17, 2020
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  11. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    File:

    IAPT v2.0 SNOMED CT mapping 3.0 13 December 2019

    https://digital.nhs.uk/binaries/con.../iapt_v2_terminology_mapping_guidance_v3.xlsx


    Caveats:


    These proposals below may have changed between the posting of these files on the IAPT webpage and the finalising of Data Set v2.0 for release in April 2020.

    More content from the above spreadsheet file:

    [​IMG]


    Note that Fibromyalgia does appear to be under LTCs (Long Term Conditions) under "Disorder characterized by pain" - ie not assigned an F45 code.

    That 373673007 code is a SNOMED CT Concept code:

    https://termbrowser.nhs.uk/?perspec...gRefset=999001261000000100,999000691000001104

    which is cross mapped in the SNOMED CT UK Edition to ICD-10 map to:

    ICD10 R52.9 Pain, unspecified
     
    Last edited: Feb 16, 2020
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  12. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    For criteria for DSM-5's Somatic symptom disorder see slides #30 and #31

    https://www.cntw.nhs.uk/content/upl...ients-With-Medically-Unexplained-Symptoms.pdf

    Northumberland, Tyne and Wear NHS

    GP Updates in Mental Health


    Practical measures with your patients with medically unexplained ‘functional’ symptoms
    Dr Sarah J Brown
    Consultant Liaison Psychiatrist
    RVI, Newcastle


    Edited to add: What you see on slides #30 and #31 are not the full diagnostic criteria. In the DSM-5 Manual, there are 5 to 6 pages of descriptive text, Diagnostic features, Differential diagnosis etc. which should be used to guide the clinician when assigning a diagnosis.

    SSD can't be anything anyone thinks it can be. There is only one set of criteria and guidelines for SSD, which are published by, and are the intellectual property of APA Publishing. If IAPT has caused SNOMED CT to add SSD to the SNOMED CT UK Edition, SSD could potentially end up being available for use, clinically, outside of IAPT. But DSM-5 isn't used much in the UK and the DSM-5 isn't mandated by NHS Digital and DSM-5 codes are cross-mapped to ICD-10-CM, but not to the WHO's ICD-10. So it seems odd to me that they have evidently requested addition of a U.S. centric term for SNOMED CT UK.

    SSD has not even been added to the SNOMED CT U.S. Edition.

    In ICD-11, SSD isn't even coded directly to the 6C20 BDD code - it's been assigned the "Residual" "6C2Z" code.

    Unless they see this as an interim solution while waiting for ICD-11's BDD.
     
    Last edited: Feb 16, 2020
  13. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    If IAPT wanted to find an alternative code for "MUS - not otherwise specified" that isn't one of the existing F45 block codes and is able to make use of SNOMED CT UK Edition codes, you might legitimately wonder why it has not proposed to use the existing SNOMED CT UK Edition Concept:

    887761000000101 Medically unexplained symptoms (finding)

    But this code, and

    702537003 Medically unexplained symptom (finding)

    are both designated as "(finding)" not "(disorder)".


    It hasn't been established yet in what year 887761000000101 Medically unexplained symptoms (finding) was approved specifically for the UK Edition or who had requested its addition, but it was added several years ago.

    It may be the case that 887761000000101 is already in use as a general "(finding)" code. (It is cross mapped to ICD-10's R68.8 Other specified general symptoms and signs).

    [702537003 Medically unexplained symptom (finding) is mapped to ICD-10's R69.X Unknown and unspecified causes of morbidity.]


    But if IAPT were seeking a more specific "Medically unexplained symptoms - not otherwise specified" term - in the sense of the disorder commonly referred to as "MUS" rather than as a general finding, then they would perhaps be looking for a code that is an ICD mental disorder chapter code or a SNOMED CT term that has a "Mental disorder" parent.


    Note that all diseases, conditions and disorders are designated "(disorder)" in SNOMED CT.

    Because of the way disorders in SNOMED CT are arranged, classification managers can be flexible around changes of parent.

    When SNOMED CT added Bodily distress disorder to the International Edition as part of the process of aligning SNOMED CT with ICD-11 codes, it had initially been assigned under the parent "Functional disorder".

    I caused the parent to be changed to the "Mental disorder" parent, for consistency with the term's chapter placement within ICD-11 and to put clear blue water between BDD and "functional disorders". I also caused the three BDD severity specifiers: Mild; Moderate; and Severe to be added as Children under BDD and assigned three discrete codes - again to better reflect its alignment with ICD-11's BDD, which has three coded-for severities.


    If IAPT were to get approval for SSD to be added to the SNOMED CT UK Edition, I would anticipate they would locate SSD as a Child under parent "Mental disorder" and use the designation "(disorder)" ie as Somatic symptom disorder (disorder).

    Whether IAPT has already discussed with APA Publishing issues around the use of a DSM-5 disorder term and criteria set in the UK (where DSM-5 is not mandated for use by NHS Digital and given that it is not used to any great extent, here) prior to submitting a request for its addition to SNOMED CT UK Edition, isn't currently known.

    As I've said in the previous post, if it has obtained approval, IAPT maybe envisages using SSD as an interim solution while waiting for ICD-11 to be adopted in England, then revise the SSD term to ICD-11's BDD (which is already included in all SNOMED CT Editions and which is very similar, conceptually to SSD).

    It's all a bit of a mess and the last thing I expected to discover this weekend was that IAPT has submitted for addition of SSD to SNOMED CT UK Edition, in order to be able to make use of the term instead of "Medically unexplained symptoms - not otherwise specified".


    It's like Wac-A-Mole.

    CFS gets sorted in SNOMED CT and then a year or two later, they add another parent. Then IAPT comes along and wants SSD added to SNOMED CT. ICD-10 finally removes the "Benign" word, but NHS Digital might not adopt Version: 2019, so we may not benefit from that change in the UK. (And ICD-11 hasn't implemented that change yet.) Then there is the Goldberg group and their bloody BSS (which WONCA are no doubt being lobbied to include in ICPC-3 - which is supposed to be being finalised later this year); and ICPC-3 is planned to be integrable with the projected primary care specialty linearization in the core ICD-11, so that needs watching even though we don't use ICPC in the UK...
     
    Last edited: Feb 16, 2020
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  14. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

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  15. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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  16. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Got it:

    https://isd.hscic.gov.uk/rsp-snomed/user/guest/request/view.jsf?request_id=29847

    Request Submission Portal > SNOMED CT Submission Portal

    Submission date: 13/11/19

    Request 29847

    Type
    Add concept

    Status
    Request provisionally accepted

    Hierarchy
    Clinical finding

    Suggested name, term or description
    Somatic Symptom Disorder

    Priority
    Urgent

    Brief summary of the request
    To add a new concept that is the equivalent of Somatic Symptom Disorder in DSM-5 (300.82).

    Description of the addition or change

    Sheree Hemingway and myself attended a call with the NHS England IAPT senior team on 11/11/19 regarding the mapping of a cohort of patients who require psychological therapy in relation to persistent physical symptoms. This cohort was previously categorised in IAPT as 'Medically unexplained symptoms - other' but this is no longer appropriate.

    The IAPT National Clinical Advisor highlighted that Somatic Symptom Disorder (300.82 I think) in DSM-5 is the appropriate definition for this cohort. However, a SNOMED or ICD-10 code was required for the IAPT Data Set submission.
    It was agreed that this DSM-5 code would be mapped to SNOMED as a new 'Somatic Symptom Disorder' concept if possible.
    I am not sure how this would map up in the SNOMED hierarchy and would be grateful for your steer.

    Request update
    Source of authority
    Provisional concept term
    SNOMED International request reference number

    ---------------------------------------------------------------------------------------

    Edited to add: Sheree Hemingway is an Advanced Terminology Specialist at NHS Digital.
     
    Last edited: Feb 17, 2020
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  17. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    I note they have cited the old ICD-9-CM mapping code. The U.S. has been using ICD-10-CM since October 2015.

    DSM-5's SSD is mapped to F45.1 Undifferentiated somatoform disorder in ICD-10-CM.
     
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  18. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    In the SNOMED CT UK Submission Portal, when a request has been processed it is marked as:

    Status
    Closed - Complete


    The IAPT request number: 29847 is marked:

    Status

    Request provisionally accepted

    -----------------------

    I'll be checking the portal every few days for any change in status.



    https://isd.hscic.gov.uk/rsp-snomed/user/guest/home.jsf

    (...)

    Request submissions for consideration in SNOMED CT UK Edition 6 monthly releases must be received by:

    30th June for the October release
    31st December for the April release


    which is a different schedule to the SNOMED CT International Edition's request schedule. So I think they have most likely requested this addition only for the UK Edition.

    Also, a request for a change or addition to the International Edition has to be submitted to, and considered and processed by the International classification team.
     
    Last edited: Feb 17, 2020
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  19. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    The Request for addition of SSD to SNOMED CT mentions "the IAPT National Clinical Advisor".

    Professor David Clark, Professor and Chair of Experimental Psychology, University of Oxford, is National Clinical & Informatics Advisor for IAPT.

    You would think he would be aware that DSM-5 is little used in the UK and not a classification system that is mandated for NHS England.
     
    Last edited by a moderator: Feb 18, 2020
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  20. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    In the run up to finalisation of the APA's new DSM-5 criteria sets and disorder description texts, I recall Prof Wessely commenting, somewhat disparagingly, on the new Somatic symptom disorder construct which has replaced most of DSM-IV's Somatoform disorders.

    He had also stated that DSM-5 was little used in the UK and would therefore have limited impact, clinically, in this country.

    I put this question to him today:




     
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