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To the Editor: Agreement on common systems of classification, coding, and terminology is important for clinical research, clinical decision support, and interoperability of electronic medical record systems. In this light, the Commentary by Dr McHugh,¹ which calls upon psychiatrists to bring coherence to the diagnostic classification represented by the DSM IV by moving away from disease classification based on symptoms, is laudable. He contrasts DSM IV with the International Classification of Diseases (ICD), which he considers a better type of scheme and refers to as "the internists’ manual."

I disagree with this characterization of ICD, particularly with regard to the version ICD, Ninth Revision, Clinical Modification (ICD-9-CM)² most widely used in the United States. Several studies have demonstrated the lack of completeness of ICD-9-CM for clinical documentation.^3-4 Moreover, without disputing the value of a terminology organized around anatomy and etiology, practicing physicians are challenged by such . . . [Full Text of this Article]

Robert A. Jenders, MD, MS
jenders@ucla.edu
Department of Medicine
Cedars-Sinai Medical Center
University of California
Los Angeles

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