About the High Demand for Medical Coding Professionals | Vista …


Why Are Medical Coders in High Demand?

The United States has a greater demand for highly qualified medical professionals than any other time in our nation’s history — and the need is only expected to increase in the coming years. Fortunately, you don’t have to spend numerous long years studying to become a doctor or nurse to take advantage of the healthcare job explosion. For many people, becoming a Medical Insurance Billing and Coding professional can be a great way to enjoy a long and rewarding career in healthcare.

According to the Bureau of Labor Statistics, the medical coding career outlook is extremely bright. The BLS includes coders in the occupational category of Medical Records and Health Information Technicians. The number of jobs within this category is expected to increase by 22% between 2012 and 2022.

What Is the Role of the Medical Coder?

Medical Coders are not directly involved in the examination and treatment of patients. However, they play a key administrative role in the function of the modern healthcare practice or treatment facility. Coders have the ability to translate complex medical terminology found in patient records into standardized codes. Physicians and hospitals rely on these codes when treating patients, and insurance companies use them as part of the healthcare provider reimbursement process. Needless to say, employers are looking for accuracy and sound judgment when hiring a Medical Coder.

The Medical Coding Career Outlook: Impacted by the Baby Boomer Generation

What makes the Medical Coding career outlook so bright? The huge Baby Boomer population, consisting of individuals born between 1946 and 1964, is getting older and requires more medical attention. This is placing a heavy demand on the healthcare system, and more workers in all areas of healthcare, including Medical Coding, are being hired to meet the demand and ensure adequate patient care.

Longer Life Expectancy

Americans are also living longer, and this trend is expected to continue in the years to come. According to the U.S. Census Bureau, the average life expectancy for individuals born in 1970 is 70.8 years. For those born in 1980, the number increases to 73.7 years, and for people born in 1990, the average jumps to 75.4 years. Additionally, the number of centenarians — those individuals who reach age 100 — is increasing by an average of 5.5% per year.

As people continue to live longer and as demonstrated by the Baby Boomers, they will require treatment for the various ailments associated with the aging process. This should also have a positive impact on the Medical Coding career outlook.

High Attrition Rate

The high number of coders leaving the professional is also expected to improve the Medical Coding career outlook for individuals seeking to gain entry into the field. According PRN Funding, an organization that provides working capital to healthcare staffing agencies, the average retirement age for Medical Coders is currently 54 — much lower than in many other professions. As a result, a large number of coders are expected to retire over the next decade.

The Job Requires a “Human Touch”

The Medical Coding career outlook is so favorable, because the job requires a unique skill set that cannot be easily replicated by a computer. While coders use computers and software programs to assist them, it still takes a well-trained human mind to accurately interpret the medical terminology and assess the most appropriate code.

This is where the coder’s ability to make sound judgments comes into play. Coders may also need to contact healthcare providers to clear up any discrepancies that could lead to inaccurate coding procedures.

Excellent Training Can Improve the Medical Coding Career Outlook for You

While the Medical Coding career outlook is certainly promising, it takes the right training to become an attractive job candidate to potential employers. There are typically two options: a Medical Insurance Billing and Coding Diploma program, which can be completed in about 50 weeks, and a Medical Insurance Billing and Coding Associate of Applied Science program, where you can earn an AAS degree in less than two years.

These comprehensive programs cover all the critical aspects that are essential to the Medical Coder job function. You’ll learn medical terms and technology, ICD-10 diagnostic coding, how to handle health insurance claims, and more. By obtaining your certification, you’ll be fully prepared to work in a hospital environment, including urgent care clinics, or even with insurance companies.

Some colleges offering these programs give you the flexibility to pursue your education by attending classes online. These online education programs offer accelerated learning, giving you the opportunity to earn your degree quickly, and allowing you to pursue your new career in Medical Coding as soon as you graduate.

Learn More About Your Medical Coding Career Options

To learn more about the wide range of Medical Coding career options, as well as the training opportunities available at Vista College, contact one of our friendly and knowledgeable Admissions Representatives today.




Medical Terminology: Honokaʻa – Event Details | CPC Exam Tips …

Medical Terminology: Honokaʻa

Tuesday, June 17, 2014, 5:00pm

Location: NHERC

Medical Terminology is essential to many fields within the healthcare industries, including coding, case management, clinical trials and health information technology. Using an anatomy and physiology systems approach, this course reviews common terms associated with healthcare delivery and medical record-keeping, as well as medical research and development. Upon completion, students are better prepared to work in healthcare or biomedical environments.


This face-to-face course will be instructed by Donna Stern, BA, MS (in progress). She is an adult education specialist with more than 25 years’ experience serving adult learners in both private and public sectors, and currently serves as operations manager for several departments within University of California, San Diego Division of Extended Studies.


Course tuition includes textbook and Certificate of Completion. This course qualifies for 50% tuition subsidies through the Employment and Training Fund (ETF) program. Deadline to qualify for ETF subsidies is May 30. Please contact CCECS for more information.


Class will run on Tuesdays and Fridays, June 17-June 27 from 5-7pm.

Special Restrictions: Tuition $350 includes textbook.

For more information, contact: ccecs@hawaii.edu 974-7664

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Correct Path, medical billing and coding certification | CPC Exam …

Medical Billing And Coding Certification

Medical Billing And Coding

There are numerous medical billing and coding institutions in America, which you can consider for your medical billing and coding training. These institutions offer a wide range of programs to suit the particular needs of students. It is imperative to consider an institution that is accredited, while looking for an institution to get the medical billing and coding certification. Accredited medical billing and coding institutions provide quality training and it is very essential as it allows you to get started on the correct path in your career.

You will have to do a very good homework to find accredited medical billing and coding schools. There are many accreditation bodies including American Academy of Professional coders and the commission of accreditation for health informatics. It is very important to find out the list of medical billing and coding institutions in your locality that have been accredited before you enroll for the course. There are many organizations that offer accreditation to these institutions.

Accredited medical billing and coding institutions offer the best programs. These institutions are certified by the national certification bodies. For this reason, the programs that they offer are acceptable and meet the required standards. You can make use of the Internet to understand more about the school that you wish to enroll for your training. This will improve your chances of becoming a competent medical billing and coding professional in the future. If you present your resume to an employer, he or she will give you a priority if the institution that you settled for is an accredited one.

After finding an accredited medical billing and coding institution, you will have to consider some other important things also.

Correct Path

Medical Coding And Billing

  • Make sure that the medical billing and coding certification programs that the school offers suits your career needs as well as your schedule.
  • The medical billing and coding program offered by the school should fit your budget.
  • Find a school that provides the best facilities and values your training.

Selecting such an institution increases the chances of getting the best training in the market. You will start on the correct path to achieve your career goals. Take your time and seek recommendations from families, friends, and relevant bodies to find a medical billing and coding certification institution that meet your requirements. Such an institution will help you reach your goals without any difficulty.

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How Long Does The Medical Billing Training Last? | Medical Coding …

Medical Billing

Medical Coders Are On Demand

Medical billing job is a field that is gaining popularity in a rapid phase nowadays. There are numerous opportunities when it comes to a professional medical coder or biller. The salary is also good and it only depends on a few things like your job location and previous experience in the sector.

When it comes to acquire a job in the medical billing segment, it is enough if you can convince that you are capable of doing this job, though of course, a basic idea of the course is mandatory. You can convince the employer by explaining your previous experiences in accounting field and the things you learnt out of it.

Nevertheless, if you look into other courses in the field of medicine, you would need to complete a professional course that would take around two to four years. Yet, when it comes to billing in medical field, the only requirement is to pass a national exam. The number of days of classroom training and the institution that you choose to study does not matter at all. It is enough that you study and pass the exam and become certified as a medical coder or biller.

However, if you are not able to prepare on your own or if you think that you need some guidance, you can choose training programs offered by institutions with medical billing courses. Alternatively, it would be a better option to choose a course online, so that you can quickly complete the basic course and then start looking for jobs at the earliest.

When you choose an institution, you will have to attend trimesters and semesters, and some of them might charge more than necessary fee. But when it comes to opting for an online course, you can save a lot of time along with a considerable amount of money.

Institutions

Professional Medical Biller

Whatever be the type of class that you choose, see to that it has all those things required to train you as a professional medical coder. Jot down a list of schools, compare, and decide on a school. Make sure that the institutions do not over-charge you for the course.

You can save some money on the course with the financial aid that is provided by the Federal government. So it is advised to check if you are eligible for the financial aid as well.

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Salter College – Technical college and career training school …




As you begin, continue, and complete your certification in Medical Billing & Coding at Salter College, you will likely be thinking a lot about where you will work when you finish school. The healthcare industry is booming and growing, so there is a seemingly never-ending need for medical professionals of all types, including medical billing and coding specialists. With your expertise in medical coding, basic claims process, and medical insurance, the possibilities of where you can work are great. The most common choices for a career in medical coding and billing are as follows: doctor’s offices, hospitals, dental offices, nursing homes, medical equipment suppliers, and insurance companies

However, there are a couple other options for where you can begin your career as a medical billing and coding specialist. Third party billing offices are often overlooked by newly certified medical specialists as a great place to begin working. Self-employment is also often seen as something far too risky and with a lower opportunity for growth and increased income. However, both third party billing offices and self-employed medical billing and coding specialists are becoming more prevalent, important, and sought after in today’s medical industry. Here are some pros and cons of both of these employment options

Third Party Billing Office Employment

Many medical facilities are beginning to realize that outsourcing their medical billing and coding is a great way to save time, money, and stress. Rather than hire someone who still requires extensive training, medical facilities can turn to third party billing offices and know that their entire staff is fully trained and highly qualified, with many resources available to them.

Third party billing offices have more advanced technology available to them, which will result in your learning much more about your profession than if you had worked in a regular medical facility. You will be surrounded by other medical billing and coding experts, and you will learn the best and most efficient way to complete tasks. With the healthcare industry constantly and rapidly changing, third party billing offices will be up-to-date and prepared to handle any change in processes or regulations so that their clients don’t have to worry about that. This means you would learn quickly about the newest changes in medical billing, and you will become more than proficient in adapting.

Self-Employment as a Medical Billing & Coding Specialist

While self-employment does carry its own risks and responsibilities, the freedom that comes with it simply cannot be understated. Many medical facilities are beginning to outsource medical billing and coding, and as a self-employed specialist, you can meet the needs of many small businesses on your own schedule. Whether you have children, like to travel, or just want freedom from a 9-5 job, self-employment as a medical billing and coding specialist is a great, but over overlooked, option.

You may work from your own home or you may travel to various medical offices to complete work. You will set your own hours, and keep in mind that there are many opportunities to work days, nights, and weekends, depending on what you prefer.

Many Options for Salter Graduates

There are clearly many career opportunities for someone who has just completed his or her medical billing and coding certification from Salter College. Keep your options open and explore every possibility, and you will surely find yourself in a career and position that you love!




ICD-10 delay impacts implementation of OASIS-C1 « CMS …

In a new S&C letter, “Outcome and Assessment Information Set (OASIS)-CI / International Classification of Diseases (ICD-)9 Webinar: September 3, 2014,” (Ref: S&C: 14-40-HHA), CMS notes that is has determined that the ICD-10 delay will have an impact on the Home Health Quality Reporting Program, especially the implementation of OASIS-CI. The new version of OASIS data set items was scheduled to be implemented on October 1, 2014, but five of these codes require the use of ICD-10 codes. The letter details the codes that require change.

Additional, the S&C group will be hosting a webinar, “OASIS-C1 / ICD-9” on September 3, 2014. The webinar will cover the OASIS-C1/ICD-9 data set and its implementation, the types of changes made to the data set and changes made to the OASIS-C1/ICD-9 Guidance Manual.

OASIS-C1/ICD-9 is scheduled to be implemented on January 1, 2015.

Read the S&C letter on the CMS website.

“Bodily distress disorder” now inserted in ICD-11 Beta draft

Post #310 Shortlink: http://wp.me/pKrrB-3X9

Caveats: The ICD-11 Beta drafting platform is not a static document: it is a work in progress, subject to daily edits and revisions, to field test evaluation and to approval by ICD Revision Steering Group and WHO classification experts. Not all new proposals may survive ICD-11 field testing. Chapter numbering, codes and Sorting codes currently assigned to ICD categories may change as chapters and parent/child hierarchies are reorganized. The public version of the Beta draft is incomplete; not all “Content Model” parameters display or are populated; the draft may contain errors and category omissions.

This report updates on recent additions to the listing for Bodily distress disorder in the public version of the ICD-11 Beta draft.

This is an edited version of the report published on July 19.

+++
Bodily distress disorder (BDD) is a new, single diagnostic category that has been proposed for ICD-11. It is intended to subsume the seven ICD-10 Somatoform disorders categories F45.0 – F45.9, and F48.0 Neurasthenia.

Bodily distress disorder (BDD) is the term that has been entered into the Beta drafting platform since February 2012.

It is the term and disorder construct that has been proposed by the ICD-11 Expert Working Group on Somatic Distress and Dissociative Disorders (S3DWG), which is chaired by Professor Oye Gureje [1].

Note: the term Bodily stress syndrome (BSS) (Lam et al, 2012) is an alternative disorder term and diagnostic construct that has been proposed by the ICD-11 Primary Care Consultation Group (PCCG), which is chaired by Professor Sir David Goldberg [2].

The disorder term and construct Bodily distress syndrome (BDS) has also been advanced for ICD-11 in a June 2013 editorial by Ivbijaro G and Goldberg D [3].

Neither of the terms Bodily stress syndrome (BSS) or Bodily distress syndrome (BDS) has been entered into the ICD-11 Beta draft.

+++
A Definition for category Bodily distress disorder was inserted into the Beta draft in late January 2014.

At that point, no definitions or characterizations for any of the uniquely coded BDD severity specifiers (currently, BDD, mild; BDD, moderate; BDD, severe) had been inserted.

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How is BDD being defined for the purposes of ICD-11?

The psychological and behavioural features that characterize Bodily distress disorder, as currently defined in the Beta draft, are drawn from the disorder conceptualizations in the 2012 Creed, Gureje paper on emerging proposals for the revision of the classification of somatoform disorders [1].

This paper sits behind a paywall but I have had a copy since it was first published.

The paper describes a disorder model that has poor concordance with Fink et al’s Bodily Distress Syndrome construct.

The 2012 Creed, Gureje paper defines BDD as:

“a much simplified set of criteria”;

eliminates the requirement that symptoms be “medically unexplained” as the central defining feature;

focuses on identification of positive psychobehavioural responses (excessive preoccupation with bodily symptoms, unreasonable illness fear, frequent or persistent healthcare utilization, activity avoidance for fear of damaging the body) in response to any (unspecific) persistent, distressing, single or multiple bodily symptom(s), resulting in significant impairment of functioning or frequent seeking of reassurance;

makes no assumptions about aetiology and in “[d]oing away with the unreliable assumption of its causality the diagnosis of BDD does not exclude the presence of (…) a co-occurring physical health condition”;

has no requirement for symptom counts, or for symptom patterns or symptom clusters from body or organ systems

– which describes a disorder framework into which DSM-5′s “Somatic Symptom Disorder (SSD)” could potentially be integrated, facilitating harmonization between a replacement for the ICD-10 Somatoform disorders and DSM-5’s new SSD.

+++
Whereas, Fink et al’s 2010 Bodily Distress Syndrome criteria are based on impairment and symptom patterns from body systems. Positive psychobehavioural features do not form part of the Fink et al criteria [4–6].

For ICD-11’s BDD, patients may be preoccupied with any bodily symptoms and the presence of a co-occurring physical health condition is not an exclusion.

But for Fink et al’s BDS, “If the symptoms are better explained by another disease, they cannot be labelled BDS.”

BDD’s three severity specifiers are proposed to be characterized on the basis of the extent to which responses to persistent, distressing symptoms are perceived as excessive and on degree of impairment, not on the basis of the number of bodily symptoms and the number of body or organ systems that are affected by the disorder.

In contrast, BDS’s two severities are based on symptom patterns (a BDS Modest, single-organ type and a BDS Severe, Multi-organ type).

Both BDD and BDS are intended to subsume the Somatoform disorders and Neurasthenia.

But BDS seeks to arrogate the so-called “functional somatic syndromes,” CFS, ME, IBS, Fibromyalgia, chronic pain disorder, MCS and some others, and subsume them under a single, overarching BDS diagnosis [6].

So although the BDD and BDS disorder names sound very similar (and the terms are sometimes seen used interchangeably), as defined in the 2012 Creed, Gureje paper and as defined by the recently inserted Beta draft Definitions, ICD-11’s BDD and Fink et al’s BDS present divergent constructs*.

It is the ICD-11 Primary Care Consultation Group‘s 2012 proposals for a “Bodily stress disorder” [2] that had stronger conceptual alignment and criteria congruency with Fink et al’s BDS.

*Discussions between Profs Creed and Fink during the Research Clinic for Functional Disorders Symposium presentations, Aarhus University Hospital, May 15, 2014, noted that Fink et al’s BDS and DSM-5’s SSD are “very different concepts.” That SSD and BDS are divergent constructs is also discussed in: Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services, Francis Creed, Peter Henningsen, Per Fink (Eds), Cambridge University Press, 2011.

+++
ICD-11 BDD, mild; moderate and severe specifiers, now defined:

In the last few days, Definitions for the three uniquely coded Severity specifiers:

6B40 Bodily distress disorder, mild

6B41 Bodily distress disorder, moderate

6B42 Bodily distress disorder, severe

have been inserted into the Beta draft.

+++
The Definition for the Title term Bodily distress disorder remains the same as previously reported:

http://apps.who.int/classifications/icd11/browse/f/en#/http://id.who.int/icd/entity/767044268

http://apps.who.int/classifications/icd11/browse/l-m/en#/http://id.who.int/icd/entity/767044268

Chapter 06 Mental and behavioural disorders

Bodily distress disorder [In Mortality and Morbidity, Primary Care High Resource, Primary Care Low Resource Linearizations]

Foundation Id: http://id.who.int/icd/entity/767044268

Parent(s)

Mental and behavioural disorders            ICD-10 : F45

Definition

Bodily distress disorder is characterized by high levels of preoccupation regarding bodily symptoms, unusually frequent or persistent medical help-seeking, and avoidance of normal activities for fear of damaging the body. These features are sufficiently persistent and distressing to lead to impairment in personal, family, social, educational, occupational or other important areas of functioning. The most common symptoms include pain (including musculoskeletal and chest pains, backache, headaches), fatigue, gastrointestinal symptoms, and respiratory symptoms, although patients may be preoccupied with any bodily symptoms. Bodily distress disorder most commonly involves multiple bodily symptoms, though some cases involve a single very bothersome symptom (usually pain or fatigue).

Synonyms

somatoform disorders
Somatization disorder

Exclusions [Ed: with the exception of Hypochondriasis, Exclusions are imported from ICD-10 F45 Somatoform disorders Exclusions.]

lisping
lalling
psychological or behavioural factors associated with disorders or diseases classified elsewhere
nail-biting
sexual dysfunction, not caused by organic disorder or disease
thumb-sucking
tic disorders (in childhood and adolescence)
Tourette syndrome
trichotillomania
dissociative disorders
hair-plucking
Hypochondriasis

+++
This is the recently added Definition for 6B40 Bodily distress disorder, mild:

http://apps.who.int/classifications/icd11/browse/f/en#/http://id.who.int/icd/entity/1472866636

http://apps.who.int/classifications/icd11/browse/l-m/en#/http://id.who.int/icd/entity/1472866636

6B40 Bodily distress disorder, mild [In Mortality and Morbidity Linearizations]

Foundation Id: http://id.who.int/icd/entity/1472866636

Parent(s)

Definition 

Bodily distress disorder, mild is a form of Bodily distress disorder in which there is excessive attention to bothersome symptoms and their consequences, which may result in frequent medical visits. The person is not preoccupied with the symptoms (e.g., spends less than an hour per day focusing on them). Although the individual expresses distress about the symptoms and they may have some impact on his or her life (e.g., strain in relationships, less effective academic or occupational functioning, abandonment of specific leisure activities) there is no substantial impairment in the person’s personal, family, social, educational, occupational, or other important areas of functioning.

All Index Terms

  • Bodily distress disorder, mild

+++
Here’s the Definition for 6B41 Bodily distress disorder, moderate:

http://apps.who.int/classifications/icd11/browse/f/en#/http://id.who.int/icd/entity/1967782703

http://apps.who.int/classifications/icd11/browse/l-m/en#/http://id.who.int/icd/entity/1967782703

6B41 Bodily distress disorder, moderate [In Mortality and Morbidity Linearizations]

Foundation Id : http://id.who.int/icd/entity/1967782703

Parent(s)

Definition 

Bodily distress disorder, moderate is a form of bodily distress disorder in which there is persistent preoccupation with bothersome symptoms and their consequences (e.g., spends more than an hour a day thinking about them), typically associated with frequent medical visits such that the person devotes much of his or her energy to focusing on the symptoms and their consequences, with consequent moderate impairment in personal, family, social, educational, occupational, or other important areas of functioning (e.g., relationship conflict, performance problems at work, abandonment of a range of social and leisure activities).

All Index Terms

  • Bodily distress disorder, moderate

+++
  And here’s the Definition for 6B42 Bodily distress disorder, severe:

http://apps.who.int/classifications/icd11/browse/f/en#/http://id.who.int/icd/entity/1121638993

http://apps.who.int/classifications/icd11/browse/l-m/en#/http://id.who.int/icd/entity/1121638993

6B42 Bodily distress disorder, severe [In Mortality and Morbidity Linearizations]

Foundation Id: http://id.who.int/icd/entity/1121638993

Parent(s)

Definition

Bodily distress disorder, severe is a form of bodily distress disorder in which there is pervasive and persistent preoccupation to the extent that the symptoms may become the focal point of the person’s life, typically requiring extensive interactions with the health care system. Preoccupation with the experienced symptoms and their consequences causes serious impairment in personal, family, social, educational, occupational, or other important areas of functioning (e.g., unable to work, alienation of friends and family, abandonment of nearly all social and leisure activities). The person’s interests may become so narrow so as to focus almost exclusively on his or her bodily symptoms and their negative consequences.

All Index Terms

  • Bodily distress disorder, severe

+++
What will ICD-11 be field testing?

Field testing of a potential replacement for the existing ICD-10 Somatoform disorders framework is expected to be conducted over the next year or two. Disorders that survive the ICD-11-PHC field tests must have an equivalent disorder in the main ICD-11 classification.

So whatever replaces the existing ICD-10-PHC categories, F45 Unexplained somatic symptoms/medically unexplained symptoms and F48 Neurasthenia, (which is also proposed to be eliminated for the ICD-11 primary care version), will need an equivalent disorder in the main classification.

International field tests across a range of primary care settings had been anticipated to start from June, last year, but there were reported delays. It isn’t known whether consensus has been reached yet over disorder construct and diagnostic criteria for use in the field tests, or whether field testing is now underway.

I cannot confirm whether ICD-11 intends to release a protocol into the public domain for whatever construct it plans to field test, or may already be field testing.

Currently, there is no publicly available protocol or other information on finalized characteristics, diagnostic guidelines, criteria, inclusions, exclusions, differential diagnoses etc. that are planned to be used for the field tests which would provide the level of detail lacking in the public version of the Beta drafting platform.

+++

So which construct does ICD-11 Revision Steering Group favour?

Although BDD (and now its three severities) have been defined within the Beta draft, much remains unclear for proposals for the revision of this section of ICD-11 Mental and behavioural disorders.

The ICD-11 Primary Care Consultation Group’s alternative 2012 Bodily stress syndrome (BSS) construct – a near clone of Fink et al’s BDS criteria but with some SSD-like psychobehavioural responses tacked on – isn’t the construct that is entered and defined within the Beta draft.

In June 2013, Prof Gabriel Ivbijaro (not, himself, a member of the PCCG) and Prof Sir David Goldberg (who chairs the PCCG) published a joint editorial in Mental Health in Family Medicine, the official journal of The World Organization of Family Doctors (Wonca) Working Party on Mental Health, for which Prof Ivbijaro is Editor in Chief.

The authors advance the position that the forthcoming revision of ICD “provides an opportunity to include BDS in a revised classification for primary care” and imply that BDS (at least at that point) was progressing, imminently, to ICD-11 field trials.

This brief editorial was embargoed from June 2013 to June 2014 and I was unable to obtain a copy until last month, but you can read it now for free and in full here: Bodily distress syndrome (BDS): the evolution from medically unexplained symptoms (MUS).

Note, firstly, that the editorial does not declare Professor Goldberg’s interest as chair of the ICD-11 Primary Care Consultation Group.

It does not clarify whether the views and opinions expressed within the editorial represent the views of the authors or are the official positions of the PCCG working group, or of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders, or of the ICD-11 Revision Steering Group (RSG), or of any committees on which co-author, Prof Ivbijaro, sits or of any bodies to which Prof Ivbijaro is affiliated.

No publicly posted progress reports are being issued by ICD-11 or by either of the two groups making recommendations for the revision of this section of ICD and I do not have a second source that confirms the status of proposals as they stood in June 2013.

But taking the editorial at face value, it would appear that the PCCG had revised its earlier proposals for a BSS construct (that drew heavily on Fink et al’s BDS criteria but had included the requirement for some psychobehavioural responses) and were now recommending that the Fink et al BDS construct and criteria should progress for ICD-11-PHC field testing and evaluation, that is, using the same disorder name and (presumably) the same criteria set that is already operationalized in research and clinical settings, in Denmark.

(The rationale for the apparent revision of the earlier BSS disorder name is not discussed within the editorial; nor whether any modifications to, or deviance from a “pure” BDS construct and criteria were being recommended for the purposes of ICD-11 field testing.)

The editorial doesn’t clarify whether the PCCG, the S3DWG and the ICD-11 Revision Steering Group (RSG) had reached consensus – it does not mention the alternative proposals of the S3DWG, at all, or discuss what is entered into the Beta draft, or discuss the views and preferences of the Revision Steering Group for any of recommendations made by the two advisory groups, to date.

It is unclear whether a “pure” BDS construct (as opposed to the PCCG’s earlier BSS modification) had already gained Revision Steering Group approval for progressing to field testing, at the point the editorial was drafted, or whether Prof Goldberg was using this Wonca house journal as a platform on which to promote his own opinions and expectations, in a purely personal capacity.

Crucially, it doesn’t explain why, if a BDS-like construct were anticipated to be progressed to field trials in the second half of 2013, it is the S3DWG’s Bodily distress disorder diagnostic construct that has been listed and defined in the Beta draft for Foundation, Mortality and Morbidity, Primary Care High Resource, Primary Care Low Resource linearizations – not the PCCG’s 2012 BSS modification, or the “pure” BDS that Prof Goldberg evidently champions.

As a source of information on the current status of proposals for the revision of the Somatoform disorders this June 2013 editorial is problematic (and now also over a year out of date).

I suspect the politics between the 12 member PCCG (which includes Marianne Rosendal*), the 17 member S3DWG and the ICD-11 Revision Steering Group are intensely fraught given Professor Goldberg’s agenda for the revision of the Somatoform disorders, since fitting BDS into ICD-11 hasn’t proved to be the shoo in that Fink, Rosendal and colleagues had hoped for**, and given that BDS cannot be harmonized with DSM-5’s SSD, as they are conceptually divergent.

*Dr Marianne Rosendal (Department of Public Health, Aarhus University), who has published with Prof Per Fink, is the European representative on WONCA’s International Classification Committee. The vice-chair of the PCCG is Dr Michael Klinkman, a GP who represents WONCA (World Organization of Family Doctors). Dr Klinkman is current convenor of WONCA’s International Classification Committee (WICC) that is responsible for the development of ICPC-2.
**Presentation, Professor Per Fink, March 19, 2014 Danish parliamentary hearing on Functional Disorders. Prof Fink stated that he and his colleagues had tried to get WHO to incorporate a section for a special group of disorders where BDS could be placed that was located neither in psychiatry nor in general medicine, but had not been successful.

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Requests for clarification repeatedly stonewalled:

ICD Revision has been asked several times, via the Beta drafting platform, to clarify current proposals for the framework and disorder construct for a replacement for the ICD-10 Somatoform disorders and to clarify which construct it intends to take forward to field testing. ICD Revision has also been asked to comment on the following:

“If, in the context of ICD-11 usage, the S3DWG working group’s proposal for a replacement for the Somatoform disorders remains for a disorder model with good concordance with DSM-5′s SSD construct, what is the rationale for proposing to name this disorder “Bodily distress disorder”?

“Have the S3DWG, PCCG and Revision Steering Group given consideration to the significant potential for confusion if its replacement construct for the Somatoform disorders has greater conceptual alignment with the SSD construct but is assigned a disorder name that sounds very similar to, and is already being used interchangeably with an operationalized but divergent construct and criteria set?”

No response has been forthcoming.

Lack of publicly posted progress reports by both working groups, confusion over the content of the Beta draft and ICD Revision’s failure to respond to queries from stakeholders is hampering stakeholder scrutiny, discourse and input. It is time clinicians, researchers, allied professionals and advocacy organizations demanded transparency from ICD Revision around current proposals and field trial intentions.

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September symposium presentation on BDD:

In September, Professor Oye Gureje (who chairs the ICD-11 Expert Working Group on Somatic Distress and Dissociative Disorders), will be presenting on Proposals and evidence for the ICD-11 classification of Bodily Distress Disorders, as part of series of symposia on the development of the ICD-11 chapter for mental and behavioural disorders, at the World Psychiatric Association XVI World Congress, in Madrid, Spain, 14–18 September 2014 [7].

Unfortunately, I cannot attend this September symposia but would be pleased to hear from anyone who may be planning to attend.

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References:

1. Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry. 2012 Dec;24(6):556-67. http://www.ncbi.nlm.nih.gov/pubmed/23244611 [Full text behind paywall]

2. Lam TP, Goldberg DP, Dowell AC, Fortes S, Mbatia JK, Minhas FA, Klinkman MS: Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Fam Pract Feb 2013 [Epub ahead of print July 2012]. [Abstract: PMID: 22843638] Full free text: http://fampra.oxfordjournals.org/content/30/1/76.long

3. Ivbijaro G, Goldberg D. Bodily distress syndrome (BDS): the evolution from medically unexplained symptoms (MUS). Ment Health Fam Med. 2013 Jun;10(2):63-4. Full free text available on 2014/6/1: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822636/pdf/MHFM-10-063.pdf

4. http://funktionellelidelser.dk/en/about/bds/

5. Fink P and Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. Journal of Psychosomatic Research 2010;68:415–26.

6. Fink et al Proposed new BDS diagnostic classification

7. World Psychiatric Association XVI World Congress, Madrid, Spain, 14–18 September 2014.

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Further reading:

Dx Revision Watch Post: Editorial: Bodily distress syndrome (BDS): the evolution from medically unexplained symptoms (Goldberg and ICD-11-PHC), June 3, 2014: http://wp.me/pKrrB-3Uh

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