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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 'Disease coding' started by Dx Revision Watch, Feb 15, 2020.

  1. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)


    Request 138 (which I noted a couple of years ago on the other forum) was for addition of the Synonym terms:

    Myalgic Encephalitis
    Myalgic Encephalopathy

    under the Synonym list for Concept SCTID 52702003 | Chronic fatigue syndrome (disorder) |

    This request had been submitted on 18/05/09 and was accepted and implemented. These two terms are exclusive to the UK Edition.

    The search engine does not return a result for "Medically unexplained symptoms" so I've not been able to determine in which year this SNOMED CT Concept term was requested and implemented. (The database may not go back that far.) This term is exclusive to the UK edition. The UK Edition and all other Editions include a Concept term for "Medically unexplained symptom" - but the UK Edition is the only edition to include a Concept term for "Medically unexplained symptoms".
    Last edited: Feb 25, 2020
    Invisible Woman, Sly Saint and Amw66 like this.
  2. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

    This is interesting:


    Request 21089 Submitted 12/08/16

    Change concept

    Closed - Complete

    Concept identifier


    Brief summary of the request
    Conflated descriptions: Dysthymia, Depressive neurosis, Neurasthenic neurosis,
    Neurasthenia,Nervous debility,Neurotic depression,Nervous breakdown

    Description of the addition or change
    78667006 | Dysthymia (disorder) | active descriptions include
    Depressive neurosis
    Neurasthenic neurosis
    Nervous debility
    Neurotic depression
    Nervous breakdown

    UMLS identifies five distinct concepts here...

    C0011581 Depressive disorder
    C0013415 Dysthymic Disorder
    C0027804 Neurasthenia
    C0221508 Nervous breakdown
    C0282126 Depression, Neurotic

    See http://www.diseasesdatabase.com/snomed/78667006

    Likewise CTV3 [Ed: the now retired Read Primary Care Terminology system that has been absorbed into SNOMED CT] antecedents of 78667006 | Dysthymia (disorder) | are several distinct concepts

    While several (even all) of these descriptions are outmoded the conflations are nonetheless major. These groups of terms are not (were not) even closely related!
    These terms are in use in medical records and this conflated concept is causing issues for reporting and decision support in the application I am working on.

    I suggest this concept be inactivated as ambiguous. Perhaps consider reversing the SNOMED historical changes

    Thank you for taking a look at this.

    Kind regards, Malcolm

    Dr Malcolm H Duncan

    Medical Object Oriented Software Enterprises Ltd

    [Ed: I'm redacting the requestor's email address and other contact details]

    SNOMED International request reference number



    So this request for inactivation of Neurasthenia and some additional terms was referred on to SNOMED International for their consideration.

    I knew these terms had been retired some years ago but not the year in which this had been implemented (the correct term in SNOMED CT for a retired term is "Inactivated" and if you want to search SNOMED CT editions for Inactivated terms, you need to select for "Active and inactive components" before you enter the term in the Search field. Inactive terms display on a pink background.)

    So we have Dr Duncan to thank for the Inactivation of the Concept Neurasthenia, in 2016.
    Last edited: Feb 24, 2020
  3. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

    Other notable Inactive Concept terms:

    Funny looking kid SCTID: 112630007 | Abnormal facies (finding) |

    GOK - God only knows SCTID: 158729002 | (Morbidity/mortality unknown [D]) or (God only knows) (situation) |
    Esther12 and Invisible Woman like this.
  4. Trish

    Trish Moderator Staff Member

    I am posting the following update on behalf of Suzy Chapman (Dx Revision Watch):

    On February 23, I submitted a formal stakeholder response to Request 29847 to Elaine Wooler, Sheree Hemingway and Lynn Bracewell (NHS Digital Terminology and classifications), Ccd to Dr James Case and Jane Millar (SNOMED CT International terminology leads).

    My response rationale text included the recommendation:

    No requests for adding DSM-5's Somatic symptom disorder to SNOMED CT UK Edition should be approved or implemented at this stage. Advice should be sought from the SNOMED CT International Edition terminology team.

    At the time of my initial contact, the request was designated as "Urgent" and its status marked as "Provisionally accepted".

    Receipt of my communication was acknowledged promptly and I was advised that this would be investigated further and would need discussion with the IAPT programme.


    Today (March 13), I contacted NHS Digital's terminology leads to ask if they could provide me with an update on the status of this request for a Concept term for Somatic symptom disorder to be added to the April release of SNOMED CT's UK Edition, in order that a SNOMED CT Concept code and a map to an ICD-10 code can be included in IAPT's new Data Set v2.0, which is scheduled to implement from April 01.

    I have been advised by Ms Wooler:

    that the managers of the SNOMED CT UK Edition won't be adding Somatic symptom disorder (SSD) to the UK Edition's April release as there are still discussions taking place regarding this;

    that further research needs to take place with SNOMED International and probably discussion with the Royal College of Psychiatrists;

    that potentially, consideration could be given to adding Somatic symptom disorder as a Synonyms term under the existing SNOMED CT Concept: 723916001 Bodily distress disorder. (For ICD-11, Somatic symptom disorder is one of a number of terms listed under Synonyms under Bodily distress disorder);

    that additions are made to SNOMED CT based on current research and each concept must be unique and meet the following criteria:

    • Understandable. The meaning of a concept can be understood by most healthcare providers, without reference to private or inaccessible information.
    • Reproducible. Multiple users apply the concept to the same situations.
    • Useful. The concept has a practical value to users that is self-evident or can be readily explained.
    that content is added to the terminology based on the criteria above; however the choice of a particular concept is the decision of the clinician based on their assessment of the patient in front of them;

    that the next release of SNOMED CT UK Edition will be the October release;

    that it may take some months to conclude the discussions around this request;

    that NHS Digital terminology leads will keep me updated with any changes.

    But for now, there will be no Concept code for Somatic symptom disorder available to IAPT for 11th hour inclusion in its new IAPT Data Set v2.0, which implements from the beginning of April.

    In light of this decision not to approve the request for the SNOMED CT April release and to further discuss with SNOMED International, it is currently unclear what term IAPT will now go forward with when it finalises its new Data Set 2.0 in the coming week or two.

    That is, will IAPT stick with the "no longer appropriate" term "MUS - not otherwise specified" mapped to ICD-10 code F45.9 (as the Data Set proposal had stood at the time of the October stakeholder consultation);

    or will they replace "MUS - not otherwise specified" with "Persistent physical symptoms" mapped to an ICD-10 F45.x code (as per a November stakeholder presentation)?

    I shall be monitoring this IAPT Data Set v2.0 web page


    for any notices regarding amendments to terminology in IAPT's Data Set v2.0 documentation and any amendments to the Data Set spreadsheets, where the mapping code had been marked as "TBC" (ie To be confirmed, pending the outcome of Request 29847).

    I will update when the finalised Data Set files have been posted towards the end of March.

    Suzy Chapman, Dx Revision Watch
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  5. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

    My addition to the above three criteria :

    • Whether the concept is useful to patients is of no interest or relevance to anyone so don't worry about it
    • It is important to remember that being able to pull the wool over patients' eyes is an integral and vital part of the naming process
  6. Trish

    Trish Moderator Staff Member

    I am posting the following update on behalf of Suzy Chapman (Dx Revision Watch):

    Important notice re IAPT and transition from Data Set v1.5 to v2.0 (previously scheduled for roll-out on April 01):


    Submitting IAPT v2.0 data - NHS Digital

    Due to the rapidly changing situation with Covid-19, NHS England have advised that we postpone the transition from IAPT v1.5 to IAPT v2.0 until 1 July 2020. This will also delay migration from Bureau Service Portal (Open Exeter) to SDCS Cloud.

    For more information:


    Due to the rapidly changing situation with Covid-19, NHS England have advised that we postpone the transition from IAPT v1.5 to IAPT v2.0 until 1 July 2020. This will also delay migration from Bureau Service Portal (Open Exeter) to SDCS Cloud.

    IAPT providers should, where possible, continue to submit April-June data using the IAPT v1.5 standard to the Bureau Service Portal.

    As most providers have now moved to home working and access to IT systems is less convenient, we believe this is the appropriate action to help reduce the burden on the NHS and IAPT providers.
    The postponement will provisionally be for three months and IAPT v2.0 will now launch from 1 July 2020.

    The first submissions to SDCS Cloud will take place from 1 August. We will review the situation regularly and communicate any further changes. Any decision to extend further will be made at least two weeks prior to the new go live date.

    If you have any queries please contact NHS Digital at enquiries@nhsdigital.nhs.uk.

    Last edited: 2 April 2020 4:12 pm


    (Note that the next release of the SNOMED CT UK Edition is scheduled for October 01, 2020.

    Therefore, if IAPT rolls out its new Data Set v2.0 on July 01, this will be before the next release of the SNOMED CT UK extension.

    If IAPT's proposal for adding a Concept term for Somatic symptom disorder were to be approved prior to July 01, the earliest a Concept term for SSD could be added to the SNOMED CT UK edition would be for incorporation in the October 01, 2020 release.)

    Suzy Chapman, Dx Revision Watch
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  7. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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