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WHO ICD Codes

"Recommendation 10:
We would encourage the classification of CFS as a 'Nervous System Disease,' as worded in the ICD-10 G93.3"
From the August 2005 meeting of the CFSAC at the DHHS (Department of Health & Human Services, USA)

"CFS/ME should be classed alongside other diseases such as multiple sclerosis and motor neurone disease".
 -Professor Sir Liam Donaldson-
Chief Medical Officer for England and Wales


The significance of the International Classification of Diseases (ICD) codes, established by the World Health Organization (WHO), cannot be understated in regards to ME and CFS patients.

From the WHO website:

"The ICD has become the international standard diagnostic classification for all general epidemiological and many health management purposes. These include the analysis of the general health situation of population groups and monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables such as the characteristics and circumstances of the individuals affected.

It is used to classify diseases and other health problems recorded on many types of health and vital records including death certificates and hospital records. In addition to enabling the storage and retrieval of diagnostic information for clinical and epidemiological purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States."

ME and CFS in the ICD

Distinguishing ME from CFS not only provides more accurate prevalence data, but better recognition, acceptance and thus funding for research and treatments so desperately needed for patients afflicted with these diseases.  It also benefits CFS patients by encouraging them to either seek the ME diagnosis if appropriate, so that appropriate treatment is undertaken immediately; or if the CFS patient does not fit the definitions for ME, it encourages them and their doctors to seek an underlying cause of their symptoms that may be treatable or even curable.  (See Dr. Hyde's page.  Also refer to For Patients and For Doctors resources pages under the ME & CFS Explained section of this website for recommendations.)

ICD-9-CM (U.S.)
At present, the U.S. still uses its modification of WHO's ICD 9th revision, the ICD-9-CM.  Chronic fatigue syndrome is classified under "Symptoms, Signs and Ill-Defined Conditions," code 780.71, under the sub-heading of "General Symptoms."  As the Definitions and Research pages of this website demonstrate, M.E. is a clearly defined clinical entity that was coded in the ICD-9 as 323.9 under "6. Diseases of the Nervous System and Sense Organs(320-389); Inflammatory Diseases of the Central Nervous System(320-326)."  However, the U.S. modification of the ICD-9 (ICD-9-CM) tabular document revised 323.9 to "Unspecified cause of encephalitis, myelitis, and encephalomyelitis"  but still lists in the ICD-9-CM Index: "Encephalomyelitis (chronic) (granulomatous) (hemorrhagic necrotizing, acute) (myalgic, benign) (see also Encephalitis) 323.9."   This is the diagnostic code we recommend doctors use when a patient fits the distinct M.E. definitions, according the the Consensus Document, Ramsay, Dowsett et al definitions, and Hyde descripton. 
According to a CDC ICD coding representative (July 2006), "M.E. has always been indexed to code 323.9.  That is the code number that patients should be assigned."  Correctly diagnosing this disease benefits patients and health care providers by acknowledging the true prevalence of ME in the U.S.

ICD-10
ME has been coded into the neurological chapter of the ICD since the 1969 publication (ICD-8). The World Health Organization also placed ME and CFS in their 10th revision of the ICD in 1991 (ICD-10), published in 1992 and currently used by most countries. (This edition has not yet been implemented in the U.S.; see ICD-9-CM above for application in the U.S.) Post-viral fatigue syndrome (PVS) and Benign myalgic encephalomyelitis are coded as G93.3 in the chapter entitled "Diseases of the Nervous System" under the subheading "Other disorders of brain." CFS is currently not present under any code in the ICD-10 on the WHO website current  tabular version. (See ICD Version 2006 at the WHO website.)  But in the current Index version, according to the WHO North American Collaborating Center representative, "Chronic fatigue syndrome is indexed in the following manner in ICD-10:
Syndrome
 - fatigue F48.0
- - - chronic G93.3
- - - postviral G93.3"

The U.S.-modified ICD-10-CM lists CFS under the R53 code, "Malaise and Fatigue", and "chronic fatigue syndrome, post viral" under G93.3 (which implies sudden onset following a virus, but excludes gradual or undetermined onset, placing CFS under R53.82, headed "Chronic fatigue, unspecified."  But the U.S. ICD-10-CM is not yet implemented, and still subject to revision.  The CFSAC has recommended CFS to be placed under the same neurological code as ME and PVS, G93.3.

For more detailed info, see:
World Health Organization International Classification of Diseases (ICD)
U.S. Centers for Disease Control (CDC) pages on US versions of the ICD tabulars and indexes


Clarification by the World Health Organization

Dr. B. Saraceno of the WHO had clarified the classification in writing on October 16, 2001.

“I wish to clarify the situation regarding the classification of neurasthenia, fatigue syndrome, post-viral fatigue syndrome and benign myalgic encephalomyelitis. Let me state clearly that the World Health Organisation (WHO) has not changed its position on these disorders since the publication of the International Classification of Diseases, 10th Edition in 1992 and version of it during later years.”

“Post-viral fatigue syndrome remains under the diseases of nervous system as G93.3. Benign myalgic encephalomyelitis is included within this category.”

“Neurasthenia remains under mental and behavioural disorders as F48.0 and fatigue syndrome (note: not THE CHRONIC FATIGUE SYNDROME) is included in this category. However, post-viral fatigue syndrome is explicitly excluded from F48.0.”

Further Clarification

Andre l’Hours of the WHO headquarters provided further written clarification on January 23, 2004.

“This is to confirm that according to the taxonomic principles governing the Tenth Revision of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD-10), it is not permitted for the same condition to be classified to more than one rubric as this would mean that the individual categories and subcategories were no longer mutually exclusive.”

Mr. L’Hours stated that any country that accepts the WHO Regulations for nomenclature is obligated to accept the ICD classification.

 
 

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