World Health Organization

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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]

Myalgic encephalomyelitis (ME) has been recognized by WHO as a neurological disease since at least 1969, when it published the ICD-8 classification of diseases.[3] The ICD-8 did not include any alternative names for myalgic encephalomyelitis; or fatigue-related alternative names were only added in later revision.[3][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.[5]

  • Diseases of the nervous system
Other disorders of brain
Other disorders of the nervous system
G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis[4]

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).[6][5]

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 American ICD-10-CM, 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),[7][8]
  • G93.3 Postviral Fatigue Syndrome, alternatively known as Benign Myalgic Encephalomyelitis or Chronic Fatigue Syndrome.[9] ICD 9 (and 10) "consider NOS the physician's fault: The documentation does not provide enough information to assign a more specific diagnosis code."[10]

ICD-11[edit | edit source]

In the newly 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.[9]

08 Diseases of the nervous system

Other disorders of the nervous system
8E49 Postviral fatigue syndrome
Benign myalgic encephalomyelitis
chronic fatigue syndrome[9]

ICD Diagnostic coding[edit | edit source]

ICD-10 is the 10th revision of the ICD and was first published in 1992.[11] The ICD-11 was published in July 2018, but is not implemented in most countries at present.[9]

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.[12] 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.[13][14][15]

Myalgic encephalomyelitis[edit | edit source]

ICD-10-CM[edit | edit source]

United States

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
postviral NEC G93.3
fatigue G93.3[17]

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[9]

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.[18]

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.[19]

Chronic fatigue syndrome[edit | edit source]

ICD-10-CM[edit | edit source]

United States

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[7]

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[9]

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.[20]

ICD Diagnostic coding[edit | edit source]

ICD-10-CM[edit | edit source]

  • M79.7 Fibromyalgia
Fibromyositis
Fibrositis
Myofibrositis[21]

In 2015, the United States adopted the 1992 ICD-10 and fibromyalgia as a diagnosis.[22][23][24]

ICD-11 (2019)[edit | edit source]

ICD-11 has diagnostic code MG30.1 Chronic widespread pain.[25]

  • 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."[25]

Inclusions

  • Fibromyalgia

Exclusions

  • Acute pain (MG31)[25]

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]

References[edit | edit source]

  1. WHO. "About Us | World Health Organization". www.who.int. Retrieved Oct 14, 2018. 
  2. World Health Organization. "International Classification of Diseases". www.who.int. Retrieved Oct 14, 2018. 
  3. 3.03.13.2 World Health Organization (1969). International Classification of Diseases (PDF). 2 (Eighth revision ed.). Geneva: WHO. p. 173. Encephalomyelitis (chronic),
    (myalgic, benign) 323
     
  4. 4.04.1 World Health Organization (2016). "G93 Other diseases of the nervous system - ICD-10 Version:2016". icd.who.int. Retrieved Apr 13, 2019. 
  5. 5.05.1 Group on Scientific Research into Myalgic Encephalomyelitis (Nov 2006). "Inquiry into the status of CFS / M.E. and research into causes and treatment (The Gibson Report)" (PDF). Retrieved Oct 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.
     
  6. World Health Organization. "F48.0 Neurasthenia - ICD-10 Version:2016". icd.who.int. Retrieved Apr 13, 2019. 
  7. 7.07.17.2 "2018/2019 ICD-10-CM Diagnosis Code R53.82: Chronic fatigue, unspecified". www.icd10data.com. Retrieved Oct 14, 2018. 
  8. 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 Oct 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" 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. The Group feels that these definitional difficulties have only served to confuse the picture and will not be resolved unless further research is done to clarify the nature of the disease. 
  9. 9.09.19.29.39.49.59.6 World Health Organization. "Postviral fatigue syndrome | ICD-11 - Mortality and Morbidity Statistics". icd.who.int. WHO. Retrieved Oct 14, 2018. 
  10. Reader Question: NEC, NOS: There Are Differences - Radiology Coding Alert - SuperCoder
  11. Manchikanti, L.; Chittle, M. D.; Barr, R. M.; Liu, R. W.; McGinty, G.; Nicola, G.; Hirsch, J. A. (Apr 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. 
  12. Chronic Fatigue Syndrome - ICD10data.com
  13. The History of ICD10 - WebPT
  14. Manchikanti, Laxmaiah; Kaye, Alan D.; Singh, Vijay; Boswell, Mark V. (Jul 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. 
  15. "Appreciating the Big Picture of ICD-10". contemporaryclinic.pharmacytimes.com. Retrieved Apr 13, 2019. 
  16. Encephalomyelitis - ICD10 Data.com
  17. "2019 ICD-10-CM Diagnosis Code G93.3: Postviral fatigue syndrome". www.icd10data.com. Retrieved Apr 13, 2019. 
  18. Westminster, Department of the Official Report (Hansard), House of Lords,. "Lords Hansard text for 22 Jan 2004 (240122-12)". publications.parliament.uk. Retrieved Oct 14, 2018. 
  19. DX Revision Watch (Nov 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 Nov 23, 2018. 
  20. World Health Organization (2016). "Fibromyalgia - ICD-10". icd.who.int. Retrieved Apr 14, 2019. 
  21. M79.7 Fibromyalgia - ICD-10 Version:2016
  22. 2015/16 ICD-10-CM Diagnosis Code M79.7
  23. The Health Care Industry Finally Recognizes Fibromyalgia - National Pain Report - Sept. 30, 2015
  24. ICD-10 FAQ on ICD - WHO en.Wikipedia.org
  25. 25.025.125.2 "ICD-11 - Mortality and Morbidity Statistics". icd.who.int. Retrieved Dec 18, 2018. 

Myalgic encephalomyelitis or M.E. has different diagnostic criteria to chronic fatigue syndrome; neurological symptoms are required but fatigue is an optional symptom.Cite error: Closing </ref> missing for <ref> tag


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From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history