| The International Statistical Classification of Diseases and Related Health Problems [most commonly known by the abbreviation ICD] is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. Under this system, every health condition can be assigned to a unique category and given a code, up to six characters long. Such categories can include a set of similar diseases. The International Classification of Diseases is published by the World Health Organization [WHO] and used worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in medicine. This system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics. |
The original DSM [DSM-1, 1952] was adapted from the classification system of our Armed Forces after World War II and was not keyed to the International Classification of Disease [ICD-7] which had only an embryonal Mental Illness section. Says Wikipedia of the DSM-II [1968]:
Although the APA was closely involved in the next significant revision of the mental disorder section of the ICD [version 8 in 1968], it decided to go ahead with a revision of the DSM. It was published in 1968, listed 182 disorders, and was 134 pages long. It was quite similar to the DSM-I. The term "reaction" was dropped, but the term "neurosis" was retained. Both the DSM-I and the DSM-II reflected the predominant psychodynamic psychiatry, although they also included biological perspectives and concepts from Kraepelin’s system of classification…
The DSM-II was keyed to the ICD-8 [same diagnosis code numbers]. By treaty, the official diagnostic system for medicine in the United States in now the ICD-9-CM since 1979:
International Classification of Diseases, Clinical Modification (ICD-9-CM) is an adaption created by the U.S. National Center for Health Statistics (NCHS) and used in assigning diagnostic and procedure codes associated with inpatient, outpatient, and physician office utilization in the United States. The ICD-9-CM is based on the ICD-9 but provides for additional morbidity detail.
The ICD-10 was completed in 1990 and came into use in 1994:
ICD-10 Adoption was relatively swift in most of the world. Several materials are made available online by WHO to facilitate its use, including a manual, training guidelines, a browser, and files for download… Adoption of ICD-10 has been slow in the United States. Since 1979, the USA had required ICD-9-CM codes for Medicare and Medicaid claims, and most of the rest of the American medical industry followed suit. On 1 January 1999 the ICD-10 (without clinical extensions) was adopted for reporting mortality, but ICD-9-CM was still used for morbidity. Meanwhile, NCHS received permission from the WHO to create a clinical modification of the ICD-10, and has production of all these systems.
Recently, HHS has postponed changing from ICD-9-CM to ICD-10-CM until 10/01/2014, and since the ICD-11 is soon to be released, may skip the ICD-10 altogether:
On August 21, 2008, the US Department of Health and Human Services proposed new code sets to be used for reporting diagnoses and procedures on health care transactions. Under the proposal, the ICD-9-CM code sets would be replaced with the ICD-10-CM code sets, effective October 1, 2013.On April 17, 2012 the Department of Health and Human Services published a proposed rule that would delay, from October 1, 2013 to October 1, 2014, the compliance date for the ICD-10-CM and PCS.
What does it all mean? The simplest meaning is that the ICD-9-CM is the official diagnostic system for the United States. The DSM’s codes are the same as the ICD-9-CM. So the answer to the question, "Can one use the ICD-9-CM as a diagnostic manual rather than the DSM-IV/DSM-5?" for coding is a resounding "Yes." "In a way, you already are using the ICD-9-CM." But, like all great answers, it only brings up more questions, like…
- If that’s true, why do we even have a separate DSM?
- What’s the CM about?
- Is the ICD-9-CM as vulnerable to the whims of its creators as the DSM?
- What are the differences between the ICD-9-CM and the DSM-IV? DSM-5?
- Is the ICD-9-CM easy to use? accessible? affordable?
- What changes are coming in the ICD-10-CM? ICD-11-CM?
… and I am clueless, but the questions are of interest. It seems like something productive to explore, given the circus atmosphere of the APA’s DSM-5 Revision at this point. So I named this post international classification of diseases, clinical modification-1… as if there’s some future point at which all the questions might be something I’m going to write about. I say "might be" because I’m not even sure that they’re the right questions, but they’ll do for the moment…
“Recently, HHS has postponed changing from ICD-9-CM to ICD-10-CM until 10/01/2014, and since the ICD-11 is soon to be released, may skip the ICD-10 altogether…”
Doesn’t look very likely. Firstly, there has been considerable industry and clinical investment in gearing up for transitioning to ICD-10-CM – training of coders and other users, production of publications, software etc. Secondly, ICD-11 isn’t scheduled for completion until 2015. (The original completion date had been 2012 and the development of DSM-5 and ICD-11 were, for a while, running more or less in parallel which would have more readily facilitated “harmonization” between category names, descriptions and criteria across the two systems.)
ICD-11 Revision Steering Group chair, Chris Chute, has intimated that ICD-11 may not be ready until 2016. The ICD-11 Beta drafting process is running behind schedule and ICD-11 is a highly ambitious technical project.
Even if ICD-11 were ready for implementation in 2016 by the 120 odd countries currently using ICD-10, the US will need to develop a “Clinical Modification” of ICD-11 for US specific use. That process will take time. It’s not expected to take as long as the adaptation of ICD-10 has taken but CMS has said that it estimates a CM of ICD-11 is unlikely to be ready for implementation until at least 2020. That is a long time to wait using a now very elderly ICD-9-CM that is running out of codes.
To answer some of your questions:
Q If that’s true, why do we even have a separate DSM?
The mental and behavioral chapter of ICD-10 is Chapter V. There is a degree of correspondence between some DSM-IV categories and ICD-10 Chapter V categories but the classifications within two systems are not identical.
The chapters of ICD-10 outside the mental and behavioral chapter don’t have textual content. There are no disease descriptions, definitions or criteria associated with classifications (but there will be descriptive content in ICD-11 for all entities). WHO’s Bedirhan Ãœstün calls ICD-10 classifications a “laundry list.”
But for Chapter V, there is more descriptive content within Volume 1: The Tabular List than for the other 20 odd chapters.
The ICD-10 Tabular List version for 2010 can be accessed here, now on an electronic platform similar to the platform being used for the public version of the ICD-11 Beta draft:
http://apps.who.int/classifications/icd10/browse/2010/en
There are also two “stand alone” publications for Chapter V which can be downloaded free here. They contain a little more descriptive content than the Tabular List text:
ICD-10 for Mental and Behavioural Disorders Clinical Descriptions and Diagnostic Guidelines [PDF]
http://www.who.int/classifications/icd/en/bluebook.pdf
ICD-10 for Mental and Behavioural Disorders Diagnostic Criteria for Research [PDF]
http://www.who.int/classifications/icd/en/GRNBOOK.pdf
As a non professional, I haven’t seen a print copy of DSM-IV, only what is available online, which isn’t the full version, but I would guess there is possibly more descriptive text in DSM-IV than in the ICD-10 Chapter V “Blue Book.”
Q What’s the CM about?
For information on the development of the CM of ICD-10 see this page on the CDC site:
http://www.cdc.gov/nchs/icd/icd10cm.htm
Lower down the page, you’ll find files for the current documentation for ICD-10-CM including the Index and the Tabular List in a zipped bundle of files. (I can send you copies if you would like these.)
The draft of ICD-10-CM was subject to partial code freeze in October 2011. No changes to the draft can now be made until 12 months after implementation, other than strict classes, for example, adding new strains of flu virus.
So you can already scrutinize ICD-10-CM and for free.
Q Is the ICD-9-CM as vulnerable to the whims of its creators as the DSM?
There has been a public process for proposals for annual updates and amendments to the ICD-9-CM. If you go to this CDC page you’ll find information about the process:
http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm
The twice yearly meetings are held in public and agendas and meeting materials and audios of meetings are available from the page above. Formal Submissions are tendered by stakeholders by specific dates and discussed at public meetings. Then decisions are made by NCHS as to whether these requests for inclusions or amendments will be incorporated into the annual update. ICD-9-CM is also now subject to partial code freeze for the remainder of its life.
(You can read meeting notes, including Darrel Regier’s participation in the meeting that discussed the proposed date of the partial code freeze where Dr Regier is calling for a delay in the partial code freeze for ICD-10-CM until October 2014, because DSM-5 has slipped its schedules. He did not get what he wanted, though. So it has not been possible for DSM-5 to be harmonized with ICD-10-CM.)
So, for example, DSM-5 proposals for the “Somatic Symptoms Disorders” (if they are approved) will not have concordance with the “Somatoform Disorders” of ICD-10-CM, which are pretty much as they sit in ICD-10. So it would be difficult to translate the new DSM-5 codes for that section of DSM across to ICD-10-CM codes, come 2014, because that section of DSM-5 is destined for radical changes to categories, their definitions and criteria. This is an issue that the SSD Work Group does not appear to have addressed in any of the documentation that I have seen around this section, that is, how useful will their proposals be in clinical settings if there is no equivalent ICD-10-CM category for coding purposes?
There is talk of “retro-fit.”
In a June 2011 presentation to the International Congress of the Royal College of Psychiatrists, APA President, John M. Oldham, spoke of “Negotiations in progress to ‘harmonize’ DSM-5 with ICD-11 and to ‘retro-fit’ these codes into ICD-10-CM†and that DSM-5 would need “to include ICD-10-CM ‘F-codes’ in order to process all insurance claims beginning October 1, 2011.â€
12 months after ICD-10-CM has been implemented, proposals for additions and amendments will be made through the same process as has been the case for ICD-9-CM.
Is the ICD-9-CM easy to use? accessible? affordable?
Information about obtaining ICD-9-CM is on this CDC page:
http://www.cdc.gov/nchs/icd/icd9cm.htm
Q What changes are coming in the ICD-10-CM? ICD-11-CM?
As I say, you can view ICD-10-CM volumes on the CDC site.
In February 2011, I asked CDC’s Donna Picket whether ICD-10-CM will have an equivalent of the ICD-10 “ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines” (“the Blue Book”). Ms Pickett’s response was “Clinical criteria and diagnostic guidelines are not included in ICD-10-CM.”
I infer then that for ICD-10-CM there won’t be two stand alone manuals like those that accompany the international version of ICD-10 adapted to accord with the changes to category location and codes made to ICD-10 for US specific use.
Ms Pickett did not clarify whether the “Blue Book” and the “Green Book” could be used in the US once ICD-10-CM is implemented. But as some codes are slightly different between ICD-10 and ICD-10-CM and disorder descriptions in ICD-10-CM Chapter 5, such as they are, may differ, using the international ICD-10 publications for research or clinical purposes in conjunction with ICD-10-CM, might be problematic and is something you might consider discussing with Ms Pickett.
There is no ICD-11-CM under development for US specific use because ICD-11 is still under development. But you can view Foundation and Linearization views of the public version of the ICD-11 Beta drafting platform here:
http://apps.who.int/classifications/icd11/browse/l-m/en
http://apps.who.int/classifications/icd11/browse/f/en#
Here for Chapter 5 (you’ll need to open the gray arrows to display child and grandchildren categories):
http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fwho.int%2ficd%23V
If you are registered to interact with the Beta platform, as I am, you can also download a PDF for Chapter 5. Caveat: the ICD-11 Beta is a work in progress, subject to daily updates and proposals and content are not approved by WHO or ICD-11 Revision.
Not all your questions answered, but I hope some of this will be of interest.
A quick point: WHO, Geneva, authorized the development of an adaptation of ICD-10 for specific use in the US. (Canada, Germany and Australia also have their own CMs, but they developed CMs of ICD-10 some years ago. Only the US is still using a CM of ICD-9.)
Modifications to the ICD-10 have needed to conform to WHO conventions for ICD. WHO has strict classificatory rules – quite unlike the way in which this DSM can, for example, dump a bunch of little used, unloved categories into a bucket, stir them up with a stick, tip them out and slap a brand new disorder name, construct and criteria on the mash up it has created. ICD doesn’t work like that.