World Health Organization
The World Health Organization (WHO) "directs and coordinates" international health within the United Nations. It was established on 7th April 1948, and is headquartered in Geneva, Switzerland. The WHO works with 194 member states across the world.[1]
The International Statistical Classification of Diseases and Related Health Problems (ICD) is the "the bedrock for health statistics" and is maintained by WHO. It aims to classify every possible injury or disease a person may experience, including causes of death.[2]
First recognition of ME/CFS[edit | edit source]
Myalgic encephalomyelitis (ME) has been recognized by the World Health Organization as a neurological disease since 1969, when it published the ICD-8 classification of diseases using code 323 for myalgic encephalomyelitis.[3][4] The ICD-8 listing for ME/CFS is:
- VI. DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS
- Inflamatory diseases of central nervous system (320-324)
- Encephalitis, myelitis, and encephalomyelitis (except acute infectious As 343)
- Encephalomyelitis (chronic) (disseminated, acute) (granulomatous)
- (hemarrhagic necrotizing. acute)
- (myalgic, benign)
- (postexanthematous)
- (postinfectious) (see also Encephalitis) 343)
- Encephalomyelitis (chronic) (disseminated, acute) (granulomatous)
- Encephalitis, myelitis, and encephalomyelitis (except acute infectious As 343)
The United States edition of the ICD-8 included both myalgic encephalomyelitis (ME) and what is now known as postviral fatigue syndrome (PVFS), classifying both with code 323:[5]
- Encephalomyelitis (chronic) (disseminated, acute) (Branulomalous)
- (hemorrhagic necrotizing, acute)
- (myalgic, benign)
- (postexanthematous)
- (postinfectious) (see also Encephalitis).
The ICD-8 did not include any alternative names for myalgic encephalomyelitis although postinfectious encephalomyelitis could be classified under the same code; fatigue-related alternative names were not added in any later revisions.[3][6] The alternative name chronic fatigue syndrome (CFS) was not in use at this time; it was proposed in 1988 by the Centers for Disease Control, which adopted new diagnostic criteria at the same time.[citation needed]
The current version of the ICD is the ICD-10; the newer ICD-11 has been published but is expected to be in widespread use within the next few years.
ICD-9 classification of ME/CFS[edit | edit source]
In the ICD-9, which was published in 1989, the entry for myalglc encephalomyelitis is uses code 323.9:[7]
- DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS
- Encephalomyelitis (chronic) (granulomatous) (hemorrhagic necrotizing, acute) (myalgic, benign) (see also Encephalitis) 323.9
- - acute disseminated (postinfectious) 136.9 323.6*
- - - postimmunization 323.5
- — due to or resulting from vaccination (any) 323.5
- - postchickenpox 052 323.6*
- - postmeasles 055.0 323.6*
- - postvaccinal 323.5
- - rubella 056.0 323.4*
ICD-10 classification of ME/CFS[edit | edit source]
The ICD-10 lists myalgic encephalomyelitis, chronic fatigue syndrome, and postviral syndrome (PVFS) as the same neurological disease, within the neurological disorders section.[8]
- Diseases of the nervous system
- Other disorders of brain
- Other disorders of the nervous system
- Other disorders of brain
- G93.3 Postviral fatigue syndrome
- Benign myalgic encephalomyelitis[6]
Myalgic encephalomyelitis (ME) has been classified by the WHO as a neurological disease since 1969[3] and has occurred in both epidemic and sporadic form since at least the 1930s, although is probably much older.
Malaise and fatigue[edit | edit source]
The World Health Organization has stated that ME and CFS can only be classed as a neurological disorder and cannot be classified under the following "malaise and fatigue" diagnosis (in the General signs, symptoms and abnormal findings), or as neurasthenia or Fatigue syndrome in the mental and behavioral disorders category:
R53.83 Malaise and fatigue categorizies "lethargy" and "tiredness" which are regarded as "Signs, symptoms and abnormal findings" rather than a specific disease.
F48.0 Neurasthenia
This is classed as a neurotic (anxiety) disorder, within the mental disorders section of the ICD-10; it is describes this as "increased fatigue" which may be after mental effort, or emphasizing "feelings of bodily or physical weakness and exhaustion after only minimal effort", with an inability to relax and "a feeling of muscular aches and pains".
In the ICD-10 this excludes burn-out (Z73.0), malaise and fatigue (R53) and postviral fatigue syndrome (G93.3).[9][8]
Chronic fatigue with no known cause which does not meet the criteria for chronic fatigue syndrome is referred to as either idiopathic chronic fatigue or a medically unexplained symptom in medical literature.
ICD-10 coding manual[edit | edit source]
The ICD-10-CM used in the United States is a coding manual used for insurance purposes, differs from other countries, and includes two different classifications, each with virtually identical symptoms:
- R53.82 Chronic fatigue, unspecified, which is given the alternative name Chronic Fatigue Syndrome and classified "not otherwise specified", and excludes Myalgic Encephalomyelitis and Chronic Fatigue Syndrome (and anything that can be classified as G93.3),[10][8]
- G93.3 Postviral Fatigue Syndrome, alternatively known as Benign Myalgic Encephalomyelitis or Chronic Fatigue Syndrome.[11] ICD 9 (and 10) "consider NOS the physician's fault: The documentation does not provide enough information to assign a more specific diagnosis code."[12]
ICD-11[edit | edit source]
In the more recently released ICD-11, Postviral fatigue syndrome (PVFS) is the name used for benign myalgic encephalomyelitis and chronic fatigue syndrome, and remains a disorder of the nervous system.[11]
08 Diseases of the nervous system
- Other disorders of the nervous system
- 8E49 Postviral fatigue syndrome
- Benign myalgic encephalomyelitis
- chronic fatigue syndrome[11]
ICD Diagnostic coding[edit | edit source]
ICD-10 is the 10th revision of the ICD and was first published in 1992.[13] The ICD-11 was published in July 2018, but is not implemented in most countries at present.[11]
Different countries' government healthcare systems might use different codes depending on their interpretation of some diseases, illnesses, and syndromes but still working within the ICD code structure. When using ICD10Data.com, certain pages will display a country's flag indicating the diagnostic coding used by that nation's healthcare system.[14] Additionally, a country does not have to officially implement the latest ICD release; the United States delayed the implementation of ICD-10 for over 20 years before implementing it's own WHO-approved adaption, the ICD-10-CM.[15][16][17]
Myalgic encephalomyelitis[edit | edit source]
ICD-10-CM[edit | edit source]
United States
- G93.3 Postviral fatigue syndrome and benign myalgic encephalomyelitis.[11][18]
ICD-10-CM G93.3 is grouped within Diagnostic Related Group(s) (MS-DRG v35.0):
- 947 Signs and symptoms with mcc
- 948 Signs and symptoms without mcc
Convert G93.3 to ICD-9-CM
Code History
- 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
- 2017 (effective 10/1/2016): No change
- 2018 (effective 10/1/2017): No change
Code annotations containing back-references to G93.3:
- Type 1 Excludes: A85, R53.82
- Type 2 Excludes: G04
Diagnosis Index entries containing back-references to G93.3:
- Akureyri's disease G93.3
- Disease, diseased - see also Syndrome
- Iceland G93.3
- Encephalomyelitis G04.90 - see also Encephalitis
- benign myalgic G93.3
- myalgic, benign G93.3
- Neuromyasthenia G93.3 (epidemic) (postinfectious)
- Syndrome - see also Disease
ICD-11 (2018)[edit | edit source]
- 8E49 Postviral fatigue syndrome
All ancestors up to top
- 08 Diseases of the nervous system
- Other disorders of the nervous system
- 8E49 Postviral fatigue syndrome
Inclusions
- Benign myalgic encephalomyelitis
- chronic fatigue syndrome[11]
The ICD-11 no longer has a fatigue syndrome of any kind in the "Mental and Behavioral Disorders" section. Neurasthenia is not mentioned in any section. In response to the Wessely school's textbook which incorrectly stated that chronic fatigue syndrome (CFS) can be classed as a mental disorder, Audre L'Hours from WHO has stated that a disorder can only be classed under one rubic, and that all WHO countries must follow the WHO classification of CFS or ME as a neurological disorder only.[20]
Dr Tarun Dua proposed moving Myalgic Encephalomyelitis from the Neurological Disorders section to Symptoms, signs or clinical findings of the musculoskeletal system, which would have re-classified ME/CFS as medically unexplained physical symptoms rather than a specific, neurological disease: this proposal was rejected.[21]
Chronic fatigue syndrome[edit | edit source]
ICD-10-CM[edit | edit source]
United States
- R53.82 is for Chronic fatigue, unspecified under ICD-10-CM Diagnosis Code.[10]
R53.82 (ICD-10-CM) is grouped within Diagnostic Related Group(s) (MS-DRG v35.0):
- 947 Signs and symptoms with mcc
- 948 Signs and symptoms without mcc
- Convert R53.82 to ICD-9-CM
- Code History
- 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
- 2017 (effective 10/1/2016): No change
- 2018 (effective 10/1/2017): No change
- Code annotations containing back-references to R53.82:
- Type 1 Excludes: G93.3
- Diagnosis Index entries containing back-references to R53.82:
- Fatigue R53.83
- chronic R53.82
- Syndrome - see also Disease
- fatigue
- chronic R53.82[10]
- fatigue
ICD-11 (2019)[edit | edit source]
- 8E49 Postviral fatigue syndrome
All ancestors up to top
- 08 Diseases of the nervous system
- Other disorders of the nervous system
- 8E49 Postviral fatigue syndrome
Inclusions
- Benign myalgic encephalomyelitis
- chronic fatigue syndrome[11]
DSM[edit | edit source]
The American diagnostic manual for mental and behavioral disorders, known as the DSM-5, does not contain include myalgic encephalomyelitis or chronic fatigue syndrome, because they are not mental health conditions.[22]
History with Fibromyalgia[edit | edit source]
The WHO ICD-10 lists fibromyalgia as a "disease of the musculoskeletal system and connective tissue," diagnostic code M79.7.[23]
ICD Diagnostic coding[edit | edit source]
ICD-10-CM[edit | edit source]
- M79.7 Fibromyalgia
- Fibromyositis
- Fibrositis
- Myofibrositis[24]
In 2015, the United States adopted the 1992 ICD-10 and fibromyalgia as a diagnosis.[25][26]
ICD-11 (2019)[edit | edit source]
Fibromyalgia was renamed to Chronic Widespread Pain in the ICD-11 update, with fibromyalgia retained as an indexed term. The ICD-11 uses diagnostic code MG30.1 Chronic widespread pain for fibromyalgia.[27]
- MG30.01 Chronic widespread pain
Parent
- MG30.0 Chronic primary pain
Description
- "Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions and there are features consistent with nociplastic pain and identified psychological and social contributors."[27]
Inclusions
- Fibromyalgia
Exclusions
- Acute pain (MG31)[27]
DSM[edit | edit source]
Fibromyalgia is not included in the American DSM-5 manual of mental and behavioral disorders because it is a physical rather than psychological illness.[22] Fibromyalgia is also classified within a chapter of physical health conditions, and not in the mental and behavioral chapter of the ICD diagnostic manual.[27]
Online presence[edit | edit source]
The WHO uses social media in many languages.
English language[edit | edit source]
See also[edit | edit source]
Learn more[edit | edit source]
- 2009, WHO ICD in relation to M.E. and "CFS"—Short via The Hummingbirds' Foundation for ME
- History of Chronic Fatigue Syndrome - International Classifications via Wikipedia
References[edit | edit source]
- ↑ World Health Organization. "About Us". World Health Organization. Retrieved October 14, 2018.
- ↑ World Health Organization. "International Classification of Diseases". World Health Organization. Retrieved October 14, 2018.
- ↑ 3.0 3.1 3.2 World Health Organization (1969). Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death Based on the Recommendations of the Eighth Revision Conference (PDF). 2 (Eighth ed.). Geneva: WHO. p. 173.
Encephalomyelitis (chronic),
(myalgic, benign) 323 - ↑ World Health Assembly, 19 (1966), "DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS", Report of the International Conference for the Eighth Revision of the International Classification of Diseases (PDF), World Health Organization, p. 42
- ↑ International Classification of Diseases, Adapted for Use in the United States, ICDA. 2 (8 ed.). Geneva: World Health Organization. 1969. p. 178.
- ↑ 6.0 6.1 World Health Organization (2016). "G93 Other diseases of the nervous system". ICD-10 Version:2016. Retrieved April 13, 2019.
- ↑ World Health Organization & International Conference for the Ninth Revision of the International Classification of Diseases (1978). Manual of the international statistical classification of diseases, injuries, and causes of death : based on the recommendations of the ninth revision conference, 1975, and adopted by the Twenty-ninth World Health Assembly, 1975 revision: alphabetic index (PDF). 2 (Ninth ed.). Geneva: World Health Organization. p. 182. ISBN 9241540044.
- ↑ 8.0 8.1 8.2 Group on Scientific Research into Myalgic Encephalomyelitis (November 2006). "Inquiry into the status of CFS / M.E. and research into causes and treatment (The Gibson Report)" (PDF). Retrieved October 14, 2018.
Andre L’Hours of the WHO Head Office confirmed this definition formally in writing in 2001 and again in 2004 to Lord Warner. The Group was concerned to find that there is no mention of this classification in the Chief Medical Officers Report 2002 or in the current NICE guidelines. CFS is currently not present under any code in the ICD-10 on the WHO website current Tabular version. However, it is in the current Index version, according to the WHO North American Collaborating Center representative, who stated via email in September 2006 that "Chronic fatigue syndrome is indexed in the following manner in ICD-10:
Syndrome- fatigue F48.0- -
- chronic G93.3- -
- postviral G93.3" 8
The ICD-10 categorises Lethargy and Tiredness under section R “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” specifically under R53 ‘Chronic Malaise and Fatigue’. It specifically excludes ME and PVS (G93.3) and fatigue syndrome (48.0) from this definition.
The ICD-10 lists Fatigue syndromes under Section F48.0 Neurasthenia, but this section explicitly excludes ME and PVS (G93.3) or Malaise and Fatigue (R53).The WHO in Geneva holds an internationally recognised classification that ME is a neurological disease. - ↑ World Health Organization. "F48.0 Neurasthenia - ICD-10 Version:2016". World Health Organization. Retrieved April 13, 2019.
- ↑ 10.0 10.1 10.2 "2018/2019 ICD-10-CM Diagnosis Code R53.82: Chronic fatigue, unspecified". icd10data.com. Retrieved October 14, 2018.
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 World Health Organization. "Postviral fatigue syndrome". ICD-11 - Mortality and Morbidity Statistics. Retrieved October 14, 2018.
- ↑ Reader Question: NEC, NOS: There Are Differences - Radiology Coding Alert - SuperCoder
- ↑ Manchikanti, L.; Chittle, M. D.; Barr, R.M.; Liu, R.W.; McGinty, G.; Nicola, G.; Hirsch, J.A. (April 1, 2016). "ICD-10: History and Context". American Journal of Neuroradiology. 37 (4): 596–599. doi:10.3174/ajnr.A4696. ISSN 0195-6108. PMID 26822730.
- ↑ Chronic Fatigue Syndrome - ICD10data.com
- ↑ The History of ICD10 - WebPT
- ↑ Manchikanti, Laxmaiah; Kaye, Alan D.; Singh, Vijay; Boswell, Mark V. (July 2015). "The Tragedy of the Implementation of ICD-10-CM as ICD-10: Is the Cart Before the Horse or Is There a Tragic Paradox of Misinformation and Ignorance?". Pain Physician. 18 (4): E485–495. ISSN 2150-1149. PMID 26218946.
- ↑ "Appreciating the Big Picture of ICD-10". contemporaryclinic.pharmacytimes.com. Retrieved April 13, 2019.
- ↑ Encephalomyelitis - ICD10 Data.com
- ↑ "2019 ICD-10-CM Diagnosis Code G93.3: Postviral fatigue syndrome". icd10data.com. Retrieved April 13, 2019.
- ↑ Westminster, Department of the Official Report (Hansard), House of Lords. "Lords Hansard text for 22 Jan 2004 (240122-12)". publications.parliament.uk. Retrieved October 14, 2018.
- ↑ DX Revision Watch (November 22, 2018). "Update on the status of the classification of PVFS, ME and CFS for ICD-11: Part Three: WHO rejects Dr Dua's proposal". Retrieved November 23, 2018.
- ↑ 22.0 22.1 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) (5th revision ed.). Washington, D.C.: American Psychiatric Pub. ISBN 9780890425572.
- ↑ World Health Organization (2016). "Fibromyalgia - ICD-10". icd.who.int. Retrieved April 14, 2019.
- ↑ M79.7 Fibromyalgia - ICD-10 Version:2016
- ↑ 2015/16 ICD-10-CM Diagnosis Code M79.7
- ↑ The Health Care Industry Finally Recognizes Fibromyalgia - National Pain Report - Sept. 30, 2015
- ↑ 27.0 27.1 27.2 27.3 World Health Organization. "MG30.01 Chronic Widespread Pain". ICD-11 Mortality and Morbidity Statistics. Retrieved December 18, 2018.
