WHO classifies CFS as Neurological

Mary S provides the following commentary:

The organization M.E. Action UK has on its website two pictures showing where "chronic fatigue syndrome" is in the PRINTED version of the relevant pages in WHO's ICD-10.

I am indebted to Orla and Pia for this information.

The International Classification of Diseases (ICD) comes in two forms:  the index, which is purely alphabetical, and the tabular, which is by category. 

In the index form, you find chronic fatigue syndrome by looking up syndrome, then fatigue, then chronic.

In the tabular form, you would find it by looking up G, then 90, then 93, then 93.3.   Unfortunately, WHO's tabular version does not include chronic fatigue syndrome.

That is even more unfortunate because all you'll ever find on WHO's website for ICD-10 is the tabular version:
http://www.who.int/classifications/apps/icd/icd10online/

The DEFINITIVE version is the INDEX, which only exists in PRINTED form.  The index contains many more conditions than the tabular version.  I don't know why it is not on WHO's ICD-10 website.  But it's not.

Fortunately, M.E. Action UK took pictures of the printed copies of ICD-10 in both tabular and index form.

So - here it is (with enough of the other material included so readers can get an idea of the difference between the tabular version and the index version).

First, here's a picture of the printed version of the TABULAR form:

http://www.meactionuk.org.uk/G93-3-ICD-10-compilation.jpg

G93 - OTHER DISORDERS OF BRAIN

G93.0 - Cerebral cysts
              Arachnoid cysts
              Porencephalic cyst, acquired
              Excludes:  acquired periventricular cysts of newborn (P91.1)
                                  congenital cerebral cysts (Q04.6)

G93.1 - Anoxic brain damage, not elsewhere classified
              Excludes:  complicating:
                                  - abortion or ectopic or molar pregnancy (O00-O07, O08.8)
                                  - pregnancy, labour or delivery (O29.2, O74.3, O89.2)
                                  - surgical and medical care (T80-T88)
                                  neonatal anoxia (P21.9)

G93.2 - Benign intracranial hypertension
               Excludes: hypertensive encephalopathy (I67.4)

G93.3 - Postviral fatigue syndrome
              Benign myalgic encephalomyelitis

G93.4 - Encephalopathy, unspecified
              Excludes:  encephalopathy
                                  - alcoholic (G31.2)
                                  - toxic (G92)

So the tabular version does not include Chronic Fatigue Syndrome. 

HOWEVER, the printed index version does, and WHO says that the printed index version is the definitive version.

INDEX VERSION:

http://www.meactionuk.org.uk/G93-3-ICD-10-index-closeup.jpg

Syndrome - continued
- epileptic (see also Epilepsy) G40.9
    - - special G40.5
- erythrocyte fragmentation D59.4
- exhaustion F48.0
- extrapyramidal G25.9
    - - specified NEC G25.8
- eye retraction H50.8
- eyelid-malar-mandible Q87,.0
- facial pain, paroxysmal G50.0
- familial eczema-thrombocytopenia
     (Wiskott-Aldrich) D82.0
- fatigue F48.0
    - - chronic G93.3
    - - postviral G93.3

So -

Syndrome, fatigue   (or Fatigue Syndrome) is coded as F48.0 (neurasthenia)
Syndrome, exhaustion (or Exhaustion Syndrome) is coded as F48.0 (neurasthenia)
Syndrome, fatigue, chronic (or Chronic Fatigue Syndrome) is coded as G93.3 in "diseases of the nervous system"
Syndrome, fatigue, postviral (or Postviral Fatigue Syndrome) is coded as G93.3
               ---------------------------------

Hope it's all clear now!  CFS is indeed coded in WHO's ICD-10, at G93.3.  You just need a printed copy of the index to find it.  Thanks to M.E. Action UK for putting a picture of it on their website.

* * *

ADDENDUM:

This is a copy of an errata sheet that was required to be sent along with a psychiatric manual in England that had reported that "chronic fatigue syndrome" should be coded as F48.0, which is "neurasthenia."  That was incorrect.

This was the correction that had to be included.  Since the errata sheet is in the public domain, I assume it is okay to post it on Co-Cure:

"Please note that on page 35 Chronic Fatigue Syndrome is a research/clinical
definition which was established after the production of ICD10, and
therefore was not considered at the time.  In ICD10 neurasthenia is coded as
F48.0 in Ch V Mental and Behavioural Disorders, while M.E. is coded as G93.3
in Ch VI, Diseases of the Nervous System.  Subsequently, the 1994 index to
ICD10 connects fatigue syndrome to F48.0 and chronic fatigue syndrome to
G93.3"

To repeat, according to WHO, "the 1994 index to ICD10 connects fatigue syndrome to F48.0 [neurasthenia] and chronic fatigue syndrome to G93.3 [post-viral fatigue syndrome and benign Myalgic Ecephalomyelitis.]"

The problem is that WHO only includes the tabular version of ICD-10 on their website.  That is a problem because the tabular version is not inclusive.  The definitive, longer version - the index - is only available in print format.  That is frustrating, but that is the way they do things.

So - to repeat - according to WHO, CFS is in G93.3 with M.E. and has been there since 1994. 

And just as English psychiatrists could not use an ICD code for CFS that was different from ICD-10 (F48.0, for neurasthenia), American members of CDC cannot use a different ICD code either.  CFS is coded in G93.3 in WHO's ICD-10 print index.  The U.S. cannot put it in R53.82.  That would be a violation of the agreement by which the U.S. is a member nation of WHO.

Referencing Co-Cure post #013584, by Jean Harrison, on August 24,2005:

On 23rd January 2004, Andre l'Hours from the WHO headquarters (Geneva) 
provided the following clarification (in writing):

"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".

Andre l'Hours added that if a country accepts the WHO Regulations 
concerning nomenclature , then that country is obliged to accept the 
ICD classification.

--------------------

This is NOT a matter of personal preference.  It is a formal ruling by WHO, the World Health Organization, stating that (a) CDC was placed in G93.3 with postviral fatigue syndrome and M.E. in 1994; and (b) a member nation cannot change the category ("rubric") under which a disease has been coded by WHO.  It is no more legal for the U.S. to place CFS in R53.82 (malaise and fatigue) than it was legal for British psychiatrists to place CFS in F48.0 (neurasthenia).

* * *

And thanks to Mary for pointing this out!