From Jean Harrison:
July 2007 ICD-10CM
You can find a copy of the new ICD-10CM which supersedes the 2003
version. There are some changes in the index which pertain directly
to those of us with ME/CFS. For those unfamiliar with the ICD codes
I will try to make a brief explanation. There are many posts on CO-
CURE about the codes, and they are also discussed in full on the NAME
website run by Steve DuPre and Lois Ventura. This makes for slightly
heavy reading considering but while the words describing this may
seem complicated the actual concept is not. Once you get the
concept, you're all set.
The ICD or International Classification of Diseases is has become of
increasing importance in the US. The numbers in the ICD are used for
billing purposes. If a given code doesn't fit insurance company
standards, the insurer will not pay for a given test or treatment.
If however the code is covered by insurance, then there is no problem
in reimbursement. It's my understanding that the code one is given
will be instrumental in the kind of benefits one receives. As we know
there is a cut off of two years for those with psychiatric
illnesses. So for those of us with ME-CFS it's very important that
we are given the correct code.
The term CM stands for "Clinical Modification" . The US has
"modified" - altered - the World Health Organization's International
Classification of Diseases, with their consent.
The actual bound books of the ICD contain several parts, of which the
Index and the Tabular list are of particular importance to us. The
index is like the index of a normal text book. In reading it the
number of dashes is critical. The tabular list could be said to co-
respond to the text of a text book.
So the new
INDEX reads:
Syndrome
-fatigue
--chronic R53.82
--psychogenic F48.8
So the above translates to: Chronic Fatigue Syndrome has the medical
code of R53.82. It appears that there is a new designation of
psychogenic fatigue syndrome, which is coded to the psychiatric category F48.8
The change is important as those who receive benefits will find their
benefits tied to a psychiatric designation should they be unfortunate
enough to be granted the category F48.8.
Coding has become so big a thing that doctors seldom do it
themselves; there are central coding centers for doctors offices and
hospitals. Some doctors are still quite aware of the significance of
a given code. IF you have one who is not aware, you might want to
gently suggest the proper code for the doctor.
The TABULAR LIST is more like the text of a text book and it reads as
follows:
G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis
Excludes1: chronic fatigue syndrome NOS (R53.82)
R53.82 Chronic fatigue, unspecified
Chronic fatigue syndrome NOS Excludes1: postviral fatigue syndrome
(G93.3)
(NOS stand for Not Otherwise Specified)
So CFS is listed under R53.82 and no longer listed under G93.3 with
the qualifier :" post viral". There was a listing in the proposed
version of the ICD-10CM which had CFS under the neurological code of G93.3. It was qualified by the term "postviral" which meant that one had to have had a viral onset to CFS. Now the listing contains only postviral fatigue. (Historical note: Melvin Ramsay made a strict
distinction between postviral fatigue and ME. His work has been
ignored by the writers of the ICD-10CM
And as you see there is a psychogenic chronic fatigue at F48.8 so we ALL need to be mindful of parsing -ie papers written about Chronic Fatigue rather than Chronic Fatigue Syndrome. And oddly enough they have made a differentiation between postviral fatigue syndrome and
CFS. So perhaps those with a viral start can claim G93.3, as well as
those who know that they have ME rather than the amorphous CFS.
As this is such an international battle, I'm sure that what the US
has done will affect others.
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