|
"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."
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. |
