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

ICPC-2 and coding/mapping of Chronic fatigue syndrome:

There is no specific code within ICPC-2 for Postviral fatigue syndrome; [Benign] myalgic encephalomyelitis; or Chronic fatigue syndrome.


This is the abridged version of the ICPC-2 Reason for Encounter (RFE) Code list:

http://docpatient.net/3CGP/QC/ICPC_desk.pdf


The General and Unspecified A Block code: A04 Weakness/Tiredness General

can be used to capture various conditions including "fatigue, exhaustion, lassitude, lethargy and post-viral fatigue".

In one of the national extensions of ICPC-2, I think I recall seeing four-character sub codes under A04 for use with CFS, PVFS and ME. But I can't currently locate this document, so do not quote me on this.

I don't have access to the ICPC-2 to ICD-10 mapping tables for the ICD mappings for A04, but this industry site:

https://www.galenreasoner.com/icpc2codes/A04

maps A04 to:

Related ICD-10 Codes

Code Title
G93.3 Postviral fatigue syndrome

Code Title
R53 Malaise and fatigue


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This Canadian primary care classification document (page A12): https://docplayer.fr/4880293-Encode...d-encounters-for-family-medicine-code-mf.html

maps ICPC-2 A04 to

g93.3 Chronic Fatigue Syndrome Syndrome de fatigue chronique

g93.3 Benign Myalgic Encephalomyelitis Encéphalomyélite myalgique bénigne

g93.3 Postviral Fatigue Syndrome Syndrome de fatigue post-virale

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I don't have access to a draft of the ICPC-3 and it's currently unclear whether the ICD-10 G93.3 terms continue to be captured by the non specific, A04 Weakness/Tiredness General code (or ICPC-3's proposed equivalent terminology and associated code), or are proposed to be relocated under the Neurological N code block, or under a different code block.

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In ICPC-2, Somatization disorder is coded under P75 Somatization disorder.

Dr Marianne Rosendal (Aarhus University), who has published with Prof Per Fink, is the European representative on WONCA's International Classification Committee and has been a member of the revision committee for ICPC-2, as is the U.S.'s, Dr Michael Klinkman, who has been the convener for the ICPC-2 update and revision committee.

Dr Klinkman is also a Vice-chair of the external advisory group - known as the Primary Care Consultation Group (PCCG) - making recommendations for the revision of the WHO's ICD-10 PHC (1996). Dr Marianne Rosendal is also a member of the PCCG.

The ICD-11 PHC is a revision of the Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. 1996.

Note: It is a misnomer to refer to the ICD-11 PHC as the "Primary Care version of ICD-11" since it contains just 27 mental disorders and no general medical diseases or conditions; and like the ICD-10 PHC (1996), it will not be mandatory for use by member states. Once completed, the WHO intends to make the guideline available as a free download to anyone who wishes to access a copy.


ICPC-2 meeting summary documents dating from 2010/2011, that I have on file, indicate that Dr Rosendal had discussed the potential for inclusion of a "Bodily distress syndrome", "Bodily stress syndrome" or similar disorder concept in the ICPC-3.

Prof Per Fink is likely to still be lobbying hard for its inclusion in ICPC-3 (possibly as a revision of, or an addition under ICPC-2's P75 Somatization disorder code), especially as he failed in his bid to get his BDS diagnostic construct included in the core ICD-11 MMS.



As I've said before, advocates and organisations need to be monitoring the development of the ICPC-3, establish how the ICD-10 G93.3 (ICD-11 8E49) terms are proposed to be captured in ICPC-3, and take action if necessary.
 
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ICD10 monitor

https://www.icd10monitor.com/icd-11-u-s-lags-in-adoption

ICD-11: U.S. Lags in Adoption

Margaret A. Skurka, MS, RHIA, CCS, FAHIMA
Original story posted on: October 26, 2020

(...)

I can report that at NCVHS, ICD-11 went on the backburner this year, and no discussion of it will be held until 2021. The Committee did last year send a letter to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar regarding ICD-11. The letter indicated that the approach in the U.S. should be adoption for mortality first, and morbidity second. I believe we are several years away from both.

The discussion of ICD-11 at the NCVHS will begin to happen sometime in 2021; we looked at the workplan for 2021 at last week’s Standards Subcommittee Zoom meeting and affirmed that it is on the agenda for discussion. Our 2019 letter asked for some research to begin re: implementation, as well as a cost/benefit analysis, and I don’t believe anything has been done at this point.

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Related NCVHS materials:

1) Initial Letter to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar, February 21, 2019: https://ncvhs.hhs.gov/wp-content/up...n-Letter-Regulatory-Simplification-of-ICD.pdf

2) (ICD-11) Subcommittee on Standards National Committee on Vital and Health Statistics (NCVHS): Expert Roundtable Preliminary Meeting Summary Held August 6-7, 2019: https://ncvhs.hhs.gov/wp-content/up...ds-Subcommittee-ICD-11-Meeting-10-10-2019.pdf

Extract from August 6-7, 2019 Expert Roundtable Preliminary Meeting Summary:

reccommendations-for-letter-ncvhs.png



3) 2nd Letter to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar, November 25, 2019: https://ncvhs.hhs.gov/wp-content/up...-a-Mandated-US-Health-Data-Standard-final.pdf
 
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The WHO has approved my February proposal for removal of "Benign" from "Benign myalgic encephalomyelitis" for ICD-11

In March 2016, a representative from the Canadian Institute for Health Information submitted a request and brief supporting rationale to the ICD-10 WHO-FIC Update and Revision Committee (URC) for removal of the prefix "Benign" from "Benign myalgic encephalomyelitis".

This request had been approved by the URC in September 2016 for implementation in the next update cycle for the WHO's International edition of ICD-10.

This change was incorporated into the final update of ICD-10 (ICD-10 Version: 2019), which was released in January, this year: https://icd.who.int/browse10/2019/en#/G93.3

(The legacy term, "Benign myalgic encephalomyelitis" has been retained as an ICD-10 Index term for backward statistical compatibility and comparability with earlier versions of ICD-10 and with the national modifications of ICD-10.)

This change, which had been approved by the WHO-FIC in 2016, had not been carried forward to ICD-11 by WHO/ICD Revision.

This revision of terminology for the final release of ICD-10 set a precedent for the national modifications of ICD-10, for example, the U.S.'s ICD-10-CM and Canada's ICD-10-CA, but also for ICD-11.


Proposals submitted by Chapman & Dimmock in March 2017, and by Lily Chu MD on behalf of the IACFS/ME, which had included rationales for the removal of "Benign" from "Benign myalgic encephalomyelitis", had been rejected by the WHO in March 2019. The WHO/ICD Revision provided no rationale for the decision to reject these proposals.

In February, this year, I submitted a new proposal and rationale for removal of the "Benign" prefix for ICD-11 citing inter alia the URC's 2016 decision and the implementation of that decision for the final release in the life of ICD-10.

February 14, 2020 proposal and rationale (#298U) here:

ICD-11 Orange Maintenance Platform Proposal Mechanism: https://icd.who.int/dev11/proposals...lGroupId=d9877203-d434-42b2-9f5f-cd649d259aec

PDF version: http://bit.ly/BenignICD11


Unfortunately, despite approaching WHO Director-General, Dr Tedros Ghebreyesus, with a request for fast tracking its review, my proposal sat unprocessed and missed the deadline for potential inclusion in the annual update of the ICD-11 for Mortality and Morbidity Statistics (Version : 09/2020), which was released in September: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/569175314

However, I am delighted to inform you that my proposal #298U was approved, yesterday:

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


Screenshot (accessed November 14, 2020): https://dxrevisionwatch.files.wordpress.com/2020/11/benign-retired-for-icd-11-13-november-2020.png

benign-retired-for-icd-11-13-november-2020.png




This change implemented today in the Orange Maintenance Platform will be incorporated into the Blue ICD-11 for Mortality and Morbidity Statistics Version for preparing implementation browser for the next annual release, in Autumn 2021.

The specified Exclusions for PVFS; BME; and CFS under 6C20 Bodily distress disorder have been revised to reflect the deprecation of the "Benign" prefix: https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/767044268

The specified Exclusions for PVFS; BME; and CFS under MG22 Fatigue have also been revised to reflect this change: https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/1109546957

It's taken a while, but we got there in the end.


Note that Germany's national modification, ICD-10-GM, and Australia's ICD-10-AM both removed the "Benign" prefix from their respective Tabular Lists some years ago.

The removal of "Benign" from the final update of the International edition of ICD-10 and now from ICD-11, sets a precedent for the removal of "Benign" for all other national modifications of ICD-10.

Note also that there is currently no consistency across the Blue and Orange browsers over whether Inclusion and Exclusion terms are ordered alphabetically or randomly; nor whether Inclusion, Exclusion, Synonyms and Index terms are listed with a capital for their initial letter - conventions which the WHO needs to standardise and address across the entire ICD-11 classification before the endorsement of ICD-11 MMS comes into effect, on January 01, 2022.
 
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Blueskytoo said:
Brilliant, adding my thanks for all your effort and persistence, it must be very gratifying to have it pay off!
Click to expand...

Thank you Blueskytoo, Mike and Oni.

Yes, I'm very pleased that this proposal was approved before I retire this month.

However, the removal of the "Benign" prefix could have been migrated from ICD-10 to ICD-11 by WHO themselves, once it had been implemented in the final ICD-10, in January.

I know the outgoing WHO-FIC ICD-10 Update and Revision Committee and the new ICD-11 CSAC and MSAC committees are differently constituted (though there is overlap of WHO-FIC reps on the CSAC), but terminology changes implemented in the final ICD-10 should have been considered for importing, where possible and appropriate, directly into ICD-11.

It makes me wonder how many other changes to the final release of the ICD-10 haven't been reflected yet in ICD-11.
 
Before retiring from ME advocacy at the weekend, I am posting a number of documents in PDF format, which I compiled or co-authored in the last couple of years, as sort of "legacy" documents.

Some of these documents have been revised this month to include updates on the outcome of ICD-11 proposals, updates on timelines, revised links and for text revisions.


1 Update on classification and coding of PVFS, ME and CFS for ICD-11, v7, November 2020
https://bit.ly/2Ja3fWg


2 NHS Digital requests addition of SEID to SNOMED CT, March 2020
https://bit.ly/2IXZzaa


3 Update to report: NHS Digital requests addition of SEID to SNOMED CT, September 2020
https://bit.ly/3pEp8NI


4 Update on classification of Bodily distress disorder in ICD-11, v2, November 2020
https://bit.ly/37pnwiI


5 Statement on SNOMED CT and Bodily distress disorder v3, November 2020
https://bit.ly/3q7FHSG


6 Comparison of SSD, BDD, BDS and BSS in classification systems v2, November 2020 (Original July 2018 version with Mary Dimmock)
https://bit.ly/33uD0kv


7 Comparison of Classification and Terminology Systems v4, November 2020 (Original July 2018 version with Mary Dimmock)
https://bit.ly/360BSGH


8 World Health Organization removes "Benign" from "Benign myalgic encephalomyelitis" for ICD-11, November 2020
https://bit.ly/3mfv1yW


9 IAPT requests code for Somatic symptom disorder for SNOMED CT, November 2020
https://bit.ly/3fLpEVL


Update to report 9: IAPT requests code for Somatic symptom disorder for SNOMED CT, November 2020

The December 02, 2020 interim release for the SNOMED CT UK Edition has been released and is available on the public browser.

Just to confirm, there was no addition of a new Concept term for "Somatic symptom disorder" added to this November 02 interim release. Nor was a new term for SSD added under Synonyms to Bodily distress disorder or as a Synonym under any other existing Concept code.

The next release of the International Edition will be the January 31, 2021 release.
 
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I've edited in links for two newly drafted documents to Post #453:

8 World Health Organization removes "Benign" from "Benign myalgic encephalomyelitis" for ICD-11, November 2020

9 IAPT requests code for Somatic symptom disorder for SNOMED CT, November 2020


So that's it. I'm retired now. Finally.

I'll be lurking, but not posting on Twitter and still contactable via Twitter PM.

I'll be watching the forum threads, here, but not posting and still contactable via Private Message.

I still have some posts to draft for my Dx Revision Watch website and a good deal of site "housekeeping" to attend to over the coming months. My intention is to keep my Dx Revision Watch and my old ME agenda websites online for at least the next 5 years.

Thank you all for your support, collaboration and companionship this past 18 years.


:emoji_elephant: ...................... .............. ....... ..... ... .
 
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