Updates on status of ICD-11 and changes to other classification and terminology systems

Latest release of SNOMED CT US Edition posted:

The March 01, 2019 release of SNOMED CT US Edition was posted today on the SNOMED CT browser platform.

I can confirm that no new SNOMED CT Concept code or Synonym term under an existing SNOMED CT Concept code for either "Systemic exertion intolerance disease" or "SEID - Systemic exertion intolerance disease" has been added to the US Edition's March release.

The US Edition posts a release twice yearly. The next release for the US Edition will be the September 01, 2019 release.

The US release can be accessed from this page - click on the blue button for "Go browsing United States edition 2019-03-01" https://browser.ihtsdotools.org/
 
A batch of recently processed ICD-11 proposals

If you've been following this thread, you'll be aware that the WHO released a frozen version of ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) in June 2018 to enable member states to start preparations for evaluation, translations and implementation.

A slightly revised release was posted in December 2018. This Blue "preparation version" does not show all the content that the Orange Maintenance Platform displays.

The current schedule is for a report to be presented by the WHO Executive Board recommending that WHA approve this preparation release at this year's World Health Assembly, in May. If endorsed, WHA endorsement won't come into effect until January 01, 2022.

After that date, member states can start reporting data using the ICD-11 - if their countries have prepared for transition and have implemented the new edition. But it's anticipated that even early implementers will require around 5 years to prepare their health systems for migration to ICD-11. For a period of time, data will be collected using both ICD-10 and ICD-11 and there is no mandatory date by which member states must transition to the new edition.

Once WHA has approved the ICD-11 MMS, it will be subject to an annual update and revision process (the responsibility of the ICD-11 CSAC Committee which takes over from the ICD-10 URC). Minor changes to content can be considered for incorporation on an annual basis. Changes that would affect the code structure would be considered for incorporation on a 5 yearly update cycle.

[See ICD-11 Reference Guide: 3.8 Annex: ICD-11 Updating and Maintenance for information on the ICD-11 update and revision cycle.]


The numerous Topic Advisory Groups (TAGs) and sub working groups have disbanded and the ICD-11 Joint Task Force has been sunsetted.

WHO, the MSAC and CSAC Committees still have a considerable backlog of proposals to process in addition to new proposals that continue to be submitted. The Proposal Mechanism platform will remain online and open for new Comments and Proposals.


The proposal submitted by the WHO's Dr Tarun Dua in November 2017 to delete PVFS from the Diseases of the nervous system chapter and relocate ME and CFS to the Symptoms, signs chapter as child categories of Symptoms, signs or clinical findings of the musculoskeletal system was processed and rightly rejected by the WHO, in November 2018. This decision was supported by the MSAC and CSAC Committees.

During February and March, this year, a number of unprocessed proposals for ICD-11 have been processed.

These include proposals for 6C20 Bodily distress disorder and 8E49 Postviral fatigue syndrome. Some of these proposals date back to 2014. Proposals that had met the March 30, 2017 submission deadline were supposed to be processed before the end of 2017 for consideration for inclusion in the initial release of the ICD-11 MMS. But many of these weren't; and proposals relating to Postviral fatigue syndrome were in any case held back while an evidence review was undertaken.

These recently processed proposals include proposals that had been submitted by Suzy Chapman since 2014; by Suzy Chapman and Mary Dimmock; and by Lily Chu on behalf of the IACFS/ME.


ICD-11 Proposal Mechanism, status of processed proposals at 10.03.19

In order to access the ICD-11 Proposal Mechanism, registration with the platform is required and the platform is clunky to navigate.

For ease of access, I have made a table which sets out the status of these recently processed proposals plus the Dr Dua proposal.

Here's a preview in the screenshot. The PDF of the full table can be downloaded here:

https://dxrevisionwatch.files.wordpress.com/2019/03/status-of-icd-11-processed-proposals-v1.pdf

or

http://bit.ly/ICD11ProposalTable

I've also attached a copy of the PDF to this post.

Extract:

statuspreview.png




Open the full Table here


As you will see, despite making such a song and dance about a protracted evidence review and encouraging stakeholders to make use of the Proposal Mechanism and Comment facilities, the WHO classification experts and WHO Proposal Mechanism Admins haven't exactly taken much trouble with their rationales for rejections. And yes, I am disappointed, of course, with these outcomes, but I would not leave this bunch in charge of a whelk stall.
 

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Thanks for all your work Suzy. Very odd that they didn't even do a better job of providing brush off responses to the rejected proposals. They could have easily made it less obvious that they were failing to engage with the points made!
 
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Open the full Table here

A brief summary of the outcomes of these various ICD-11 proposals:

Approved: Add Exclusion for (Benign) myalgic encephalomyelitis under Fatigue (was Malaise and fatigue in ICD-10).
Approved: Add Exclusion for Chronic fatigue syndrome under Fatigue.
Awaiting processing: Add Exclusion for Postviral fatigue syndrome under Fatigue. Update: Approved and Implemented on April 15, 2019

Approved: Add Exclusion for Fatigue under Postviral fatigue syndrome; Benign myalgic encephalomyelitis; and Chronic fatigue syndrome.

Rejected: Delete the Bodily distress disorder diagnostic category entirely.
Rejected: Reconsider the proposed nomenclature for the Bodily distress disorder diagnostic category.

Rejected: Add Exclusions for Postviral fatigue syndrome; Benign myalgic encephalomyelitis; and Chronic fatigue syndrome under Bodily distress disorder.
Rejected: Add Exclusion for Bodily distress disorder under Postviral fatigue syndrome; Benign myalgic encephalomyelitis; Chronic fatigue syndrome.

NB: There is an Exclusion for Bodily distress disorder under Fatigue.
There is also an Exclusion for Bodily distress disorder under DD91 Irritable bowel syndrome or certain specified functional bowel disorders.
There is an Exclusion for 6B60 Dissociative neurological symptom disorder under Bodily distress disorder's parent class (which is Disorders of bodily distress or bodily experience).

Approved: The three ICD-10 G93.3 entities should be retained under their legacy chapter: Diseases of the nervous system under parent: Other disorders of the nervous system.

Rejected: Remove Postviral fatigue syndrome as Concept Title term.
Rejected: Deprecate the term "Benign" from Myalgic encephalomyelitis.
Rejected: Create new Concept Title for Myalgic encephalomyelitis.
Rejected: Create new Concept Title for Chronic fatigue syndrome.
Rejected: Assign separate sequential codes to two new Concept Titles: Myalgic encephalomyelitis; and Chronic fatigue syndrome.
Rejected: Relocate Postviral fatigue syndrome to the Synonyms list for new Concept Title: Myalgic encephalomyelitis.

Rejected: Elevate all three terms to the level of Concept Titles and assign three unique codes.

Rejected: Delete Postviral fatigue syndrome from the Disorders of the nervous system chapter. Move "Myalgic encephalitis/Chronic Fatigue Syndrome (ME/CFS)" [sic] from the Diseases of the nervous system chapter and reclassify in the Symptom, signs chapter, under parent: Symptoms, signs or clinical findings of the musculoskeletal system. (Submitted by WHO's Dr Tarun Dua in November 2017.)

Approved: Delete chronic fatigue, unspecified from the Synonyms list for Postviral fatigue syndrome. (Marked as Approved/Implemented but not yet actioned.)


So ICD-11 goes forward for WHA approval this May with these WHO/MSAC/CSAC decisions:

retain all three terms in the Diseases of the nervous system chapter under parent: Other disorders of the nervous system;
retain Postviral fatigue syndrome as the Concept Title term;
specify both Benign myalgic encephalomyelitis; and Chronic fatigue syndrome as inclusion terms under Postviral fatigue syndrome (so they remain coded to the same code as Postviral fatigue syndrome and are not assigned unique codes or sub codes);

plus the Approved proposals above.
 
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Dear Suzy @Dx Revision Watch , you are a star. Just trying to follow these points makes my head ache.

Sorry that they have not provided robust reasons for rejecting your suggestions in respect of Bodily Distress Disorder being linked to ME/PVFS/CFS. Your hard work is much appreciated (even though I don’t understand most of it.......I used to have a brain......now only have a few brain cells lurking about). Thank you!
 
From the ICD-11 Reference Guide (last updated: 05.03.2019)

https://icd.who.int/icd11refguide/en/index.html

https://icd.who.int/icd11refguide/en/index.html#2.02ICD-11conventions|icd11-conventions|c2-2

2.2 ICD–11 conventions
ICD–11 has standard ways of presenting its content. Conventions describe textual content and also apply to the coding structure.

(...)


2.2.2 Inclusions
Within the coded categories there are typically other optional diagnostic terms. These are known as ‘inclusion terms’ and are given, in addition to the title, as examples of the diagnostic statements to be classified to that category. They may refer to different conditions or be synonyms. They are not a sub-classification of the category.

Inclusion terms are listed primarily as a guide to the content of the category, in addition to the definition*. Many of the items listed relate to important or common terms belonging to the category. Others are borderline conditions or sites listed to distinguish the boundary between one subcategory and another. The lists of inclusion terms are by no means exhaustive.

Alternative names of diagnostic entities (synonyms) are included and shown in the electronic coding tool and the Alphabetic Index.

It is sometimes necessary to read inclusion terms in conjunction with titles. This usually occurs when the inclusion terms describe lists of sites or pharmaceutical products, where appropriate words from the title (e.g. ‘malignant neoplasm of …’, ‘injury to …’, ‘toxic effects of …’) need to be understood. General diagnostic descriptions common to a range of categories, or to all the subcategories in a four-character category, are to be found in the notes heading ‘Inclusions’, immediately following a chapter, group, or category title.


2.2.3 Exclusions
Certain categories contain lists of conditions preceded by the word ‘Exclusions’. These are terms which are classified elsewhere. An example of this is 5A60 Hyperfunction of pituitary gland which excludes Cushing syndrome.

Exclusions serve as a cross reference in ICD and help to delimitate the boundaries of a category.

General exclusions for a range of categories or for all subcategories are found in the notes heading ‘Excludes’, immediately following a chapter, group or category title.

(...)


https://icd.who.int/icd11refguide/e...ditionalStructureAdmission|description|c3-1-1

3.1.1 Description
The description is a short characterization (maximum of 100 words) of the entity that states things that are always true about a disease or condition and necessary to understand the scope of the rubric. Descriptions do not contain elements intended for in level 3 (common epidemiology) or things that may be true for level 4 (clinical criteria). Descriptions were formerly called ‘short definitions’.

3.1.2 Additional Information
This is a text field that is not mandatory, but that may contain any additional information about, or characteristics of, the diseases or conditions included in the entity. This text field provides more context for the entity. For example, the most common epidemiologic circumstances, putative or highly suspected aetiologic agents, or other information that may not always be true but may be common, typical, or expected. Additional information was formally called ‘long definition’.

[Extracts end]


*ED: Description texts: In ICD-10, the only chapter which includes disorder descriptions text is Chapter V: Mental and behavioural disorders. Descriptions are expanded on in the derivative publication, the ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines (CDDG) (aka the "Blue Book"). An equivalent publication has been developed for ICD-11 which expands on Chapter 06 Mental, behavioural or neurodevelopmental disorders. The ICD-11 CDDG won't be publicly available until after the ICD-11 MMS code sets have received WHA endorsement but the draft content has been available to clinicians who have signed up to participate in its development and review.

For ICD-11, as part of the new "Content Model" feature, all categories in all chapters were intended to include a "short" and "long" Definition text field - now known as the Description text field.

Descriptions are intended as a guide for coders/clinicians to assist with the selection of appropriate codes. They are not intended to be used in order to make diagnoses. There are around 55,000 unique codes in ICD-11 and not all the Description texts have been drafted, edited and approved - so you will often see empty Description fields. For some categories, international consensus definitions have been used, where these exist.

There is no text entered into the Description field for 8E49 Postviral fatigue syndrome and none of the proposals which have been recently processed had included proposed draft text for this field.

The Coding Tools can be accessed here:

Blue Implementation Platform Coding Tool: https://icd.who.int/ct11_2018/icd11_mms/en/release#/
Orange Maintenance Platform Coding Tool: https://icd.who.int/devct11/icd11_mms/en/current#/
 
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In post #204 and in my document ICD-11 Proposal Mechanism, status of processed proposals at 10.03.19 I had set out that my Proposal (submitted January 19, 2018) to Delete the term chronic fatigue, unspecified from the Synonyms list for 8E49 Postviral fatigue syndrome had been marked as Implemented on January 29, 2018, but deletion of the term from the Synonyms list in the Foundation view and from the Index list in the Mortality and Morbidity Statistics Linearization had not been actioned, despite several requests that WHO Admins rectify this.

Following a further request, I am pleased to confirm that the term chronic fatigue, unspecified has now been deleted.

The Rationale I had submitted for Deletion of the term chronic fatigue, unspecified was:

chronic fatigue, unspecified is a term imported from the U.S. ICD-10-CM. The entity is specific to the U.S. clinical modification and does not appear in the WHO’s unmodified ICD-10. In ICD-10-CM, Chronic fatigue, unspecified is coded under Chapter 18: Symptoms, signs etc. under R53 Malaise and fatigue > R53.82 Chronic fatigue, unspecified with an Excludes1 for postviral fatigue syndrome (G93.3).
​

ICD-11 Mortality and Morbidity Statistics Linearization at March 16, 2019:

https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/569175314

​
chronic-fatigue-unspecified-2.png



​
I've updated the PDF of the Table in Post #202 to Version 2 to reflect this change:

https://dxrevisionwatch.files.wordpress.com/2019/03/status-of-icd-11-processed-proposals-v2.pdf
 

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[Australia] Potential adoption of ICD-11: Pre-consultation for decision makers

AIHW: Australia and ICD-11 Flyer: https://www.aihw.gov.au/getmedia/048dfef8-44f7-42f1-a27a-03c6b61e7376/ICD-11-review-flyer.pdf.aspx

Pre-Consultation document: https://www.aihw.gov.au/getmedia/bb383668-e426-4db0-8362-a579ab79bedf/ICD-11-Review-Pre-consultation-Paper.docx.aspx

Extracts:

"ICD-11 was released by the WHO in an advanced ‘preview’ version in June 2018 and is expected to be formally presented to the Seventy-second World Health Assembly in May 2019 for official endorsement by Member States.

"If endorsed, ICD-11 will then be available for implementation by Member States and there is an expectation by the WHO that its Member States will take steps to begin using ICD-11 in some capacity, whether that be exclusively for mortality purposes or for more broader application in morbidity systems and beyond."

"...The Australian Institute of Health and Welfare (AIHW) is conducting a review of ICD-11 to inform and assist decision-makers about ICD-11 and its potential for adoption in Australia."

"The aim of stakeholder consultation is to identify all issues relevant to a potential adoption of ICD-11 so that, if and when, Australia decides to adopt ICD-11 it can start to ready its relevant systems, processes and people for implementation in some capacity."

"A decision to adopt and implement ICD-11 would require a detailed understanding of the stakeholders impacted, the resources needed, the time frames required, and the impact on existing workforces."

"The WHO has ceased to update ICD-10 and this will, over time, result in ICD-10 and ICD-10-AM becoming out of date. However, a decision to adopt ICD-11 for use in Australia has not yet been made. A lot of research and consultation will need to be undertaken before such a decision could be made and this may take several years. In addition, it is anticipated that several years lead time will be required for implementation of ICD-11 once a decision is made to implement."

See full document for stakeholder questions for decision-makers.


From the Flyer:

The World Health Organization’s International Classification of Diseases, Tenth Revision (ICD-10) is used to standardise the way we report causes of death across the world. Australia uses ICD-10 for coding mortality (cause of death) and ICD-10-AM for coding of diseases and related health problems in hospitals (morbidity). The WHO’s Eleventh Revision of ICD (ICD-11) brings the reporting of mortality and morbidity into one classification. Scientific research institutions, clinical working groups and international data analysts from over 90 countries have assisted in the development and field testing of ICD-11.

Countries have been given a version of ICD-11 to start looking at how it might be implemented for reporting. The WHO anticipates that ICD-11 will be presented to the World Health Assembly (the decision-making group of WHO) in May 2019 which will pave the way for countries to begin the adoption of ICD-11.

ICD-11 Review for Australia

The Australian Institute of Health and Welfare (AIHW) is conducting a review of ICD-11 to inform and assist decision-makers about ICD-11 and its potential for adoption in Australia.

The AIHW is designated as the Australian Collaborating Centre (ACC) for the WHO’s Family of International Classifications. The membership of the ACC is Australian and New Zealand organisations that have an interest and experience in working with health classifications. The work of the ACC has contributed to the development of ICD-11.

Contribute to the Review

If you have comments about the potential adoption of ICD-11 in Australia please contact the AIHW project team:
Email: who-fic-acc@aihw.gov.au
 

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Clarifications regarding the ICD-10 PHC (Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. 1996); its forthcoming revision to ICD-11 PHC; and the ICPC-2 and ICPC-2e (International Classification of Primary Care):


ICD-10 PHC:

The ICD-10 PHC (1996) diagnostic and management guideline is not mandatory for use by WHO member states.

It is not an abridged version of the core ICD-10 since it comprises only mental disorder categories and includes no categories for general medical diseases or conditions.

The ICD-10-PHC guideline is an abridged and simplified version of ICD-10's Chapter V and its companion specialist guideline, the ICD-10 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders.

ICD-10's Chapter V contains in the region of 450 mental and behavioural disorders. ICD-10 PHC comprises just 25 mental disorders which correspond to classes or categories within ICD-10 Chapter V, selected for utility in primary care and low resource settings.

The revision of ICD-10 PHC (1996) has been under development since 2010. The revision is the responsibility of the WHO Department of Mental Health and Substance Abuse advised by an external advisory group - the Primary Care Consultation Group (PCCG) which is chaired by Prof Sir David Goldberg; Vice-chairs: Dr Michael Klinkman* and WHO's, Dr Geoffrey Reed.

*Prof Sir David Goldberg had also chaired the working group for the development of ICD-10 PHC (1996). Dr Klinkman is a GP who represents WONCA (World Organization of Family Doctors). Dr Klinkman is current convenor of WONCA’s International Classification Committee (WICC) that is responsible for the development of ICPC-2.


ICD-11 PHC:

Whilst the WHO hopes that ICD-11 PHC will have greater clinical utility than the ICD-10 PHC, again, ICD-11 PHC will not be a mandatory diagnostic and management guideline for WHO member states.

ICD-11 PHC will also comprise only a small number of selected mental disorders and no general medical diseases and conditions.

25 of the 27 categories proposed for inclusion in the ICD-11 PHC have correspondence with mental disorder classes or categories in ICD-11's Chapter 06. Two categories, one of which is the proposed "Bodily stress syndrome (BSS)", don't have direct equivalence to an ICD-11 disorder category and diagnostic construct.

(For the core ICD-11, WHO is going forward with the differently conceptualized, SSD-like Bodily distress disorder (BDD) diagnostic construct, which captures a different patient population to the proposed "BSS" for the ICD-11 PHC. The other proposed new category for ICD-11 PHC which does not have a direct equivalent in the core ICD-11 is "Anxious depression".)


The full draft texts for the 27 disorder categories proposed for inclusion in ICD-11 PHC have not been made available for public scrutiny but a number of progress papers and field trial evaluations have been published since 2010.

The WHO intends to make the ICD-11 PHC publication, once completed, free to download by anyone who wishes a copy. There is currently no projected date publicly available for the finalization of the ICD-11 PHC publication or when WHO anticipates it will be available for download.

The core ICD-11 MMS is scheduled for presentation for endorsement at the 72nd World Health Assembly, May 20-28. Assuming endorsement is approved, WHA's adoption will not take effect until January 01, 2022. After that date, member states can begin reporting using ICD-11 MMS when their countries have evaluated the new edition, prepared their health systems for transition and implemented the new edition. This will take even the earliest implementers several years.

It is not known which speciality versions and derivative publications, for example, the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders (CDDG) and the ICD-11 PHC, have been finalized or whether they are also intended to be presented at WHA72 in May, along with the core ICD-11 MMS.**

**EXECUTIVE BOARD, 144th session, 31 January 2019, Agenda item 5.9 EB144/CONF./9
Eleventh revision of the International Classification of Diseases, Draft resolution proposed by the Secretariat with amendments from Member States
https://dxrevisionwatch.files.wordpress.com/2019/03/b144_conf9-en.pdf



ICPC-2:

The WONCA managed ICPC-2 (International Classification of Primary Care, Second Edition) is a WHO approved classification system for recording data in Primary Care.

"WHO has accepted ICPC-2 within the WHO FIC mainly as a reason for encounter classification, and users may use it as a classification for primary care or general practice wherever applicable. ICPC-2 classifies patient data and clinical activity in the domains of General/Family Practice and primary care, taking into account the frequency distribution of problems seen in these domains. It allows classification of the patient’s reason for encounter (RFE), the problems/diagnosis managed, interventions, and the ordering of these data in an episode of care structure."***

*** https://www.who.int/classifications/icd/adaptations/icpc2/en/


ICPC-2 contains categories for both mental disorders and general medical diseases and conditions. It is available in 34 countries and used in primary care in 27 countries; its use is mandatory in 6 EU countries. ICPC-2 is cross mapped to ICD-10 for interoperability.



For a table of Comparison of Classification and Terminology Systems, Chapman & Dimmock (2018) see document: https://dxrevisionwatch.files.wordpress.com/2018/07/comparison-of-classification-and-terminology-systems-v-3.pdf
 
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Update on the March 2019 release of SNOMED CT Netherlands Edition:

The SNOMED CT Concept term Neurasthenia and some associated terms had been retired from the International Edition and from national editions some years ago.

But the Netherlands Edition retained the term neurasthenie under the chronischevermoeidheidssyndroom (CVS) Synonyms list.

See below, from the September 2018 Netherlands Edition:

snomed-ct-netherlands-edition-201809302.png



In October 2018, @mecvsnieuws on Twitter approached Pim Volkert (Coördinator terminologie bij Nictiz) with a request for retirement of the term neurasthenie from the Synonyms list for Concept SCTID: 52702003 chronischevermoeidheidssyndroom for consistency with the International Edition and with other national extensions.

This request and accompanying rationale was promptly accepted and approved for implementation in the March 31, 2019 release.


I am pleased to confirm that this content change has been incorporated into the Netherlands Edition March 31 release, which was posted on the SNOMED CT browser platform, today:

https://browser.ihtsdotools.org/?pe...snomed/&langRefset=31000146106,15551000146102

netherlands-2-31.03.19.png




A note about retired SCTID Concept terms and retired Synonyms terms in SNOMED CT International Edition and National Editions:

The technical term for the retirement of SNOMED CT Concepts or other terms is "Inactivation".


https://browser.ihtsdotools.org/?

Select the edition required (International Edition or one of the National Editions).

Look under Options on the left of the Search box.

Select:

"Status: Active and inactive concepts" from the Options dropdown.

Enter a search term in the Search box.


In the Matches list, Inactive concepts will display on a light pink ground.

Click on a term to display the Concept Details panel for that specific term.

Inactive concepts also display on a pink ground in the box under Parents in the Concept Details panel, like so:


SNOMED CT International Edition:

https://browser.ihtsdotools.org/?pe....org/api/snomed&langRefset=900000000000509007


neurasthenie2.png



So although retired or "Inactive" terms remain searchable for within the SNOMED CT terminology system, they are identified as retired/Inactive terms by their pink ground (and also by textual content within the Concept Details tabs).
 
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WHO has issued a new release of the Blue ICD-11 MMS platform for April 2019

A new release for April 2019 has been posted in the last day or so, designated as:

https://icd.who.int/browse11/l-m/en

ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) Version : 04 / 2019

Version for preparing implementation

Release Notes
  • The code structure for the ICD-11 MMS is stable.
  • Updating mechanism is in place, based on the proposals submitted on the maintenance platform



This April 2019 release replaces the versions released in June 2018 and December 2018. This will likely be the final release before presentation of ICD-11 MMS to the 72nd World Health Assembly, in May, for WHA's endorsement. Endorsement would take effect from January 2022.

Note that the Blue "Version for preparing implementation" does not contain the level of detail that the Orange "Maintenance Platform" contains; for example, although it displays Descriptions (where these have been populated) and the terms that are specified as Inclusions, Exclusions and Coded Elsewhere, it does always display the lists of Synonyms or Index terms which are included in the Orange Maintenance Platform.

Nor does the Blue "Version for preparing implementation" display both the Foundation and the Mortality and Morbidity Statistics Linearization. However Index terms are searchable via the Blue platform Coding Tool or if entered into the Search field in the MMS, Index terms will point to the code to which they are indexed.



Some key listings for the April 2019 ICD-11 MMS:

https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/569175314

08 Diseases of the nervous system

Other disorders of the nervous system

8E49 Postviral fatigue syndrome

icd11mmsv0420194.png





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

https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1109546957

21 Symptoms, signs or clinical findings, not elsewhere classified

General symptoms, signs or clinical findings

MG22 Fatigue

fatigueapril20191.png




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

Bodily distress disorder: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/767044268

Mild BDD: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1472866636
Moderate BDD: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1967782703
Severe BDD: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1121638993

06 Mental, behavioural or neurodevelopmental disorders

Disorders of bodily distress or bodily experience

6C20 Bodily distress disorder

bddapril20192.png



The 72nd WHA Assembly takes place in Geneva, Switzerland from 20 – 28 May 2019.

WHA72 Documents site: http://apps.who.int/gb/e/e_wha72.html

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

For more information on which proposals have been Approved and which have been Rejected see summary in:

Post #204:

https://www.s4me.info/threads/updat...-terminology-systems.3912/page-11#post-149689

and for greater detail plus rationales for decisions, see PDF in:

Post #202:

https://www.s4me.info/threads/updat...-terminology-systems.3912/page-11#post-149514
 
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Two additional key documents prepared for the WHA Assembly in May:

The 72nd WHA Assembly takes place in Geneva, Switzerland from 20 – 28 May 2019.

WHA72 Documents site: http://apps.who.int/gb/e/e_wha72.html


WHO SEVENTY-SECOND WORLD HEALTH ASSEMBLY
A72/29
Provisional agenda item 12.7 4
April 2019

Eleventh revision of the International Classification of Diseases
Report by the Director-General
http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_29-en.pdf

"1. The Executive Board at its 144th session considered an earlier version of this report,1 containing a draft resolution.2 The Board noted the report but agreed to suspend consideration of the draft resolution so that informal consultations could be held during the intersessional period prior to the Seventy-second World Health Assembly. A separate report will be submitted to provide details of the outcome of the consultations. 3"


and

the revised Draft Resolution on ICD-11 MMS:

A72/29 Add.1
Provisional agenda item 12.7 11
April 2019

http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_29Add1-en.pdf

"1. In line with the course of action agreed by the Executive Board at its 144th session in January 2019,1 the Secretariat convened informal consultations during the intersessional period in respect of a draft resolution on the eleventh revision of the International Classification of Diseases. The consultations took place in Geneva on 22 February, 7 March and 21 March 2019. The three sessions enabled the draft resolution to be revised."
 

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ICD-11 proposals: An update to Post #202 and Post #204

A proposal submitted by me on December 30, 2014 had requested Exclusions for (Benign) myalgic encephalomyelitis; Chronic fatigue syndrome; and Postviral fatigue syndrome under Fatigue.

Although exclusions for (Benign) myalgic encephalomyelitis; and Chronic fatigue syndrome were approved and implemented on March 26, 2017, the proposal for an exclusion for Postviral fatigue syndrome had been left hanging.

On March 29, 2017, I also submitted a proposal for exclusion of Fatigue under 8E49 Postviral fatigue syndrome.

This was approved and implemented at some point in February/March 2019. (A request for reciprocal exclusions for Fatigue had also been included in the Chapman & Dimmock multi-part proposal of March 27, 2017.)


On November 19, 2018, the WHO decided that 8E49 Postviral fatigue syndrome and its inclusion terms should be retained in the Diseases of the nervous systems chapter and rejected the proposal submitted by Dr Tarun Dua, the previous November. This decision was supported by the ICD-11 MSAC and CSAC committees.

Since that decision, I had made a number of requests for the still unprocessed proposal for an exclusion for Postviral fatigue syndrome under Fatigue to be attended to.

As Benign myalgic encephalomyelitis and Chronic fatigue syndrome are specified inclusion terms to Concept Title: 8E49 Postviral fatigue syndrome, it would be illogical for these two terms to be excluded under Fatigue without also excluding the Concept Title term.

I also asked: If WHO does not intend to approve an exclusion for postviral fatigue syndrome (8E49) under Fatigue, what is the rationale for not doing so?

I am pleased to report that on April 15, the Orange Maintenance Platform admins finally processed this proposal and an Exclusion for postviral fatigue syndrome (8E49) has been approved for implementation.

All three terms are now specified as exclusions under Fatigue.

The Table setting out the status of proposals for PVFS, BME, CFS; BDD; and Fatigue has been revised (now v3) to reflect this recent approval:

ICD-11 Proposal Mechanism, status of processed proposals at 15.04.19 v3:
https://dxrevisionwatch.files.wordp...l-status-of-icd-11-processed-proposals-v3.pdf



A note about ICD-11's MG22 Fatigue:

In the WHO's unmodified ICD-10 Tabular List, the Concept Title term is:

R53 Malaise and fatigue

https://icd.who.int/browse10/2016/en#/R53


R53 Malaise and fatigue has a number of specified exclusions, including:

(...)​
fatigue syndrome (F48.0)
fatigue syndrome

There is a reciprocal exclusion for malaise and fatigue (R53) under F48.0 Neurasthenia.

But no reciprocal exclusion in ICD-10 for malaise and fatigue (R53) under G93.3 Postviral fatigue syndrome.



For ICD-11, the ICD-10 concept term "Malaise and fatigue" has been revised to

MG22 Fatigue​

and it remains in Chapter 21: Symptoms, signs or clinical findings, not elsewhere classified under category block, General symptoms.


With the restructure of ICD-11, the term "malaise" is listed under the Chapter 21 category block, General symptoms as an inclusion and index entity to term:


In sum:

For ICD-10, an exclusion for fatigue syndrome, postviral (G93.3) is listed under R53 Malaise and fatigue.

For ICD-11, exclusions for Chronic fatigue syndrome (8E49); (Benign) myalgic encephalomyelitis (8E49); Postviral fatigue syndrome (8E49) have been approved and implemented under MG22 Fatigue.

Additionally, there is a reciprocal exclusion for Fatigue (MG22) under 8E49 Postviral fatigue syndrome.



WHA and endorsement of ICD-11:

A version of the ICD-11 MMS (ICD-11 for Mortality and Morbidity Statistics - Version for preparing implementation) is being presentation for endorsement at the 72nd World Health Assembly, in Geneva, May 20-28, 2019. If endorsed, endorsement would take effect from January 01, 2022.

Draft Resolution for WHA72: http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_29Add1-en.pdf
 
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Sly Saint said:
Could this be raised as a reason not to treat ME/CFS patients in 'fatigue clinics'?
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I am not sure. We already know the PACErs think WHO is a bunch of idiots who just don't see the truth, and we know that they don't give a damn about ICD.
 
adambeyoncelowe said:
I'm not sure if that's something NICE would consider relevant. The scope, as published, doesn't really consider categorisation or coding. It's about treatment and diagnosis.
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There have been long-standing exclusions in ICD-10 for G93.3 Postviral fatigue syndrome under both R53 Malaise and fatigue and F48.0 Neurasthenia and its inclusion: Fatigue syndrome.

That does not seem to have safeguarded patients from being channelled into Fatigue or general "MUS" clinics or IAPT services.

There is also this caveat in the National Clinical Coding Standards ICD-10 5th Edition (2019):

https://hscic.kahootz.com/gf2.ti/f/...oding_Standards_ICD10_reference_book_2019.pdf

clinical-standards-5th-edition.png


Nevertheless, since the ICD-11 Alpha and Beta drafts did not inherit the ICD-10 exclusion from Malaise and fatigue, it was important to have this restored for ICD-11, even if it has taken over 7 years to secure these exclusions.
 
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