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Classification Principles provided by the World Health Organisation

On 28th June 2001 Andre L'Hours, the Technical Officer at the WHO headquarters in Geneva who is responsible for the ICD, confirmed that it was "unacceptable" if the same disorder had been included in two places in the ICD-10 and that the same disorder could not be differently categorised under the one WHO banner.  When he was informed of what was happening in the UK, he promised to look into the matter.

( this refers to the attempt by the UK WHO Collaborating Centre - Kings College - to list post-viral fatigue syndrome and benign myalgic encephalomyelitis under G93.3 and F48.0)

Andre l'Hours confirmed that the ICD classifications are approved by the World Health Assembly and therefore take legal precedence over unapproved modifications made by a WHO Collaborating Centre.

On 16th October 2001, Dr B Saraceno from the WHO provided the following clarification in writing:
"I wish to clarify the situation regarding the classification of neurasthenia, fatigue syndrome, post-viral fatigue syndrome and benign myalgic encephalomyelitis.  Let me state clearly that the World Health Organisation (WHO) has not changed its position on these disorders since the publication of the International Classification of Diseases, 10th Edition in 1992 and versions of it during later years.
"Post-viral fatigue syndrome remains under the diseases of nervous system as G93.3.  Benign myalgic encephalomyelitis is included within this category.
"Neurasthenia remains under mental and behavioural disorders as F48.0 and fatigue syndrome   (note: not THE CHRONIC FATIGUE SYNDROME) is included within this category. However, post-viral fatigue syndrome is explicitly excluded from F48.0.
"The WHO ICD-10 Diagnostic and Management Guidelines for Mental Disorders in Primary Care, 1996, includes fatigue syndrome under neurasthenia (F48.0) but does not state or imply that conditions belonging to G93.3 should be included here.
"I would also like to state that the WHO's position concerning this is reflected in its publications and electronic material, including websites.
"It is possible that one of the several WHO Collaborating Centres in the United Kingdom presented a view that is at variance with WHO's position.
"Collaborating Centres are not obliged to seek approval from WHO for the material they publish.  I understand that the Collaborating Centre concerned has now made changes to the information on their website after speaking with WHO".

In the debate on ME/CFS in the House of Lords on 22nd January 2004, the Health Minister (Lord Warner) stated:
"The current version, ICD-10, classifies CFS in two places: as neurasthenia in the mental health chapter, F48.0; and also as myalgic encephalomyelitis in the neurology chapter, G93.3.  The diagnostic criteria used in the ICD shows that the WHO has essentially put the same condition in both places.  That is the WHO's formal position".
Following his speech (recorded in Hansard at column 1195), a copy of this letter was  given to the Health Minister by the Countess of Mar; Lord Warner said that he would take it to the Chief Medical Officer to be discussed.

On 23rd January 2004, Andre l'Hours from the WHO headquarters 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 also stated that if a country accepts the WHO Regulations concerning nomenclature (which the UK does), then that country is obliged to accept the ICD classification.  For the avoidance of doubt, the UK has registered no reservations about the ICD-10 and therefore formally accepts it.

US ICD-10 CM (tabular)

The above page{link) contains extracts from the US ICD-10 CM,(2007) (draft since 2003), it should be noted that while postviral fatigue syndrome, benign myalgic encephalomyeliyis, are listed under the code G93.3 and chronic fatigue syndrome,postviral which was listed in the 2003 draft has now been removed; there is an exclusion,(NOT CODED HERE) chronic fatigue syndrome NOS (R53.82). Thus CFS is listed cfs NOS (R53.82). Note that R53.82 excludes postviral fatigue syndrome (G93.3)