# ICPC_Info

Exclusion:
low self-esteem P28; depressive disorder P76

Criteria:
feelings reported by the patient as an emotional or psychological experience not attributed to the presence of a mental disorder. A gradual transition exists from feelings that are unwelcome - but quite normal - and feelings that are so troublesome to the patient that professional help is sought


Exclusion:
overactive child P22; irritability in partner Z13

Criteria:
feelings reported by the patient as an emotional or psychological experience not attributed to the presence of a mental disorder, or behaviour indicating irritability or anger. A gradual transition exists from feelings or behaviour that are unwelcome - but quite normal - and those that are so troublesome that professional help is sought


Inclusion:
insomnia, nightmares, sleep apnoea, sleepwalking, somnolence

Criteria:
sleep disturbance as a diagnosis requires that the sleeping problem forms a major complaint, which, according to both patient and doctor, is not caused by another disorder but is a condition in its own right. Insomnia requires a quantitative or qualitative deficiency of sleep which is unsatisfactory in the patients' opinion, over a considerable period of time. In hypersomnia excessive daytime sleepiness and sleep attacks exist which limit the patient's performance


Exclusion:
non-organic impotence/loss of sexual fulfilment P08; concern with sexual preference P09

Criteria:
sexual problems with regard to desire not caused by any organic disorder or disease, but a reflection of the inability of a patient to participate in the sexual relationship s/he wants because of lack of desire, failure of genital response or function


Inclusion:
non-organic impotence or dyspareunia, premature ejaculation, vaginismus of psychogenic origin

Exclusion:
sexual problems with desire P07; concern with sexual preference P09; vaginismus NOS X04; organic impotence/sexual problems Y07

Criteria:
sexual problems with regard to fulfilment not caused by any organic disorder or disease, but a reflection of the inability of a patient to participate in the sexual relationship s/he wants because of failure of genital response or function, or problems with sexual development


Exclusion:
reduced sexual desire P07; reduced sexual fulfilment P08

Criteria:
sexual problems with regard to preference not caused by any organic disorder or disease, but a reflection of the inability of a patient to participate in the sexual relationship s/he wants because of problems with sexual identity, preference or orientation


Criteria:
stammering and stuttering: disorder of speech characterized by frequent repetitions/prolongations of sounds, or by frequent hesitations/pauses disrupting speech


Inclusion:
feeding problem, problem with eating behaviour of child

Exclusion:
anorexia nervosa P86; eating problem in adult T05

Note:
Problems with behaviour of children are particularly difficult to classify, which is illustrated by the fact that they are distributed over four chapters of ICPC. Whether or not parents present these problems to a GP will reflect their ideas about the gradual differences between normal - though maybe annoying - behaviour, and behaviour that is considered worrying or 'pathological'


Criteria:
involuntary voiding of urine by day/night not determined to be related to any organic disorder


Criteria:
encopresis requires repeated passage of usually well formed faeces in inappropriate places, considered abnormal in relation to age, and not caused by constipation/sphincter control disorder/another disease


Inclusion:
alcohol brain syndrome, alcohol psychosis, alcoholism, delirium tremens

Criteria:
a disorder due to the use of alcohol resulting in one or more of the following: harmful use with clinically important damage to health; dependence syndrome; withdrawal state; psychotic disorder

Note:
Substance abuse problem definitions should take into account the considerable differences between countries and cultures. A doctor can decide to label an episode as 'chronic alcohol abuse'  without the patient's agreement, and consequently also without the patient's  willingness to any medical intervention.


Criteria:
a disorder due to the use of alcohol resulting in acute intoxication, with/without a background of chronic abuse

Note:
A doctor can decide to label an episode as 'acute alcohol abuse' without the  patient's agreement, and consequently also without the patient's  willingness to agree to any medical intervention.


Criteria:
a disorder due to the use of tobacco resulting in one or more of the following: acute intoxication; harmful use with clinically important damage to health; dependence syndrome; withdrawal state

Note:
Substance abuse problem definitions should take into account the considerable differences between countries and cultures. An alcohol dependent or heroin addicted patient needs medical attention, but the definitions of 'tobacco abuse' are controversial. A physician can decide to label an episode as 'tobacco abuse' without the patients agreement, and consequently also without the'patient's willingness to agree to any medical intervention


Note:
Substance abuse problem definitions should take into account the considerable differences between countries and cultures. Some patients request and use tranquillizers, sleeping tablets, anorectics or laxatives inappropriately and for too long. In these cases physicians can decide to label the episode as 'medicine abuse' without the patients' agreement, and consequently also without the patient's willingness to agree to any medical intervention.


Criteria:
a disorder due to the use of a dependence producing psychoactive substance, resulting in one or more ofthe following conditions: acute intoxication; harmful use with clinically important damage to health; dependence syndrome; withdrawal state; psychotic disorder

Note:
Substance abuse problem definitions should take into account the considerable differences between countries and cultures. An alcohol dependent or heroin addicted patient needs medical attention, but the definitions of 'use of hashish' are controversial. Doctors can decide to label an episode as 'drug abuse' without the patient's agreement, and consequently also without the patient's willingness to agree to any medical intervention.


Inclusion:
amnesia, disorientation, disturbance of concentration


Inclusion:
delayed milestones, jealousy, overactive child, speech delay, temper tantrum

Exclusion:
behaviour symptom/complaint adolescent, adult P23, P80; concern about physical development/growth delay T10


Exclusion:
behaviour symptom/complaint child, adult P22, P80, P81


Exclusion:
attention deficit disorder P81; mental retardation P85

Criteria:
specific speech, language and learning problems with onset in childhood, together with an impairment of functions related to biological maturation of the central nervous system, and a steady course over time without spontaneous remissions or relapses, although the deficit may diminish as the child grows older


Inclusion:
empty nest syndrome, mid-life crisis, retirement problem

Exclusion:
senility, feeling/behaving old P05; menopause X11


Inclusion:
concern about mental disease, fear of attempting suicide

Criteria:
concern about/fear of mental disease in a patient without the disease/until the diagnosis is proven


Criteria:
limitation of function/disability due to a psychological problem


Inclusion:
delusions, eating disorders NOS, hallucinations, multiple psychological symptoms/complaints, poor hygiene, strange behaviour, suspiciousness


Criteria:
a syndrome due to a disease of the brain, usually of a chronic and/or progressive nature, with clinically significant disturbance of multiple higher cortical functions (memory, thinking, orientation, comprehension), together with intact consciousness

Consider:
senility P05; other psychological symptoms P29


Exclusion:
psychosis caused by alcohol P15; unspecified psychosis P98

Criteria:
organic psychiatric disorders as a diagnosis require psychological syndromes, patterns or behaviour due to organic disease


Criteria:
fundamental and characteristic distortions of thinking, perception and affect that are inappropriate or blunted (eg. thought-echo, -insertion, -withdrawal, delusional perceptions, hallucinatory voices, delusions of control), together with a clear consciousness and unaffected intellectual capacity.


Inclusion:
bipolar disorder, hypomania, mania, manic depression

Criteria:
a fundamental disturbance in affect and mood, alternately being elated and depressed (with/without associated anxiety). In manic disorder mood, energy and activity are simultaneously elevated. In bipolar disease, at least two periods of disturbed mood, shifting from elevated to lowered are observed


Exclusion:
anxiety with depression P76; anxiety NOS P01

Criteria:
clinically significant anxiety that is not restricted to any particular environmental situation. It manifests as a panic disorder (recurrent attacks of severe anxiety not restricted to any particular situation, with or without physical symptoms) or as a disorder in which generalized and persistent anxiety, not related to any particular situation, occurs with variable physical symptoms


Inclusion:
conversion disorder, hypochondriacal disorder, hysteria, pseudocyesis

Criteria:
somatization disorder is characterized by a preoccupation with and repeated presentations of physical symptoms and complaints together with persistent requests for medical investigations in spite of repeated negative findings and reassurances by doctors. For this diagnosis, the presentation of multiple, recurrent and frequently changing physical symptoms presented to the family physician over a period of at least one year is required. Hypochondriacal disorder requires a persistent preoccupation with either the physical appearance or with the possibility of having a serious disease, together with persistent somatic complaints over a period of at least one year, in spite of repeated negative findings and reassurances by doctors

Note:
Somatization is the repeated presentation of physical symptoms and complaints suggesting physical disorders for which no demonstrable organic findings or physiological mechanisms are responsible, and for which there is positive evidence that they are linked to psychological factors while the patient does not experience a sense of controlling the production of these symptoms in dealing with the psychological factors. Physical symptoms and complaints including pain which are presented as if they were due to a physical disorder of a system/organ under autonomic nervous control, or which consist of persistent, severe/distressing pain which cannot be explained by a physiological process/disorder, are coded with a symptom/complaint diagnosis representing the physical aspect, and - if possible - with a code representing the emotional or psychosocial problem with which it is associated. The definition of somatization disorder in ICD-10 (a minimum of 2 years) is too stringent for use in general pract.


Inclusion:
depressive neurosis/psychosis, mixed anxiety and depression, reactive depression, puerperal/postnatal depression

Criteria:
fundamental disturbance in affect and mood towards depression. Mood, energy and activity are simultaneously lowered, together with an impaired capacity for enjoyment, interest and concentration. Sleep and appetite are usually disturbed and self-esteem and confidence are decreased


Inclusion:
suicide gesture, successful attempt (double code with A96)


Criteria:
increased fatigueability with unpleasant associations, difficulties in concentration and a persistent decrease in performance and coping efficiency; the feeling of physical weakness and exhaustion after mental effort or after a minimal physical effort is often accompanied by muscular pain and an inability to relax

Consider:
fatigue/postviral fatigue/chronic fatigue syndrome A04


Criteria:
phobic anxiety disorder requires outspoken anxiety, evoked only in well defined situations that are not generally considered dangerous: the patient tries to avoid these situations, or endures them with dread. Obsessive compulsive disorder requires distressing and recurrent obsessional thoughts/acts recognized by the patient as his/her own; compulsive stereotyped behaviours are repeated again and again, intended to prevent some objective unlikely event and recognized by the patient as pointless and ineffective


Inclusion:
psychopathy, compensation neurosis, Munchhausen's syndrome, adult behaviour disorder

Criteria:
persistent and clinically important conditions and behaviour patterns in an individual's lifestyle and mode of relating to him/herself and others, reflecting significant/extreme deviations from the way an average individual in a given culture perceives, feels and behaves. This pattern is deeply ingrained and longlasting


Inclusion:
attention deficit disorder (ADD), hyperactivity

Exclusion:
hyperkinetic disorder with adolescent onset P23; learning disorder P24

Criteria:
early onset of a lack of persistence in activities requiring cognitive involvement, with a tendency to move from one activity to another without completing any one, with disorganised and ill-regulated behaviour, and excessive activity


Criteria:
a stressful event followed by a major state of distress and disturbance, with a delayed or protracted reaction, flashbacks, nightmares, emotional blunting and anhedonia interfering with social functioning and performance, and including depressed mood, anxiety, worry and feeling unable to cope, persistent over time

Consider:
feeling anxious P01; acute stress reaction P02; feeling depressed P03


Exclusion:
mental retardation due to congenital anomaly A90

Criteria:
arrested/incomplete development of the mind with impairment of skills during the developmental period, and a low overall level of intelligence, with/without impairment of behaviour.


Criteria:
Anorexia nervosa: deliberate weight loss induced and sustained by the patient, associated with an intensive and overvalued dread of fatness and flabbiness of body contures.  
Bulimia: repeated bouts of overeating and an excessive preoccupation with body weight, leading to a pattern of overeating followed by induced vomiting or use of purgatives

Consider:
eating disorder, food refusal P11, P29; feeding problem T04, T05


Inclusion:
painful respiration, pleuritic pain, pleurodynia

Exclusion:
chest pain A11; musculoskeletal chest pain L04; nose pain R08; sinus pain R09; sore throat R21; chest tightness R29; pleurisy R82


Exclusion:
wheezing R03; stridor R04; hyperventilation R98


Exclusion:
dyspnoea R02; stridor R04; hyperventilation R98


Inclusion:
abnormal breathing, apnoea, holding breath, respiratory distress, snoring, stridor, tachypnoea

Exclusion:
sleep apnoea P06; respiratory pain R01; dyspnoea R02; wheezing R03; cough R05; hyperventilation R98


Inclusion:
pain in nose, post-nasal drip, prominent nose, red nose

Exclusion:
anosmia N16; epistaxis R06; blocked nose/sneezing R07; complaint of sinuses R09; rhinophyma S99


Inclusion:
blocked sinus, congested sinus, pain/pressure in sinus

Exclusion:
headache N01; face pain N03; nasal congestion R07


Inclusion:
dry/inflamed/red/sore throat, large tonsils, lump in throat, tonsillar pain

Exclusion:
voice symptoms R23; tonsillar hypertrophy R90


Exclusion:
neurological disorder of speech N19; stammering/stuttering/tic P10; sore throat R21


Criteria:
concern about/fear of cancer of respiratory system in a patient without the disease/until the diagnosis is proven


Exclusion:
fear of respiratory cancer R26; if patient has the disease, code the disease

Criteria:
concern about/fear of other respiratory disease in a patient without the disease/until the diagnosis is proven


Inclusion:
disability due to hypoxia, hypercapnia, reduced lung function, respiratory disease, disease of nose/larynx/throat

Criteria:
limitation of function/disability due to a respiratory problem


Inclusion:
chest tightness, fluid on lung, hiccough, lung congestion


Criteria:
respiratory infection with a characteristic staccato paroxysmal cough ending with a high-pitched inspiratory whoop; or respiratory infection with cough of at least three weeks duration in contact with known pertussis; or demonstration of Bordetella pertussis or parapertussis

Consider:
cough R05; upper respiratory infection R74


Exclusion:
scarlet fever A78; erysipelas/strep skin infection S76

Criteria:
acute inflammation of the throat, plus demonstration of beta-haemolytic streptococci


Inclusion:
acute rhinitis, coryza, head cold, nasopharyngitis, pharyngitis, URTI/URI

Exclusion:
measles A71; infectious mononucleosis A75; viral pharyngoconjunctivitis F70; sinusitis R75; tonsillitis/quinsy R76; laryngitis/croup R77; influenza R80; chronic pharyngitis R83; allergic rhinitis R97

Criteria:
evidence of acute inflammation of nasal or pharyngeal mucosa with absence of criteria for more specifically defined acute respiratory infection classified in this section


Criteria:
purulent nasal/post-nasal discharge, or previous medically treated episodes of sinusitis, plus tenderness over one/more sinuses, or deep-seated aching facial pain aggravated by dependency of head, or opacity on transillumination; or imaging evidence of sinusitis; or pus obtained from the sinus

Consider:
headache N01; face pain N03; upper respiratory tract infection R74


Exclusion:
infectious mononucleosis A75; strep throat R72; diphtheria R83; hypertrophy/chronic infection of tonsils R90

Criteria:
sore throat or fever with reddening of tonsil(s) more than the posterior pharyngeal wall, and either pus on swollen tonsil(s) or enlarged tender regional lymph nodes

Consider:
acute upper respiratory tract infection R74


Criteria:
hoarseness/stridor with/without respiratory distress, or deep dry painful cough (barking in children), and normal chest signs


Inclusion:
acute lower respiratory infection NOS, bronchitis NOS, chest infection NOS, laryngotracheobronchitis, tracheobronchitis

Exclusion:
influenza R80; chronic bronchitis R91; allergic bronchitis R96

Criteria:
in children and adults: cough and fever with scattered or generalized abnormal chest signs: wheeze, coarse rales, rhonchi or moist sounds;
in infants (bronchiolitis): dyspnoea and hyperinflation

Consider:
wheezing R03; cough R05; upper respiratory tract infection R74


Exclusion:
emphysema/chronic obstructive pulmonary (lung, airways) disease R95; bronchiectasis R99

Criteria:
cough with sputum on most days for at least 3 months in each of at least 2 years; and scattered rales/rhonchi on auscultation of the chest during these episodes

Consider:
cough R05; abnormal sputum/phlegm R25; bronchitis NOS R78


Exclusion:
gastric flu D70; influenza pneumonia R81

Criteria:
myalgia and cough without abnormal respiratory physical signs other than inflammation of nasal mucous membrane and throat, plus three or more of the following: sudden onset (within 12 hours); rigors/chills/fever; prostration and weakness; influenza in close contacts; influenza epidemic; or viral culture/serological evidence of influenza virus infection

Consider:
fever A03; virus infection NOS A77; upper respiratory tract infection R74


Inclusion:
bacterial/viral pneumonia, bronchopneumonia, influenzal pneumonia, Legionnaire's disease, pneumonitis


Exclusion:
tuberculosis A70; pneumonia R81; malignant effusion to be coded to origin of malignancy

Criteria:
clinical evidence of pleural exudate; or pleuritic pain accompanied by pleural friction rub; or investigative evidence of inflammatory pleural exudate


Inclusion:
chronic nasopharyngitis, chronic pharyngitis, chronic rhinitis NOS, diphtheria, empyema, epiglottitis, fungal respiratory infection, lung abscess, protozoal infection (without pneumonia)


Exclusion:
malignancy of unknown site A79; a secondary malignancy from known site to be coded to site


Exclusion:
Hodgkin's disease B72, malignancy of trachea/bronchus/lung R84


Exclusion:
unspecified respiratory neoplasm R92; nasal polyp R99

Criteria:
characteristic clinical or histologic appearance


Exclusion:
drowning A88; foreign body lodged in oesophagus D79; foreign body in ear H76; aspiration pneumonia R99

Criteria:
visualization of foreign body directly/endoscopically/using imaging

Consider:
other complaint of respiratory system R29


Exclusion:
drowning A88; fractured nose L76; foreign body in respiratory system R87


Exclusion:
cleft lip/palate D81; cystic fibrosis T99


Exclusion:
acute tonsillitis R76; allergic rhinitis R97


Inclusion:
respiratory neoplasm unspecified as benign or malignant/when histology is not available

Exclusion:
secondary neoplasm unknown site A79; malignant respiratory neoplasm R84, R85; benign respiratory neoplasm R86


Inclusion:
chronic obstructive airways (COAD), lung (COLD), pulmonary (COPD) disease, chronic airways limitation (CAL), emphysema

Exclusion:
chronic bronchitis R79; asthma R96; bronchiectasis R99; cystic fibrosis T99

Criteria:
objective evidence of airway obstruction, not/only partially relieved by bronchodilators


Inclusion:
reactive airways disease, wheezy bronchitis

Exclusion:
bronchiolitis R78; chronic bronchitis R79; emphysema R95

Criteria:
recurrent episodes of reversible acute bronchial obstruction with wheeze/dry cough; or diagnostic test meeting currently accepted criteria for asthma


Inclusion:
hay fever, nasal allergy, vasomotor rhinitis

Exclusion:
upper respiratory tract infection R74, chronic rhinitis NOS R83


Criteria:
symptoms related to hyperventilation and relieved by rebreathing expired air


Inclusion:
aspiration pneumonia, bronchiectasis, deviated nasal septum, lung complication of other disease, mediastinal disease, nasal polyp, other disease of larynx; pneumoconiosis, pneumothorax, pneumonitis due to allergy/chemicals/dust/ fumes/mould, pulmonary collapse, respiratory failure


Inclusion:
burning sensation, painful lesion or rash, soreness

Exclusion:
tingling fingers/feet/toes N05; other sensation disturbance N06


Exclusion:
anogenital pruritus D05; dermatitis artefacta S99; vulval pruritus X16; nipple pruritus X20


Exclusion:
molluscum contagiosum S95; genital warts X91, Y76


Inclusion:
blotches/erythema/redness occurring in multiple sites

Exclusion:
other viral exanthem A76; generalized lumps/swellings skin S05


Inclusion:
'circles under eyes', cyanosis, flushing, freckles, pallor, pigmentation


Exclusion:
post-traumatic infection finger/toe S11; tinea S74; monilia/candida S75


Exclusion:
lymphadenitis B70; perianal boil D95; external auditory meatus H70; boil of nose R73; infected finger/toe S09; wound infection S11; erysipelas S76; pilonidal abscess S85; hydradenitis S92; boil female external genitalia X99; boil male external genitalia Y99


Exclusion:
surgical wound infection A87; erysipelas, pyoderma S76; impetigo S84


Exclusion:
toxic effects non-medical substance A86; infected bite S11; scabies S72; pediculosis S73


Exclusion:
toxic effects non-medical substance A86; infected bite S11


Inclusion:
burn/scald of all degrees, external chemical burn


Criteria:
bruise/contusion with intact skin surface


Exclusion:
sweating problem A09; scalp symptom/complaint S24;  ichthyosis S83; sweat gland disease S92; vulval symptom/complaint X10


Exclusion:
trichotillomania P29; folliculitis S10; hair loss/baldness S23; dandruff S86


Criteria:
concern about/fear of cancer of skin in a patient without the disease/until the diagnosis is proven


Exclusion:
fear of cancer of skin S26; if patient has the disease, code the disease

Criteria:
concern about/fear of having other skin disease in a patient without the disease/until the diagnosis is proven


Criteria:
limitation of function/disability due to a skin problem


Inclusion:
cellulite, petechiae, problems with umbilicus, skin lesion, sore(s)


Inclusion:
post-herpetic neuralgia, shingles, herpes zoster ophthalmicus

Criteria:
grouped vescicular eruptions, unilateral distribution, over area of a single dermatome


Exclusion:
herpes simplex of eye without corneal ulcer F73; genital infections X90, Y72

Criteria:
vesicles with erythematous base in localised area(s); plus past history of similar lesions, or virological or serological evidence


Criteria:
intense pruritic skin lesions plus arrays of burrows on sides of palms, fingers, penis or skin folds; or demonstration of parasites or ova in lesions


Exclusion:
infected insect bites S11; insect bites S12

Criteria:
demonstration of nits on hair shafts or insects on skin/clothes


Inclusion:
fungal skin infection, onychomycosis, pityriasis versicolor, ringworm, tinea

Criteria:
pruritic scaly lesions with central clearing and small vesicles at border; or demonstration of fungus


Inclusion:
monilial intertrigo, thrush involving nails/perianal region/skin

Exclusion:
oral thrush D83; genital infection X72, Y75


Inclusion:
cellulitis, erysipelas, pyoderma, strep skin infection

Exclusion:
boil/carbuncle/other localized skin infection S11; impetigo S84; molluscum contagiosum S95; acne S96


Inclusion:
basal cell carcinoma, malignant melanoma, rodent ulcer, squamous cell carcinoma of skin

Consider:
other malignant neoplasm (when primary site is uncertain) A79; neoplasm of skin unspecified as benign or malignant/when histology is not available S79


Inclusion:
benign skin neoplasm/skin neoplasm not specified as benign or malignant/when histology is not available, dermoid cyst, premalignant lesion

Exclusion:
residual haemorrhoidal skin tag K96; solar keratosis S80; haemangioma S81; mole/pigmented nevus S82; keloid, hyperkeratosis, seborrhoeic/senile warts S99


Inclusion:
photosensitivity, radiation skin damage, senile keratosis, solar hyperkeratosis, polymorphous light eruption

Exclusion:
skin damage due to man made radiation A87, A88


Criteria:
vascular or lymphatic tumour, elevated above skin and emptying on pressure


Criteria:
spreading skin lesion consisting of macules, vesicles, pustules or crust with underlying raw area


Criteria:
greasy, scaly lesions with underlying erythema on one or more areas of scalp, face, sternum, interscapular areas, around umbilicus and in body folds, not attributable to other skin disease

Consider:
localized rash S06; generalized rash S07


Exclusion:
dermatitis/atopic eczema affecting external auditory meatus H70; allergic dermatitis S88; diaper rash S89

Criteria:
pruritic exudative lesions with/without lichenification over face and neck, wrists and hands, chest, back of knees and front of elbow


Inclusion:
allergic dermatitis, chemical dermatitis, dermatitis NOS, eczema NOS, intertrigo, plant sting, skin allergy

Exclusion:
allergy/allergic reaction unspecified A92; contact and other dermatitis of the eyelid F71; contact/other dermatitis of external auditory meatus H70; atopic eczema S87; diaper rash S89; urticaria S98 ; dermatitis artefacta/neurodermatitis S99

Criteria:
pruritic erythematous lesions related to exposure to chemical substance


Criteria:
dermatitis, primarily of the diaper area and sparing creases


Criteria:
oval, scaly eruptions along skin tension lines of trunk, with a history of a solitary lesion preceeding presenting rash


Criteria:
plaques with silvery scales on knees, elbows or scalp and/or stippled/pitted nails


Inclusion:
dyshidrosis, heat rash, hydradenitis, miliaria, pompholyx, prickly heat, sweat rash


Inclusion:
bedsore, decubitus ulcer, pressure sore, varicose ulcer


Exclusion:
drug allergy A85; angioedema/allergic oedema A92


Inclusion:
dermatitis artefacta, discoid lupus erythematosus, erythema multiforme, erythema nodosum, granuloma, granuloma annulare, hyperkeratosis NOS, keloid, keratoacanthoma, lichen planus, neurodermatitis, onychogryphosis, rosacea, rhinophyma, scar, seborrhoeic or senile warts, striae atrophicae, vitiligo


Inclusion:
problem of what and how to eat/feed infant/child

Exclusion:
food allergy A92; food intolerance D99; feeding problem/eating disorders with psychological cause P11


Inclusion:
problem of what and how to eat/feed adult

Exclusion:
food allergy A92; dysphagia D21; food intolerance D99; psychological eating disorders/ food refusal P29; anorexia/bulimia nervosa P86; loss of appetite T03


Inclusion:
failure to thrive, physiological delay growth

Exclusion:
delayed milestones P22; learning disorder P24; mental retardation P85; delayed puberty T99


Criteria:
concern about/fear of cancer of endocrine system in a patient without the disease/until the diagnosis is proven


Exclusion:
fear of cancer of endocrine system T26; if patient has the disease, code the disease

Criteria:
concern about/fear of other endocrine/metabolic/nutritional disease in a patient without the disease/until the diagnosis is proven


Criteria:
limited function/disability due to a problem of the endocrine/metabolic/nutritional system


Consider:
other/unspecified endocrine neoplasm T73; goitre T81


Exclusion:
other/unspecified endocrine neoplasm T73; goitre T81


Inclusion:
other endocrine neoplasm/endocrine neoplasm not specified as benign or malignant/when histology is not available


Exclusion:
neoplasm of thyroid gland T71-T73; thyroglossal cyst T78; toxic goitre T85; hypothyroidism T86


Criteria:
a body mass index greater than 25 but less than 30


Criteria:
laboratory evidence of excessive thyroid hormone; or thyroid nodule or goitre plus tremor, weight loss, and rapid pulse (over l00/min at rest) or eye signs (exophthalmos, lid lag, or ophthamoplegia)


Criteria:
laboratory evidence of diminished thyroid hormone activity and excessive thyroid stimulating hormone; or four or more of the following: weakness/tiredness; mental changes: apathy, poor memory, slowing; voice changes: coarser, deeper slower speech; undue sensitivity to cold; constipation; coarse puffy facial features; cool dry, sallow skin, decreased sweating; peripheral oedema


Criteria:
hypoglycaemia demonstrated by biochemical testing, or characteristic symptoms in a diabetic patient relieved by ingestion or injection of sugar


Inclusion:
juvenile onset diabetes, type 1 diabetes

Exclusion:
drug induced hyperglycaemia A85; hyperglycaemia as isolated finding A91; non-insulin dependent diabetesT90; gestational diabetes W85

Criteria:
patient requiring regular ongoing treatment with insulin after diagnosis confirmed by one of the following:(a) the classic symptoms of diabetes, such as polyuria, polydypsia, and rapid weight loss, together with unequivocal elevation of plasma glucose (b) fasting blood glucose levels of 8mmol/l (l40mg/dl) or more on two or more occasions (c) random blood glucose levels of 11mmol/l (200mg/dl) or more on two or more occasions (d) an oral Glucose Tolerance Test (75gm glucose) with one value of plasma glucose at between one and two hours of 11mmol/l (200mg/dl) or more, and plasma glucose at two hours of 11mol/l (200mg/dl) or more;
these WHO-criteria may change over time; also, criteria differences may exist between national health care systems

Consider:
hyperglycaemia A91; diabetes, non-insulin dependent T90

Note:
1.double code complications such as retinopathy F83, nephropathy U88
2. in pregnancy, double code with W84


Inclusion:
diabetes NOS, late onset diabetes, type 2 diabetes

Exclusion:
drug induced hyperglycaemia A85; hyperglycaemia as isolated finding A91; insulin-dependent diabetes T89; gestational diabetes W85

Criteria:
patient not requiring regular ongoing treatment with insulin after diagnosis confirmed by one of the following:(a) the classic symptoms of diabetes, such as polyuria, polydypsia, and rapid weight loss, together with unequivocal elevation of plasma glucose (b) fasting blood glucose levels of 8mmol/l (l40mg/dl) or more on two or more occasions (c) random blood glucose levels of 11mmol/l (200mg/dl) or more on two or more occasions(d) an oral Glucose Tolerance Test (75gm glucose) one value of plasma glucose at between one and two hours of 11mmol/l (200mg/dl) or more and plasma glucose at two hours of 11mol/l (200mg/dl) or more;
these WHO-criteria may change over time; also, criteria differences may exist between national health care systems

Consider:
consider: hyperglycaemia A91; diabetes, insulin dependant T89

Note:
1. double code complications such as retinopathy F83, nephropathy U88
2. In pregnancy, double code with W84


Inclusion:
beri-beri, dietary mineral deficiency, iron deficiency without anaemia, malnutrition, marasmus, scurvy

Exclusion:
iron deficiency anaemia B80; pernicious anaemia B81; malabsorption syndrome/sprue D99


Exclusion:
drug induced gout A85; raised uric acid A91; pseudo-gout/other crystal arthropathy T99


Inclusion:
abnormality of lipoprotein level, hyperlipidaemia, raised level of cholesterol/triglycerides, xanthoma


Inclusion:
acromegaly, adrenal/ovarian/ pituitary/parathyroid/ testicular/other endocrine dysfunction, amyloidosis, crystal arthropathy, Cushing's syndrome, cystic fibrosis, diabetes insipidus, Gilbert's syndrome, hyperaldosteronism, osteomalacia,porphyria, precocious/delayed puberty, pseudo-gout, renal glycosuria, thyroiditis

Exclusion:
food allergy A92; food intolerance D99; osteoporosis L95


Exclusion:
frequent/urgent urination U02; urethritis U72


Inclusion:
enuresis of organic origin, involuntary urination, stress incontinence

Exclusion:
urine incontinence of psychogenic origin P12


Criteria:
blood in urine proven by macroscopic/microscopic/chemical test


Inclusion:
kidney pain, kidney trouble, renal colic


Criteria:
concern about/fear of urinary cancer in a patient without the disease/until the diagnosis  is proven


Exclusion:
fear of cancer of urinary system U26; if patient has the disease, code the disease

Criteria:
concern about/fear of other urinary disease in a patient without the disease/until the diagnosis is proven


Criteria:
limitation of function/disability due to a urinary problem


Exclusion:
irritable bladder/bladder pain U13; kidney problems U14


Inclusion:
infection of kidney, renal/perinephric abscess

Criteria:
two of  the following: flank pain, renal tenderness, investigation evidence of chronic renal damage; plus clinical or laboratory evidence of urinary tract infection


Inclusion:
acute/chronic cystitis (non-venereal), asymptomatic bacteriuria, lower urinary tract infection, urinary tract infection NOS

Exclusion:
pyelonephritis U70; urethritis U72; vaginitis X84; balanitis Y75


Inclusion:
chlamydial urethritis, nonspecific urethritis, urethral syndrome, meatitis

Exclusion:
gonococcal urethritis female X71; urethritis trichomonal, female X73; gonococcal urethritis male Y71

Criteria:
urethral discharge with frequency, burning, pain or urgency on urination without bacteriuria by microscopy or culture; or inflammation of external urinary meatus

Consider:
painful urination U01; frequent/urgent urination U02; irritable bladder U13; urethral discharge X29, Y03


Inclusion:
malignant neoplasm ureter, malignant neoplasm urethra


Inclusion:
bladder papilloma, polyp of urinary tract


Exclusion:
histologically proven urinary tract neoplasms U75, U76, U77, U78


Inclusion:
contusion kidney, foreign body in urinary tract


Inclusion:
duplex kidney/ureter, congenital polycystic kidney


Inclusion:
acute glomerulonephritis, analgesic nephropathy, chronic glomerulo-nephritis, nephritis, nephropathy, nephrosclerosis, nephrotic syndrome

Criteria:
three or more of the following: hematuria, proteinuria, renal salt and water retention, decreased renal function, persistent urinary sediment abnormalities; or renal biopsy evidence

Consider:
abnormal urine test result U98; kidney complaint U14


Criteria:
albuminuria following ambulation, no albuminuria following overnight recumbency and no evidence of renal disease


Criteria:
colicky pain and either haematuria or history of urinary stone in the past; or passage of calculus; or imaging evidence of calculus

Consider:
blood in urine U06; renal colic U14; other urinary symptom U29; abnormal urine test U98


Inclusion:
glycosuria, proteinuria, pus in urine, pyuria

Exclusion:
haematuria/blood in urine U06; orthostatic albuminuria/proteinuria U90


Inclusion:
bladder diverticulum, hydronephrosis, hypertrophic kidney, obstruction bladder neck, renal failure, urethral caruncle, urethral stricture, ureteric reflux, uraemia


Inclusion:
delayed menstruation, symptoms suggestive of pregnancy

Exclusion:
fear of pregnancy W02, pregnancy confirmed W78, W79


Inclusion:
concern about possibility of unwanted pregnancy

Exclusion:
concern/fear if unwanted pregnancy confirmed W79


Inclusion:
hyperemesis, morning sickness in confirmed pregnancy


Inclusion:
family planning in women using oral hormonal therapy


Inclusion:
family planning involving female sterilization


Exclusion:
genetic counseling A98; oral contraception W11; IUD W12; family planning by female sterilization W13


Criteria:
failure to conceive after 2 years of trying

Consider:
other symptom/complaint about pregnancy W29


Criteria:
heavy bleeding at or within 6 weeks of parturition


Exclusion:
puerperal depression P76; post-partum bleeding W17; lactation complaints W19; complications of puerperium W96

Criteria:
complaints related to and within six weeks of parturition


Inclusion:
galactorrhoea, suppression of lactation, weaning

Exclusion:
puerperal mastitis W94; cracked nipples W95


Exclusion:
if patient has the complication, code the complication

Criteria:
concern about/fear of complications in a patient without them/until they are proven


Criteria:
limitation of function/disability due to or related to pregnancy


Criteria:
infection of birth canal or reproductive organs within 6 weeks of parturition


Exclusion:
puerperal infection W70; puerperal mastitis W94


Inclusion:
results of injury interfering with pregnancy

Exclusion:
new injury caused by childbirth W92, W93


Inclusion:
maternal anomaly which could affect pregnancy/childbirth


Exclusion:
unwanted pregnancy W79, ectopic pregnancy W80, high risk pregnancy W84


Criteria:
confirmation by ultrasound, laparoscopy, culdoscopy or surgery

Consider:
antepartum bleeding W03, other symptom/complaint in pregnancy W29


Inclusion:
eclampsia, hypertension, oedema and proteinuria in pregnancy, pre-eclampsia

Consider:
other symptom/complaint in pregnancy W29


Exclusion:
antepartum bleeding W03; induced abortion W83; premature contractions after the 28th week of pregnancy W92; foetal death/stillbirth after the 28th week of pregnancy W93


Inclusion:
termination of pregnancy, all complications


Inclusion:
aged primipara, anaemia of pregnancy, diabetes/other pre-existing chronic disease affecting pregnancy, disproportion, hydramnios, malpresentation, multiple pregnancy, placenta praevia, previous caesarian section, premature labour, small foetus for age

Exclusion:
infections complicating pregnancy W71; ectopic pregnancy W80; toxaemia of pregnancy W81; gestational diabetes W85


Criteria:
fasting plasma glucose over 5.5 mmol/L and/or plasma glucose level greater than 8.0 mmol/L two hours after a 75g oral glucose tolerance test


Inclusion:
livebirth after complicated delivery: assisted extraction, breech delivery, caesarian section, dystocia, induction of labour, injuries caused by childbirth, placenta praevia in delivery, version

Exclusion:
post-partum haemorrhage W17, eclampsia W81


Inclusion:
stillbirth after complicated delivery: assisted extraction, breech delivery, caesarian section, dystocia, induction of labour, injuries caused by childbirth, placenta praevia in delivery, version


Criteria:
pain, inflammation of breast within 6 weeks of parturition or while lactating


Inclusion:
breast disorder in puerperium, cracked nipple

Exclusion:
disorders of lactation W19; mastitis W94; breast problem not related to pregnancy/lactation X21


Exclusion:
puerperal depression P76; puerperal psychosis P98; puerperal infection W70; toxaemia of pregnancy W81; breast disorder in pregnancy W95


Exclusion:
menstrual pain X02; dyspareunia female X04; breast pain female X18


Exclusion:
question of pregnancy W01; fear of pregnancy W02


Inclusion:
breakthrough bleeding, dysfunctional uterine bleeding, metrorrhagia, ovulation bleeding, spotting

Exclusion:
post-menopausal bleeding X12; post-coital bleeding  X13


Criteria:
postponement of the expected regular menstruation by hormonal treatment


Inclusion:
atrophic vaginitis, menopause syndrome, symptom/complaint related to menopause, senile vaginitis


Criteria:
vaginal bleeding following either at least six months amenorrhoea or demonstration of menopause by appropriate laboratory test


Exclusion:
bleeding X06, X07, X08; atrophic vaginitis X11; gonorrhoea female X71; urogenital candidiasis female X72; urogenital trichomoniasis female X73; chlamydia female X92


Exclusion:
genital pain X01; organic vaginismus X04; atrophic vaginitis X11


Inclusion:
nipple discharge, nipple fissure, nipple pain/pruritus, nipple retraction

Exclusion:
nipple symptom/complaint in pregnancy/lactation W19


Inclusion:
mastitis (non lactating), mastopathy, galactorrhoea


Exclusion:
fear of HIV/AIDS B25; if the patient has the disease, code the disease

Criteria:
concern about/fear of sexually transmitted disease in a patient without the disease/until the diagnosis is proven


Criteria:
concern about/fear of sexual dysfunction in a patient without sexual dysfunction


Criteria:
concern about/fear of female genital cancer in a patient without the disease/until the diagnosis is proven


Criteria:
concern about/fear of female breast cancer in a patient without the disease/until the diagnosis is proven


Exclusion:
fear of female genital cancer X25; fear of female breast cancer X26; if patient has the disease, code the disease

Criteria:
concern about/fear of other female genital/breast disease in a patient without the disease/until the diagnosis is proven


Exclusion:
sexual dysfunction P07, P08; painful intercourse female/ vaginismus X04

Criteria:
limitation of function/disability due to a problem of the female genital system (including breast)


Criteria:
demonstration of Treponema pallidum on microscopy, or positive serological test for syphilis


Criteria:
purulent vaginal discharge in a patient after a contact with a proven case; or gram negative intra-cellular diplococci demonstrated in discharge; or culture of Neisseria gonorrhea


Inclusion:
monilial infection of vagina/cervix, thrush

Criteria:
inflamed urogenital mucosa or skin with characteristic white adherent exudate; or demonstration of candida


Criteria:
characteristic foul smelling discharge or demonstration of trichomonads on microscopy


Exclusion:
sexually transmitted diseases female X70-X73; chlamydia infection female X92

Criteria:
lower abdominal pain with marked tenderness of uterus or adnexa by palpation, plus other evidence of inflammation


Inclusion:
carcinoma-in-situ cervix, cervical intraepithelial neoplasia (CIN) grade 3

Exclusion:
abnormal  cervix smear (CIN) grades 1 and 2  X86


Inclusion:
carcinoma-in-situ female breast, intraductal carcinoma


Inclusion:
malignancy of adnexae, ovaries, uterus, vagina, vulva

Exclusion:
carcinoma-in-situ cervix X75; other female genital carcinoma-in-situ X81

Consider:
other/unspecified female genital neoplasm X81


Inclusion:
fibroid uterus, fibromyoma of cervix, myoma

Criteria:
enlargement of the uterus not due to pregnancy or malignancy, with single or multiple firm tumours of the uterus


Exclusion:
polyp of cervix X85; physiological cyst of ovary X99


Exclusion:
carcinoma-in-situ cervix X75; endometrial polyp X99


Inclusion:
foreign body in vagina, female circumcision

Exclusion:
genital injury due to childbirth W92, W93


Exclusion:
atrophic vaginitis X11; genital candidiasis X72; genital trichomoniasis X73


Inclusion:
cervical erosion, cervical leukoplakia, cervicitis, mucous cervical polyp, old laceration of cervix

Exclusion:
abnormality of cervix in pregnancy/childbirth/puerperium W77; abnormal cervix smear X86


Inclusion:
cervical intraepithelial neoplasia (CIN) grades 1 and 2, cervical dysplasia

Exclusion:
cervical intraepithelial neoplasia (CIN) grade 3 X75


Inclusion:
chronic cystic disease of breast, cystic fibroadenosis of breast, dysplasia of breast, solitary cyst of breast


Criteria:
cyclic occurrence in the menstrual cycle of two or more of  the following: oedema; breast tenderness/swelling; headache; irritability; mood changes


Criteria:
small vesicles with characteristic appearance and location which evolve to painful ulcers and scabs


Inclusion:
venereal warts, human papilloma virus infection

Criteria:
characteristic appearance of lesions, or characteristic histological appearance


Inclusion:
Bartholin cyst/abscess, endometriosis, genital tract fistula, pelvic congestion syndrome, physiological ovarian cyst


Exclusion:
pain in penis Y01; painful erection/priapism Y08


Exclusion:
urinary frequency/urgency U02; urinary retention U08


Exclusion:
reduced sexual desire P07; psychogenic impotence/reduced sexual fulfilment P08


Criteria:
failure of conception after 2 years of trying


Inclusion:
family planning involving male sterilization


Exclusion:
if the patient has sexual dysfunction, code the condition

Criteria:
concern about/fear of sexual dysfunction in a patient without the condition


Exclusion:
fear of HIV/AIDS B25; in a patient with the disease, code the disease

Criteria:
concern about/fear of venereal disease in a patient without the disease/until the diagnosis is proven


Criteria:
concern about/fear of cancer in a patient without the disease/until the diagnosis is proven


Exclusion:
fear of sexually transmitted disease Y25; fear of genital cancer Y26; in a patient with the disease, code the disease

Criteria:
concern about/fear of other genital disease in a patient without the disease/until the diagnosis is proven


Exclusion:
sexual dysfunction P07, P08; impotence NOS Y07

Criteria:
limitation of function/disability due to a problem of the male genital system (including breast)


Criteria:
urethral or rectal discharge with gram-negative intracellular diplococci demonstrated in a patient after a contact with a proven case, or Neisseria gonorrhoea cultured


Inclusion:
anogenital herpes, herpes genitalis male


Criteria:
tenderness of prostate/seminal vesicles to palpation, and indications of inflammation in urine test


Exclusion:
tuberculosis A70; mumps D71; gonococcal orchitis Y71; torsion of testis Y99

Criteria:
both swelling and tenderness of testes/epididymis, and absence of a specific aetiology (mumps, gonococcal, tuberculosis, trauma, or torsion)


Exclusion:
scabies S72; male syphilis Y70; male gonorrhea Y71; male genital herpes Y72

Criteria:
signs of inflammation of the prepuce/glans penis


Inclusion:
venereal warts, human papilloma virus infection in men


Consider:
benign/unspecified neoplasm male genital Y79


Inclusion:
carcinoma testis/seminoma, carcinoma male breast


Inclusion:
benign male genital neoplasm, neoplasm not specified as benign or malignant/when histology is not available, benign neoplasm male breast


Criteria:
for redundant prepuce: excessive length of prepuce, with inability to retract over the glans penis; 
for phimosis: tightness of the prepuce which prevents retraction over the glans penis


Criteria:
the testicle has never been observed in the scrotum, and the testicle cannot be manipulated into the scrotum


Inclusion:
fibroma, hyperplasia, median bar of prostate, prostatic obstruction, prostatomegaly

Criteria:
enlarged, smooth, firm prostate demonstrated by palpation/cystoscopy/imaging, with no evidence of prostatic carcinoma

Consider:
symptom/complaint about urination U01, U02, U03, U04, U05; retention of urine U08


Criteria:
non-tender fluctuant swelling surrounding testis or spermatic cord with transillumination of the swelling or imaging evidence

Consider:
symptom/complaint of scrotum/testis other Y05


Inclusion:
disease of male breast; epididymal cyst; spermatocoele, torsion of the testis

Exclusion:
sexually transmitted disease NOS A78; gynaecomastia Y16; carcinoma male breast Y78


Note:
Problems with living conditions essentially require the patient's expression of concern about them, with agreement about the existence of the problem and desire for help. Whatever the objective living conditions, patients can consider these as a problem. Labelling these problems requires acknowledgement of absolute differences in living conditions, as well as the individual's perception.


Note:
Problems with working conditions essentially require the patient's expression of concern about them, with agreement about the existence of the problem and desire for help. Whatever the objective working conditions, patients can consider these as a problem.  Labelling these problems requires acknowledgement of absolute differences in working conditions, as well as the individual's perception.


Note:
Problems with unemployment essentially require the patient's expression of concern about them, with agreement about the existence of the problem and desire for help. Whatever the objective nature of the unemployment, patients can consider this as a problem. Labelling these problems requires acknowledgement of absolute differences in unemployment, as well as the individual's perception.


Note:
Problems with education essentially require the patient's expression of concern about them, with agreement about the existence of the problem and desire for help. Whatever the objective education status, patients can consider this as a problem. Labelling these problems requires acknowledgement of absolute differences in education, as well as the individual's perception.


Note:
Problems with social welfare essentially require the patient's expression of concern about them, with agreement about the existence of the problem and desire for help. Whatever the objective social welfare situation, patients can consider this as a problem. Labelling these problems requires acknowledgement of absolute differences in social welfare, as well as the individual's perception.


Note:
Problems with legal issues essentially require the patient's expression of concern about them, with agreement about the existence of the problem and desire for help. Whatever the objective legal issues, patients can consider these as a problem. Labelling these problems requires acknowledgement of absolute differences in legal issues as well as the individual's perception.


Note:
Problems with the health care system essentially require the patient's expression of concern about them, with agreement about the existence of the problem and desire for help. Whatever the objective health care system, patients can consider this as a problem. Labelling these problems requires acknowledgement of absolute differences in the health care system as well as the individual's perception.


Note:
The diagnosis of social problems arising due to being ill requires the patient's agreement on the existence of the problem and desire for help.


Note:
The diagnosis of problems in the relationship between family partners requires the patient's agreement on the existence of the problem and desire for help.


Note:
The diagnosis of problems arising from the behaviour of a family partner requires the patient's agreement on the existence of the problem and desire for help.


Note:
The diagnosis of problems arising from one or both family partners being ill requires the patient's agreement on the existence of the problem and desire for help.


Note:
The diagnosis of problems arising from the loss or death of a family partner requires the patient's agreement on the existence of the problem and desire for help.


Note:
The diagnosis of problems in the relationship with a child requires the patient's agreement on the existence of the problem and desire for help.


Note:
The diagnosis of problems arising due to a child being ill requires the patient's agreement on the existence of the problem and desire for help.


Note:
The diagnosis of problems arising from the loss or death of a child in the family requires the patient's agreement on the existence of the problem and desire for help.


Inclusion:
relationship problem with parent/adult sibling/other family member

Exclusion:
relationship problem with partner Z12; relationship problem with child Z16; relationship problem with friend Z24

Note:
The diagnosis of problems in the relationship between family members requires the patient's agreement on the existence of the problem and desire for help.


Exclusion:
symptom/complaint behaviour of child P22; symptom/complaint behaviour  adolescent P23; problem with behaviour partner Z13

Note:
The diagnosis of problems arising from the behaviour of a family member requires the patient's agreement on the existence of the problem and desire for help.


Note:
The diagnosis of problems arising from the illness of a family member requires the patient's agreement on the existence of the problem and desire for help.


Note:
The diagnosis of problems arising from the loss or death of a family member requires the patient's agreement on the existence of the problem and desire for help.


Exclusion:
relationship problem with family member Z20

Note:
The diagnosis of problems in the relationship with friends requires the patient's agreement on the existence of the problem and desire for help.


Inclusion:
victim of physical abuse, rape, sexual attack

Exclusion:
physical problems to be coded in appropriate rubric(s) in other chapters; psychological problems to be coded in Chapter P

Note:
The diagnosis of social problems arising from assaults and other harmful events requires the patient's agreement on the existence of the problem and desire for help.


Inclusion:
concern about/fear of having a social problem

Exclusion:
if patient has a social problem, code the problem

Criteria:
fear of a social problem in a patient without the problem


Criteria:
limitation of function/disability caused by social problems, including isolation/living alone/loneliness


