Issues related to possible coordination of DSM-V with CDC publication of ICD-10-CM and WHO ICD-11

There is discussion that: "The APA [the American Psychological Assn., the sponsor of the new DSM-V] has already worked with the CMS [U.S. Centers for Medicare and Medicaid Services] and CDC to develop a common structure for the currently in-use DSM-IV and the mental disorders section of the ICD-10-CM."

The ICD-10-CM, overseen by the CDC, will be a revised coding system in the U.S. for all diseases and conditions. This coding system includes disorder names, logical groupings of disorders and code numbers. The new ICD-10-CM will contain codes for all Medicare and Medicaid claims reporting. The ICD-10-CM is scheduled to be published Oct. 1, 2013.

Currently the coding system in the U.S. is the ICD-9-CM. The U.S. Coding System is separate from the international coding system under the auspices of the World Health Organization. The WHO system is currently the ICD-10. WHO will be revising its system in 2014 to the ICD-11.

Concerns about confusion of CSSD with CFS/ME and fibromyalgia in DSM-V, ICD-10-CM and ICD-11

CFS/ME and fibromyalgia medical researchers, patients and patient organizations are rightly concerned that flawed CSSD definition will adversely affect CFS/ME and fibromyalgia research and clinical care through the application of DSM-V; as well as any coordination of the CSSD diagnosis with the coding of CFS/ME and FM in the ICD-10-CM and ICD 11.

The real issues for CFS/ME and FM are two.

If the CSSM diagnosis appears in either of the new ICD codings, there are two possibilities. First, by itself, the new CSSM diagnosis would be more confused with CFS/ME and FM than any of the DSM-IV diagnostic categories.

Second, what would be the influence of the diagnostic category of CSSD in the direct categorization of CFS/ME and FM in both the new WHO definitions and the U.S. definitions. The categorization of CFS/ME and FM could be directly applied to the CSSD definition; or alternately be redefined, detrimentally, in other WHO ICD or CDC ICD categories. Certainly, cooperation of the APA, WHO and CDC is expected and very useful—except when a flawed category is shared.

Moreover, the direct categorization of CFS/ME historically both in the WHO ICD-10 and the CDC ICD-9-CM (both current) must be noted. WHO has been clearly the more medically progressive and accurate. The ICD-10 since 1990 has listed CFS/ME under G93.3 "neurological disorders". During the same period of time through to the present, the CDC has instead listed CFS under R53.82 under the general category of Symptoms, Signs and Ill-Defined Conditions as Chronic Fatigue Syndrome (780.71). Many efforts have been made to get the CDC to reassign CFS/ME to the neurological section, but the CDC has resisted. Under the U.S. system CFS/ME has been listed as a vague syndrome as opposed to a defined disease entity, thereby undermining its medical credibility.

How will the APA's new definition of CSSD—which could misdiagnose CFS/ME—influence the CDC's publication of the new U.S. ICD-10-CM?

CFS/ME and FM patients and organizations sincerely hope that the APA will be mindful of the detrimental effects that the flawed CSSD category could have on the ICD codings.

All new ICD-10-CM coding categories will be mandatory for reimbursement for Medicare and Medicaid and are also widely used by private insurance companies. A flawed classification of CFS/ME and FM in any of the new systems—DSM-V, ICD-10-CM or ICD-11—will have both medical system access consequences, as well as diagnostic ramifications, that could place greater focus on CFS/ME and FM as psychiatric disorders as opposed to a medical/biological disorders.