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OXFORD MEDICAL PUBLICATIONS

International Classification of Primary Care

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Oxford University Press makes no representation, express or implied, that the drug
dosages in this book are correct. Readers must therefore always check the product
information and clinical procedures with the most up to date published product infor-
mation and data sheets provided by the manufacturers and the most recent codes of con-
duct and safety regulations. The authors and the publishers do not accept responsibility
or legal liability for any errors in the text or for the misuse or misapplication of material
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01_Wonca-[Link] 06/04/2005 1:47 PM Page iii

ICPC-2-R
International Classification
of Primary Care
Revised Second Edition

Prepared by the International Classification Committee of WONCA,

the World Organization of Family Doctors.

With a CD-ROM:
ICPC in the Amsterdam Transition Project

3
01_Wonca-[Link] 06/04/2005 1:47 PM Page iv

3
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First published 1998
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Okkes IM, Oskam SK, Lamberts H. ICPC in the Amsterdam Transition Project.
CD-Rom. Amsterdam: Academic Medical Center / University of Amsterdam,
Department of Family Medicine, 2005
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01_Wonca-[Link] 06/04/2005 1:47 PM Page v

Contents

The WONCA International Classification Committee (1998) vii

Foreword ix
1 Introduction 1
2 The structure of ICPC 8
3 Episode of care: a central concept of general/family practice 11
4 Use of ICPC for recording reason for encounter 19
5 Use of ICPC for recording health problems and process of care
(interventions) 25
6 Inclusion criteria in ICPC 30
7 Severity of illness coding 34
8 Functional status assessment: the COOP/WONCA Charts 38
9 References 42
10 International Classification of Primary Care-2-Revised: tabular list 45
11 Conversion codes from ICD-10 147
12 Alphabetical index 167
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01_Wonca-[Link] 06/04/2005 1:47 PM Page vii

The WONCA International

Classification Committee (1998)

C. BRIDGES-WEBB, Chairman, Sydney, Australia

B. BENTSEN, Oslo, Norway
N. BENTZEN, Odense, Denmark
R. BERNSTEIN, Ottawa, Canada
N. BOOTH, Newcastle, UK
S. BRAGE, Oslo, Norway
H. BRITT, Sydney, Australia
L. CULPEPPER, Boston, USA
G. FISCHER, Hannover, Germany
T. GARDNER, Dunedin, New Zealand
J. GERVAS, Madrid, Spain
A. GRIMSMO, Surnadal, Norway
J. HUMBERT, Beauvoir sur Mer, France
M. JAMOULLE, Jumet, Belgium
M. KLINKMAN, Michigan, USA
M. KVIST, Turku, Finland
H. LAMBERTS, Amsterdam, The Netherlands
A. LEE, Shatin, Hong Kong
M. LIUKKO, Helsinki, Finland
I. MARSHALL, Mallorca, Spain
F. MENNERAT, Paris, France
L. MICHENER, Durham, USA
G. MILLER, Sydney, Australia
M. MIRZA, Lahore, Pakistan
S. MOHAN, Vijayawada, India
J. NUNES, Mem Martins, Portugal
I. OKKES, Amsterdam, The Netherlands
G. PARKERSON, Durham, USA
W. PATTERSON, Edinburgh, Scotland
M. RAJAKUMAR, Kuala Lumpur, Malaysia
D. SALTMAN, Sydney, Australia
P. SIVE, Herzlia, Israel
M. WOOD, Roseland, USA
T. YAMADA, Gifu, Japan
G. ZORZ, Ljubljana, Slovenia
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viii The Wonca International Classification Committee

Current Chair (2005):

Professor Niels Bentzen
Department of Community Medicine and General Practice
Norwegian University of Science and Technology
7489 Trondheim
Norway

Tel: +47 7359 8885

Fax: +47 7359 7851
E-mail: [Link]@[Link]
01_Wonca-[Link] 06/04/2005 1:47 PM Page ix

Foreword

Increasing health care information needs are being recognized all over the world. In
order to deliver optimal health care, professionals need information about the epidemi-
ological situation in their community, diagnostic tools based on patients’ reasons for
encounters, and best practice information for the diagnosis and the interventions that
follow. The amount of information is huge and needs to be ordered in a way that allows
intuitive searches.
The International Classification of Primary Care (ICPC) is internationally the most
widely used tool for ordering clinical information in primary care and family medicine.
ICPC is developed and updated by the Wonca International Classification Committee
(WICC) which consists of a group of practicing primary care doctors and academics.
This combination of orientation on practical work and research, and the active, open minded
attitude of the group is the best guarantee for the continuous development of ICPC.
The co-operation between WONCA and the World Health Organization (WHO)
has a long tradition. Although the classification work originally has common roots,
because of some disputes around the development of ICD and ICPC, the WHO’s
International Classification of Diseases in its 10th revision (ICD-10) and the second
revision of ICPC (ICPC-2) have been running independently. Therefore, it was a major
step forward when the WHO Family of International Classifications (WHO-FIC)
network in October 2003 accepted ICPC-2 as a related classification to be used in
primary care. The network also decided that a continuous co-operation between WICC
and WHO-FIC network is necessary as an integral part of the revision process of ICD
towards ICD-11.
WHO has expanded the scope of its classification work in the WHO-FIC system
because the backbone of health care information systems is supported by three refer-
ence classifications - ICD for health problems, ICF (International Classification of
Functioning, Disability and Health) for functional aspects of health, and ICHI for inter-
national classification of health care interventions.
ICPC was originally developed as a reason for encounter classification. Since a
patient’s reason for encounter may be a known disease, a functional health problem, or
a request for an intervention, ICPC needs to cover all three reference classifications on
the level of a single primary care provider. Therefore, ICPC has codes for functioning
and for interventions, although it has been mainly used in the diagnostic area.
The need for coding systems has been questioned by the developers of the termino-
logical systems. For international use one of the main problems is translation. Terms are
language specific and, therefore, a detailed classification of concepts tends to be diffi-
cult to translate. For primary care, the main information needs are covered by ICPC
which is already available in over 20 languages. This creates an international frame-
work that allows international exchange of information.
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x Foreword

Most information systems have been developed in and for developed countries. The
role of developing countries in this process is important because of the information
paradox in world health care: countries with the least information about the popula-
tion’s health face the worst health care problems. Although ICPC has been mainly
developed in industrialized countries, the basic principle of a limited number of high
frequency problems is applicable for any primary care setting. Modified modules may
be necessary, for example for tropical conditions.
This revised edition of ICPC-2 is based on the electronic version of ICPC-2
(ICPC-2-E) which has been continuously updated since ICPC-2 was published as a
book (1998). It includes all the corrections made by WICC, while most translations are
already based on this version.
The availability of this updated version of the book is therefore an important
milestone.

Martti Virtanen
Head of Centre, Classification expert, Pediatrician
Nordic Centre for Classifications in Healthcare
WHO-FIC network collaborating centre
Member of WICC since 1998
02_Wonca-[Link] 06/04/2005 7:49 AM Page 1

1 Introduction

Historical background
Until the mid-1970s most morbidity data collected in primary care research were classi-
fied using the International Classification of Diseases (ICD).1,2 This had the important
advantage of international recognition, aiding comparability of data from different
countries. However, there was the disadvantage that the many symptoms and non-disease
conditions that present in primary care were difficult to code with this classification, origi-
nally designed for application to mortality statistics and with a disease-based structure.
The following early references deal with some of the issues, developments and ideas
about general practice classifications in the period before and after the formation of the
WONCA Classification Committee in 1972:
● Research Committee of Royal College of General Practitioners. A classification of
disease. J. Roy. Coll. Gen. Pract. 1959; 2: 140–59.
● Westbury R C, Tarrant M. Classification of disease in general practice: a comparative
study. Can. Med. Assoc. J. 1969; 101: 82–7.
● Bentsen B G. Illness and general practice: a survey of medical care in an inland
population in South-East Norway. Oslo: Scandinavian University Books, University
Press 1970; second edition 1986.
● Hutchinson I M. The Australian morbidity survey 1969–70. Annals of General
Practice 1971; 16: 68–72.
● Anderson J E, Leese R E M. Patient morbidity and some patterns of family practice
in South-Eastern Ontario. Can. Med. Assoc. J. 1975; 113: 123–6.
● Kjaer P, Mabeck C E, Olsen O M, Pederson P. Testing WONCA’s classification of
diseases for use in general practice (in Danish). Ugeskrift Laeger 1977; 139:
1614–16.
Recognizing the problems of the ICD, and the need for an internationally recognized
classification for general practice, the WONCA Classification Committee designed the
International Classification of Health Problems in Primary Care (ICHPPC), first pub-
lished in 1975,3 with a second edition in 19794 related to the ninth revision of ICD.
Although this provided a section for the classification of some undiagnosed symptoms,
it was still based on the ICD structure and was still inadequate. A third edition in 1983
had added to it criteria for the use of most of the rubrics5 greatly adding to the reliability
with which it could be used, but not overcoming its deficiencies for primary care.
A new classification was needed for both the patient’s reason for encounter and the
provider’s record of the patients’ problems.
At the 1978 World Health Organization (WHO) Conference on Primary Health Care
in Alma Ata,6 adequate primary health care was recognized as the key to the goal of
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2 WONCA International Classification of Primary Care

‘health for all by the year 2000’. Subsequently both WHO and WONCA recognized
that the building of appropriate primary care systems to allow the assessment
and implementation of health care priorities was only possible if the right information
was available to health care planners. This led to the development of new classification
systems.
Later in 1978 WHO appointed what became the WHO Working Party for Development
of an International Classification of Reasons for Encounter in Primary Care.7 This
group, a majority of whose members were also members of the WONCA Classification
Committee, developed a Reason for Encounter Classification (RFEC)7–9 which later
became ICPC.
Reasons for encounter (RFEs) are the agreed statement of the reason(s) why a patient
enters the health care system, representing the demand for care by that person. They may
be symptoms or complaints (headache or fear of cancer), known diseases (flu or diabetes),
requests for preventive or diagnostic services (a blood pressure check or an ECG), a
request for treatment (repeat prescription), to get test results, or administrative (a medical
certificate). These reasons are usually related to one or more underlying problems
which the doctor formulates at the end of the encounter as the conditions that have been
treated, which may or may not be the same as the reason for the encounter.
Disease classifications are designed to allow the health care providers’ interpretation
of a patient’s health care problem to be coded in the form of an illness, disease, or
injury. In contrast, a Reason for Encounter Classification focuses on data elements from
the patient’s perspective.7,10,11 In this respect, it is patient-oriented rather than disease-
or provider-oriented. The reason for encounter, or demand for care, given by the patient
has to be clarified by the physician or other health worker before there is an attempt to
interpret and assess the patient’s health problem in terms of a diagnosis, or to make any
decision about the process of management and care.
The working group developing the RFE classification tested its several versions in
field trials. The first field trial to test the completeness and reliability of the RFEC was
a pilot study carried out in The Netherlands in 1980.8 The results obtained from this
pilot study prompted further feasibility testing in 1983. This was carried out in nine
countries, namely Australia, Brazil, Barbados, Hungary, Malaysia, The Netherlands,
Norway, The Philippines, and The United States.9,12,13 The entire classification was
translated from English into several languages, including French, Hungarian, Norwegian,
Portuguese, and Russian. The analysis of more than 90 000 reasons for encounter recorded
during over 75000 individual encounters and the collective experience of the participants
resulted in the development of a more comprehensive classification.9,12,13
In the course of this feasibility testing it was noted that the RFEC could easily be
used to classify simultaneously the reasons for encounter and two other elements of
problem-oriented care, namely the process of care and the health problems diagnosed.
Thus this conceptual framework allowed the evolution of the Reason for Encounter
Classification into the International Classification of Primary Care.
Problems in relation to the concurrent development of ICD-10 prevented WHO from
publishing the RFEC. However, WONCA was able to develop ICPC from it and publish
the first edition in 1987. While ICPC-1 was much more appropriate for primary care
than previous classifications based on the ICD framework, it did not include inclusion
criteria for the rubrics, or any cross-referencing. It was thus in this respect less
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Introduction 3

useful than the previous publication, ICHPPC-2-defined, though it referred to it as a

source of inclusion criteria which could be used.
In 1985 a project began in a number of European countries to use the new classifica-
tion system to produce morbidity data from general practice for national health infor-
mation systems. This involved translations of the classification and comparative studies
across countries. The results were published in 1993 in a book including an update of
ICPC.14
In 1980 WONCA became a Non-Government Organization (NGO) in official relations
with WHO, and joint work together since has led to a better understanding of the
requirements of primary care for its own information systems and classifications within
an overall framework encompassing all health services.

The International Classification of Primary Care

The International Classification of Primary Care (ICPC†)15 broke new ground in the
world of classification when it was published in 1987 by WONCA, the World
Organization of National Colleges, Academies, and Academic Associations of General
Practitioners/Family Physicians, now known more briefly as the World Organization of
Family Doctors. For the first time health care providers could classify, using a single
classification, three important elements of the health care encounter; reasons for
encounter (RFE), diagnoses or problems, and process of care. Linkage of elements
permits categorization from the beginning of the encounter with RFE to its conclusion.
The new classification departed from the traditional International Classification of
Disease (ICD) chapter format where the axes of its several chapters vary, from body
systems (Chapters III, IV, V, VI, VII, VIII, IX, X, XI, XIII and XIV) to aetiology
(Chapters I, II, XVII, XIX, XX), and to others (Chapters XV, XVI, XVIII, XXI). This
mixture of axes creates confusion, since diagnostic entities can with equal logic be clas-
sified in more than one chapter, for example influenza in either the infections chapter or
the respiratory chapter, or both. Instead of conforming to this format, the ICPC chapters
are all based on body systems, following the principle that localization has precedence over
aetiology. The components that are part of each chapter permit considerable specificity for
all three elements of the encounter, yet their symmetrical structure and frequently uni-
form numbering across all chapters facilitate usage even in manual recording systems.
The rational and comprehensive structure of ICPC is a compelling reason to consider
the classification a model for future international classifications.
Since publication, ICPC has gradually received increasing world recognition as an
appropriate classification for general/family practice and primary care, and has been
used extensively in some parts of the world, notably in Europe14 and Australia.16
More recently the WONCA Classification Committee has participated in the interna-
tional development of further initiatives related to classification, including functional

†ICPC was first published in 1987.14 This is now referred to as ICPC-1. In 1993 it was included in a publica-

tion about its use in Europe.13 This is referred to as ICPC-E. The 1998 publication is referred to as ICPC-2,
and this revision as ICPC-2-R. ICPC is used when referring to the generic classification.
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4 WONCA International Classification of Primary Care

status measures, severity of illness indicators, and an international glossary for general/
family practice. Information about these is included in this book.

Classification, nomenclature, and thesaurus

Labelling aspects of general/family practice, such as reasons for encounter and health
problems, requires that the available labels reflect the characteristics of the domain:
general practice/family medicine. Labels should be derived from a nomenclature or
thesaurus. A nomenclature contains all the terms and professional jargon of medicine,
and a thesaurus is a storehouse of terms like an encyclopaedia or computer tape with a
large index and synonyms.17
Classification systems provide a structure to order named objects in classes accord-
ing to established criteria. They do not necessarily contain all terms, and difficulties
arise when they are used as a nomenclature and terms are not found within them. Often
many terms are included within one rubric, so that the use of coding based on a classifi-
cation does not provide adequate specificity.17
ICPC is a classification which reflects the characteristic distribution and content of
aspects of primary care. It is not a nomenclature. The richness of medicine at the level of
the individual patient needs a nomenclature and thesaurus much more extensive than
ICPC, particularly for recording the specific detail required in an individual patient record.
The use of ICPC together with ICD-10 and other classification systems, such as the
Anatomical-Therapeutic-Chemical classification of medications (ATC), can provide the
basis of an adequate nomenclature and thesaurus, but if full coding is required these must
be supplemented by even more specific coding systems. However, unless such coding
systems are based upon a suitable classification, such as ICPC is for general/family practice,
it is not possible to extract coherent data about populations rather than just individuals.17
Over the years there have been frictions in the relation between the available primary
care classifications (ICHPPC and ICPC) and ICD because of conceptual and taxonomi-
cal problems. ICD-10, however, now provides a widely recognized nomenclature of
diseases and health problems suitable for primary care. Although ICD-10 is not the
most appropriate tool for a primary care classification,18 its use with ICPC as the order-
ing principle opens a route to good computer-based patient records allowing for the
exchange of patient data with other specialists and hospitals.17

ICPC-2
This second edition of ICPC has been prepared for two main reasons; to relate it to the
tenth edition of ICD, ICD-10, published by WHO in 1992,2 and to add inclusion criteria
and cross-referencing for many of the rubrics. The latter are explained in Chapter 6 and
detailed in the tabular list in Chapter 10. In the interests of stability and consistency
very few changes to the classification have been made, though many have been suggested,
and will be the subject of ongoing work by the WONCA Classification Committee.
Feedback from users to assist this process is specially requested.
At the same time this second edition includes information about new developments in
the conceptual basis of understanding general/family practice which have arisen
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Introduction 5

in large part from the use of a classification appropriate to the discipline. These are out-
lined in Chapters 2–5. The book is based on the use of standard terminology as defined in
the international glossary published by the WONCA Classification Committee in 1995.19
The book also includes information about a number of new initiatives related to
classification. The Duke/WONCA Severity of Illness Checklist (DUSOI/WONCA)
enables either individual health problems, or the combined health problems of the
patient, to be graded in terms of severity (Chapter 7). The COOP/WONCA functional
status assessment charts allow assessment of functional status of the patient independent
of any particular reason for encounter or health problem (Chapter 8).
The alphabetical index to the tabular list (Chapter 12) is limited to terms from
the rubric titles and their inclusion terms. It is not meant to be fully comprehensive
(see Chapter 2).

ICPC and ICD

ICPC has always been linked with the widely recognized and used International
Classification of Diseases published by the World Health Organization. The first edition
contained a list of conversion codes to ICD-9. Since then ICD-10 has been introduced,
and ICPC-2 has been carefully mapped to ICD-10 so that conversion systems can
be used (Chapter 11). Users who still require a conversion to ICD-9 may obtain a
disc from the WONCA Classification Committee. Extensive empirical research has
confirmed that ICPC and ICD are complementary rather than in competition.

Translations
WONCA is an international organization and wishes to promote versions of ICPC in
languages other than English, which is the working language of the Classification
Committee. ICPC has already been translated into 19 languages, and has
been published as a book in some of these (Table 1).13,20,21 There are already several

Table 1. Availability of ICPC in

different languages17
Basque Hungarian
Danish+ Italian
Dutch+ Japanese+
English+ Norwegian+
Finnish+ Polish
French+ Portuguese+
German Russian
Greek+ South African
Hebrew Spanish+
Swedish
+A separate edition exists in these languages.
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6 WONCA International Classification of Primary Care

translations of ICPC-2 being undertaken. The committee encourages anyone wishing to

promote, assist with, or undertake translations of ICPC-2 to contact them to arrange
cooperative work.
The WONCA policy on ICPC-2 translations is:
1. WONCA encourages versions in languages other than English.
2. These must include the whole book, not just the rubrics.
3. There must be no changes to the rubrics. Any extensions must be clearly indicated
as such, and approved by the WONCA Classification Committee prior to publication.
4. Translations must be prepared by named translators working in cooperation with the
WONCA Classification Committee and to the standards that it sets, particularly in
relation to the extent of back translation for checking which may be required.
5. While WONCA will retain the copyright it will usually grant without fee the rights
to translating organizations to retain royalties on their versions. This will require a for-
mal agreement between WONCA and the organization or publisher concerned.

Policy on copyright and licensing

The copyright of ICPC, both in hard copy and in electronic form, is owned by WONCA.
This policy relates to the electronic version and has the following aims.

Aims
1. To allow the WONCA Classification Committee to promote, distribute, and support
ICPC-2, and further develop it as the best classification for primary care.
2. To maintain international comparability of versions of ICPC-2.
3. To obtain feedback and maintain a clearing-house of international experiences with
ICPC-2.
4. To achieve recognition of WONCA’s initiative and expertise in classification.
5. To promote understanding of appropriate links between ICPC-2 and other classifica-
tion and coding systems, particularly ICD-10.
6. To encourage use of ICPC-2 rather than inhibit it with restrictions.
7. To obtain financial support to enable achievement of these aims and allow the work
of the WONCA Classification Committee to continue and expand.

Policy
1. The electronic version of ICPC-2 should be made available in as many countries as
possible.
2. Versions involving additions, translations, or alterations should be made with input
from and agreement of the WONCA Classification Committee if they are to be
regarded as official WONCA versions.
3. WONCA should license appropriate organizations to promote and distribute
electronic versions of ICPC-2 in countries, regions, and language groups.
4. Licence fees may be charged through these organizations to the end users and
collected by the distributors for WONCA. The fees will be set by negotiation and
may be waived when there are advantages to WONCA by so doing, such as when use
is for research or development.
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Introduction 7

Readers wishing to obtain this book in electronic form, or incorporate electronic versions of
ICPC in computer systems, or develop and use ICPC in other ways should contact a local
member of the WONCA Classification Committee (see p. vii) or WONCA (see below).

Abbreviations
As far as possible abbreviations have not been used in this book. In a few places abbre-
viations which are more commonly used in English than the full expansion, and which
are clear in the context, are included in the rubrics. However, some have been needed,
and these are as follows:
abn abnormal
dis disease
complt complaint
excl excludes
incl includes
NOS not otherwise specified
sympt symptom
/ or

User feedback
In order to continue to develop ICPC the WONCA Classification Committee would like
to have feedback from as many users as possible with suggestions for clarification,
alterations, or extensions. Please contact a local member of the committee (see p. vii) or
the Chair (see p. viii), or WONCA Executive: ceo@[Link].
03_Wonca-[Link] 06/04/2005 7:50 AM Page 8

2 The structure of ICPC

ICPC is based on a simple bi-axial structure: 17 chapters based on body systems on one
axis, each with an alpha code, and seven identical components with rubrics bearing a
two-digit numeric code as the second axis (Fig. 1 and Table 2).
ICPC has a significant mnemonic quality which facilitates its day-to-day use by
physicians, and simplifies the centralized manual coding of data recorded elsewhere.
It is presented as a tabular list (Chapter 10). The rubrics for components 1 and 7 are
given in full for each chapter. The rubrics in components 2 to 6 are uniform across all
chapters and are set out only once. Each rubric has a three-digit code number, a title of
limited length, and the codes of the corresponding ICD-10 rubrics. Most rubrics also have
inclusion terms, exclusion terms, and ‘consider’ terms (see Chapter 6). Abbreviations
have been used sparingly, and are listed on p. 6. When the word ‘multiple’ is used in ICPC
this refers to three or more.
The alphabetical index to the tabular list (Chapter 12) contains terms from all the
rubric titles and their inclusion terms. It is not meant to be fully comprehensive;
the terms included are only those which are common or important in primary care.

CHAPTERS

A B D F H K L N P R S T U W X Y Z
Components
1.

2.

3.

4.

5.

6.

7.

Fig. 1. The structure of ICPC: 17 chapters and 7 components.

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The structure of ICPC 9

Table 2. ICPC chapters and components

A General and unspecified
B Blood, blood-forming organs and immune mechanism (spleen, bone marrow)
D Digestive
F Eye
H Ear (Hearing)
K Circulatory
L Musculoskeletal (Locomotion)
N Neurological
P Psychological
R Respiratory
S Skin
T Endocrine, metabolic and nutritional
U Urological
W Pregnancy, child-bearing, family planning (Women)
X Female genital (X.-chromosome)
Y Male genital (Y-chromosome)
Z Social problems
Components (standard for each chapter):
1 Complaint and symptom component
2 Diagnostic, screening, and preventive component
3 Medication, treatment, procedures component
4 Test results component
5 Administrative component
6 Referrals and other reasons for encounter
7 Disease component:
—infectious diseases
—neoplasms
—injuries
—congenital anomalies
—other
A mnemonic alpha code has been used where possible.

Users seeking terms not included could use the ICD-10 index to find the ICD-10 rubric,
and then the conversion tables (Chapter 11) to find the ICPC rubric. A fuller thesaurus
in electronic form has been developed by some users, but an approved international
version is yet to be developed.
While ICPC is comprehensive enough to allow classification of the main elements
of primary care, it still has some limitations. The rubrics in components 2 to 6 covering
the process of care are very broad and non-specific. A classification of medications
and drugs was developed for and is described in the report of the European study,14
but is not yet formally included. ICPC does not include objective findings found
during physical examination or investigations. These are all matters for further
development.
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10 WONCA International Classification of Primary Care

Residual rubrics
Residual rubrics (‘rag-bags’) are found at the end of a section or subsection; their
description includes the word ‘other’. Clearly, not otherwise specified (NOS) is implied
for all of the terms in these rubrics. Knowledge of the boundaries of each section or
subsection is required for the best use of the classification. If in doubt, consult the
alphabetical index.

The practical use of morbidity/diagnostic data

Until recently classifications were mainly used for the collection of data for health statis-
tics and formulation of policy. The advent of computer-based medical records has led to
even more widespread use as a means of organizing and storing data gathered during
routine clinical encounters. These data are needed both as part of the patient medical
record and for extraction for health statistics. The classification and coding requirements
for those two purposes differ; patient medical records require as much specific detail as
possible, whereas health statistics require data which are systematically aggregated into
categories based on their frequency or their importance for policy. ICPC was developed
for the latter purpose, and must be modified for coding clinical data in medical records.

Optional hierarchical expansion

Clearly, no single international classification can fulfil every need for every user;
inevitably users will sometimes want to separate certain problems contained in a single
rubric. This usually requires expanded codes using the principle of optional hierarchy.
A great deal of expansion is usually needed for coding clinical data in medical records.
It is recommended that whenever possible such expansions conform to the usage in
ICD-10, or that ICD-10 codes are used as expansion codes, so that maximum compara-
bility between data systems is maintained. Even then provision for including patient-
specific text is needed for adequate specificity for patient care records.17

Severity of illness and functional status

Information about severity of illness and functional status assessment of the patient
may be recorded in association with use of ICPC, and means of classifying these are
therefore included in this book. The Duke/WONCA Severity of Illness Checklist
(DUSOI/WONCA) can be related to ICPC rubrics and may be applied to individual
health problems, as well as being summed to indicate the severity of the patient’s
combined health problems (Chapter 7). The COOP/WONCA functional status assess-
ment charts apply to the patient independent of his/her health problems, and are
explained in Chapter 8.
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3 Episode of care: a central

concept of general/family
practice

Changes in the need for and use of classifications in primary care have continued
since the publication of ICPC in 1987. The main purpose of the classification was
then seen to be its use in gathering data for research and policy formulation. However,
its use has now widened as research data and practical experiences with ICPC, as well
as the emergence of new concepts in general/family medicine, have resulted in new
applications.
The most important new applications of the use of ICPC are in describing the
construct of episodes of care and in computer patient records. The two are closely
related, and depend upon the use of ICPC as the ordering principle of patient data gath-
ered in general/family practice and primary care.
The WONCA definition of general/family practice refers to ‘a physician who pro-
vides personal, primary, and continuing comprehensive health care to individuals and
families’.19 This is quite similar to that of primary care in the new Institute of Medicine
(IOM) definition: ‘Primary care is the provision of integrated accessible health care
services by clinicians who are accountable for addressing a large majority of personal
health care needs, developing a sustained partnership with patients and practising in the
context of family and community’.22

Episode of care
These definitions have been made operational by choosing the ‘episode of care’ as the
appropriate unit of assessment. Episodes of care are distinguished from episodes of ill-
ness or disease in a population. An episode of care is a health problem or disease from
its first presentation to a health care provider until the completion of the last encounter
for that same health problem or disease (Fig. 2).17
Reasons for encounter, health problems/diagnoses, and process of care/interventions
form the core of an episode of care consisting of one or more encounters, including
changes in their relations over time (‘transitions’). An episode of care, consequently,
refers to all care provided for a discrete health problem or disease in a particular patient.
The ‘large majority of personal health care needs’, the ‘comprehensiveness’, the degree
of ‘integration’, of ‘accessibility’, and of ‘accountability’ can be assessed when
episodes of care are classified with ICPC in a computer-based patient record.
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12 WONCA International Classification of Primary Care

Start of episode

Perceived Perceived Reason Intervention,

Health
health > need for > for process of
problem
problem care encounter care

Second encounter of same episode

Reason Intervention,
Health
for process of
problem
encounter care

Fig. 2. An episode of care.

The use of the concept of episode of care was demonstrated in the European study
using ICPC.14 In this study, characteristic epidemiological and clinical similarities and
differences between the various sites were established. Also, the concept of reason for
encounter proved to be an innovative and practical operationalization of the patient’s
perspective and demand for care; the validity of the reason for encounter as it was
coded by family doctors when compared with the patient’s point of view after the
encounter, was consistently very high.23
The new International Glossary of Primary Care defines the content of general/family
practice and gives rules to structure episodes with ICPC in order to allow epidemiological
standard retrievals, and to make them comparable in different countries.19

Reason for encounter

The reason for encounter (RFE) has been established to be a practical source of patient
information, also useful for research and education. This is illustrated by epidemiological
data from the Dutch Transition project in the form of standard output, following the
rules of the glossary.17 Beginning with the reason for encounter allows the determination of
the probabilities of any given health problem at the start or during follow-up of the episode,
per standard sex age group. Thus the top 10 problems related to cough at the start of
an episode show clinically important differences between children aged 5–14 and
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Episode of care: a central concept of general/family practice 13

Table 3. Top 10 episode titles starting with cough (R05) as

the reason for encounter (prior probabilities)
RFE R05 Cough (N = 1267) N %
R74 URI (head cold) 456 35.6
R78 Acute bronchitis/bronchiolitis 261 20.4
R05 Cough 159 12.4
R77 Acute laryngitis/tracheitis 110 8.6
A77 Other viral diseases NOS 54 4.2
R96 Asthma 40 3.1
R81 Pneumonia 33 2.6
R75 Sinusitis acute/chronic 30 2.3
R80 Influenza without pneumonia 24 1.9
R71 Whooping cough 22 1.7

Total top 10 1189 92.8

Total 1281 100.0
Men aged 65–74 (N = 646) N %
R78 Acute bronchitis/bronchiolitis 256 39.1
R74 URI (head cold) 155 23.7
R05 Cough 65 9.9
R77 Acute laryngitis/tracheitis 45 6.9
R75 Sinusitis acute/chronic 22 3.4
K77 Heart failure 15 2.3
R96 Asthma 13 2.0
R91 Chronic bronchitis/bronchiectasis 12 1.8
R81 Pneumonia 10 1.5
R95 Emphysema/COPD 9 1.4

Total top 10 602 92.0

Total 654 100.0
Source: Transition Project, reported in Hofmans-Okkes and Lamberts.17

men aged 65–74 (Table 3). The reverse procedure is equally relevant from a clinical point
of view: what reasons for encounter were presented at the start and during follow-up of a
problem in each standard sex age group? This is illustrated for acute bronchitis (Table 4).
These tables document the clinical differences in far more detail than has been possible
until now.

The health problem/diagnosis

The health problem/diagnosis is central to the episode of care and gives it its name.
Many health problems are in fact medical diagnoses, but many in primary care are other
conditions such as fear of disease, symptoms, complaints, disabilities, or need for care
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14 WONCA International Classification of Primary Care

Table 4. Top 10 reasons for encounter in an episode of

acute bronchitis/bronchiolitis (R78)
Children aged 5–14 (N = 377) N %
R05 Cough 321 46.1
A03 Fever 98 14.1
R31 Med exam/health evalua/partial 64 9.2
R02 Shortness of breath/dyspnoea 43 6.2
R74 URI (head cold) 24 3.4
A04 General weakness/tiredness 18 2.6
R03 Wheezing 17 2.4
R64 Provide init episode new/ongoing 17 2.4
R78 Acute bronchitis/bronchiolitis 13 1.9
R21 Sympt/complt throat 9 1.3

Total top 10 624 89.5

Total 697 100.0
Men aged 65–74 (N = 422) N %
R05 Cough 324 39.4
R02 Shortness of breath/dyspnoea 133 16.2
R78 Acute bronchitis/bronchiolitis 100 12.2
R31 Med exam/health evalua/partial 79 9.6
A03 Fever 34 4.1
R25 Abnormal sputum/phlegm 23 2.8
R64 Provide init episode new/ongoing 21 2.6
R74 URI (head cold) 14 1.7
A04 General weakness/tiredness 13 1.6
R01 Pain attrib to respir system 8 1.0

Total top 10 749 91.1

Total 822 100.0
Source: Transition Project, reported in Hofmans-Okkes and Lamberts.17

such as immunization. ICPC includes all of these. The health problem may be qualified
in terms of its status in the encounter, the certainty which the provider assigns to its
diagnosis, and its severity.
The status of the episode in an encounter can be specified as new to both doctor and
patient, new to doctor but previously treated outside the current provider system, or
neither in the case of follow-up encounters (Fig. 3D). A good computer patient record
warns the provider when s/he tries to enter a follow-up encounter for an episode that
has not yet been established in the database, or whenever a new one is started when an
episode with the same title already exists. This is, obviously, vital to ensure the quality
of day to day recording.
The extent to which the doctor is certain that his or her diagnosis is correct is another
aspect of an episode of care; this can be graded from uncertain to certain, but a standard
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Episode of care: a central concept of general/family practice 15

The old structure

Reason for encounter Health problem Intervention

(RFE)

The new structure

A B C D E F

RFE: RFE: RFE: Health Immediate Subsequent

sympt. inter- clinical problem inter- inter-
complt. vention findings + vention vention
problem certainty
+
status

Fig. 3. A new structure for describing encounters.17

means of doing this has not yet been adopted. The inclusion criteria for use of rubrics in
ICPC-2 will, however, help to ensure that the label chosen for the episode is used
consistently by all providers. Pop-up screens can be used to display options at the time
of coding in computer-based records.
The third qualification of an episode of care, severity, is discussed in Chapter 7.
Patients with multiple health problems and episodes of care are common in primary
care. A good data system will be able to display the interrelationships of these, and pro-
vide data on comorbidity (Table 5).

Interventions, the process of care

The specificity of the three-digit ICPC process code to classify immediate interventions
is limited, but usually adequate. However, when drugs are prescribed a drug code is
needed. Because of the vast number of medications involved, and the idiosyncrasies
of national drug availabilities, no internationally suitable code has yet been produced.
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16 WONCA International Classification of Primary Care

Table 5. Comorbid episodes for patients with R78, acute bronchitis/

bronchiolitis
Children aged 5–14 (N = 329) N % Prev.
R74 URI (head cold) 90 9.6 274
R71 Acute otitis media/myringitis 57 6.1 173
R78 Acute bronchitis/bronchiolitis 48 5.1 146
R96 Asthma 37 3.9 112
R97 No disease 32 3.4 97
S03 Warts 29 3.1 88
A77 Other viral diseases NOS 21 2.2 64
R76 Tonsillitis acute 20 2.1 61
S18 Laceration/cut 20 2.1 61
D73 Presumed GI infection 17 1.8 52

Total top 10 371 39.6 1128

Total 938 100.0 2851
Mean number of comorbid episodes = 2.9
Men aged 65–74 (N = 350) N % Prev.
R78 Acute bronchitis/bronchiolitis 72 4.7 206
A97 No disease 56 3.7 160
R95 Emphysema/COPD 47 3.1 134
K86 Uncomplicated hypertension 46 3.0 131
R74 URI (head cold) 46 3.0 131
K77 Heart failure 35 2.3 100
A85 Adv effect med agent proper dose 30 2.0 86
H81 Excessive ear wax 30 2.0 86
K76 Other/chron ischemic heart dis 30 2.0 86
T90 Diabetes mellitus 25 1.6 71

Total top 10 417 27.4 1191

Total 1521 100.0 4346
Mean number of comorbid episodes = 4.3
Prev. = Number of comorbid episodes per 1000 patients with R78.
Source: Transition Project, reported in Hofmans-Okkes and Lamberts.17

In Europe an ICPC drug code which is ATC compatible has been valuable and may be
suitable for wider adoption.13

Patient records
The core of a computer-based patient record is data coded with ICPC which is language
independent: this enhances the use of practice records for a comparison of data from
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Episode of care: a central concept of general/family practice 17

different countries, and it supports the development of general/family practice as an

internationally well developed profession with a well defined and empirically based
frame of reference. The availability of ICPC in 19 languages and the growing number
of translations of ICD-10 accompanied by alphabetical indexes will allow family
doctors in many countries to incorporate a detailed language-specific thesaurus in their
system, at the same time using ICPC to systematically structure their records and the
database in a more standardized way.

Further developments
The original three basic elements of encounters to be coded with ICPC (reason
for encounter, health problem, and interventions) (Fig. 2) have now been expanded
into six data entry options (A–F) for computer-based patient records (Fig. 3).17 The
reason for encounter is recorded in two sections: the patient’s symptoms and
complaints, and the patient’s requests for interventions. The clinical findings elicited
by the physician in the form of symptoms and complaints are coded in addition to those
presented as reasons for encounter. Interventions or processes of care are recorded
as immediate (those occurring during the encounter) or subsequent (those which will
be done subsequently). Work with these, particularly in The Netherlands, has confirmed
the usefulness of the concept of reason for encounter, and further refined the concepts
of reason for encounter, health problem/diagnosis, and process of care.14
The use of reasons for encounter to estimate prior probabilities is clearly very useful;
it can be even more so if reasons for encounter presented by the patient such as cough,
shortness of breath, fever, abnormal sputum, or wheezing (Fig. 3A) are distinguished
from clinical findings elicited by the physician during history taking (Fig. 3C). ICPC
incorporates over 200 symptoms and complaints serving the classification of reasons
for encounter and of clinical findings equally well, though it should be noted that it
does not yet include a classification of objective findings. Both applications can be
included in the encounter and episode structure of a computer-based patient record
(Fig. 3A and C). Together they allow a complete calculation of prior probabilities,
while the difference between a symptom expressed by the patient as a reason for
encounter or elicited by the physician is retained, and the probabilities can be calculated
separately if required.
Reasons for encounter in the form of symptoms, complaints or health problems/
diagnoses should be distinguished explicitly from those in the form of requests for
interventions such as a prescription, an X-ray, a referral, or advice (Fig. 3A and B).
Requests for a certain intervention are often followed by this intervention being per-
formed: when patients ask for medication or a blood test, they often receive it.17 Since
patients do actively influence the care provided by general practitioners/family doctors
it is important to explicitly document this, also to obtain a better understanding of
compliance.
Recording systems should be able to distinguish between diagnostic and therapeutic
interventions during the encounter (‘immediate’, Fig. 3E) and those that will follow
(‘subsequent’, Fig. 3F). The difference between what is in fact being done by the family
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18 WONCA International Classification of Primary Care

doctor at the time of the encounter and what is expected to follow is important for the
analysis of utilization data, interdoctor variation, and compliance. It also allows better
understanding of the shift from prior probabilities in the first encounter of an episode of
care to the posterior probabilities during follow-up.17
For recording subsequent interventions a more specific process classification than
ICPC provides is needed. Development of this is an ongoing activity of the WONCA
Classification Committee.
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4 Use of ICPC for recording

reason for encounter

Procedures for coding information using ICPC vary somewhat according to the type of
information being recorded, for example reason for encounter, health problem, or inter-
vention. In order to promote consistent recording and therefore better comparability of
data between centres, the following standards are suggested.

Reason for encounter

The primary care provider should identify and clarify the reason for the encounter
(RFE) as stated by the patient without making any judgments as to the correctness or
accuracy of the reason. This use of the classification is guided by three principles:
1. The reason for encounter should be understood and agreed upon between the patient
and the provider and should be recognized by the patient as an acceptable description.
2. The ICPC rubric chosen should be as close as possible to the original statement of
the reason given by the patient and must represent a minimal or no transformation by
the provider. However, clarification of the patient’s reasons for encounter within the
framework of ICPC is necessary so that the most appropriate rubric in the classifica-
tion can be applied.
3. The inclusion criteria listed for rubrics for use in recording health problems/diagnoses
are NOT to be used, since the reason for encounter is to be documented from the
patient’s point of view, based entirely on the patient’s statement of the reason.
The way in which a patient expresses his/her reason(s) for encounter determines
which chapter and which component to use (Fig. 1 and Table 2). The entire classifica-
tion is applicable as patients can describe their reasons for seeking health care in the
form of symptoms or complaints, as requests for services, or as health problems.

Choosing the chapter code

To code the RFE it is necessary to first select the appropriate organ system or chapter,
assign the correct alpha code, and then the two-digit numeric code in the relevant com-
ponent such as a symptom or complaint, a diagnosis, or an intervention. The alphabetical
index should be used when there is uncertainty about the chapter or component in
which a specific reason for encounter should be placed. Chapter A is used for reasons
for encounter which relate to unspecified or multiple body systems.
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20 WONCA International Classification of Primary Care

When ICPC is used for recording RFE four rules apply to the use of the chapters, and
three rules to the use of components. Those rules are listed below with examples of the
application of those rules.

Rule 1
The reason for the encounter should be coded as specifically as possible and may
require some clarification by the provider.

Example
Chest pain can be coded as All (chest pain not otherwise specified (NOS)), or as KOI
(pain attributed to heart), or as R01 (pain respiratory), or as L04 (chest symptoms/
complaints). The decision as to the correct selection is not based on the opinion of
the provider as to the type of chest pain but, rather, to the manner in which the
patient expresses his/her reason for encounter when clarification is sought by the
provider.
‘Its all over my chest …’ A11
‘My chest hurts when I cough’ R01
‘I have chest pain … I think its my heart’ KO1
‘I have chest pain after falling down stairs’ L04

Rule 2
Whenever the patient makes a specific statement use his/her terminology.

Example
Jaundice, in the form of a diagnostic descriptive term can be found in Chapter D (digestive)
but the patient may present this symptom as a yellow discoloration of the skin (Chapter S).
If the patient expresses the problem as ‘jaundice’, the ICPC code is D13. If, however,
the patient states ‘my skin has gone yellow’ the correct code would be SOS, regardless
of the fact that the health care provider is positive that the diagnosis is some form of
hepatitis.

Rule 3
When the patient is unable to describe his/her complaint, the reason given by the
accompanying person is acceptable as that stated by the patient (e.g. a mother bringing
in a child or relatives accompanying an unconscious patient).

Rule 4
Any problem whatsoever presented verbally by the patient should be recorded as a rea-
son for encounter. Multiple coding is required if the patient gives more than one reason.
Code every reason presented at whatever stage in the encounter it occurs.
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Use of ICPC for recording reason for encounter 21

Example
‘I need my blood pressure tablets. Also my breasts are tender and sore’ —K50, XI8.
If later the patients asks ‘What is this lump on my skin?’ that is also coded as a reason
for encounter —S04.

Choosing the component code

1. Symptoms and complaints
The most common reasons patients give for seeking health care are presented in the
form of symptoms and complaints.14,16,23,24 Therefore, it is expected that Component 1
(symptoms and complaints) will be used extensively. These symptoms are specific for
each chapter; nausea is found in the Digestive chapter (D09), while sneezing (R07) is
located in the Respiratory chapter. While most of the entries in this component are
symptoms specific to the chapter in which they are found, some standardization has
been introduced for ease of coding.
Throughout most of the chapters, with the exception of psychological and social, the first
rubric(s) relate to the symptom pain. Examples of these are earache (HOI) and headache
(N01). There are also four standard Component 1 rubrics in each chapter. They are:
● 26 Fear of cancer
● 27 Fear of having a disease or condition
● 28 Limited function/disability
● 29 Other symptoms/complaints
Codes 26 and 27, and sometimes also a few others, are used when the patient expresses
concern about or fear of cancer or some other condition or disease. Examples are:
‘I’m afraid I have TB’ A27
‘I’m worried that I have cancer of the breast’ X26
‘I’m scared of venereal disease’ Y25
Even though the provider thinks that such an expressed fear is unwarranted or illogical, it
constitutes the patient’s reason for encounter.
Rubric —28 should be used when the patient’s reason for encounter is expressed in
terms of a disability which affects activities of daily life and social functions.

Examples
‘I cannot climb stairs because of the cast they have put on my leg for my fractured
ankle’ —L28 (Component 1) and L76 (Component 7).
‘I can’t work in the office because I can’t sit for any length of time because of my
hemorrhoids’ —K28 (Component 1) and K96 (Component 7).
In each chapter the component code 29 is the residual or ‘rag-bag’ rubric for symptoms/
complaints. This contains uncommon and unusual symptoms and complaints which do
not have a separate rubric, and is also appropriate for symptoms/complaints which are
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22 WONCA International Classification of Primary Care

not clearly stated. The index should be checked for synonymous terms in other rubrics
before using this rubric.

2. Diagnostic, screening and preventive procedures

The reasons included in this concept are those in which the patient seeks some sort
of procedure, such as ‘I‘m here to have a blood test’ (—34). The patient may request a
particular procedure in connection with an expressed problem or as a single demand,
such as
‘I want the doctor to examine my heart’ K31, or
‘I think I need to have my urine tested’ (—35), or
‘I‘ve come for the result of my X-ray’(—60), or
‘I need a vaccination’(—44).
Clarification by the provider is necessary to find out why the patient thinks he or she
needs a urine test in order to select the appropriate alpha code. If it is because of a
possible bladder infection the code is U35; if because of diabetes T35. If the result of an
X-ray which is being requested refers to a barium meal D60. A request for vaccination
against rubella A44.

3. Medication, treatment, procedures

These reasons are expressed when the patient requests a treatment or when the patient
refers to the physician’s instructions to return for specific treatment, procedure, or medi-
cation as the reason for encounter. Further clarification by the provider is often necessary
in order to identify the most appropriate code.

Examples

‘I need my medication’ (—50). If the patient expresses the reason why he is taking the
medication or the provider knows the reason, select the appropriate alpha code, e.g. for
a sinus infection the code would be R50.
‘I’m here to have my cast removed’ (—54). If it is evident that, for instance, the patient
had a fracture of the left arm the correct alpha code to select would be L.
‘I was told to come for removal of the stitches today’ (—54). Although at first one
might assume that all suture removal would be in the Skin chapter, the patient might
have stitches from eyelid surgery F54 or from a phimosis operation Y54.

4. Test results
This component should be used when the patient is specifically requesting the results of
tests previously carried out. The fact that the results of the test may be negative does not
affect the use of this component. Often the patient will request the test result and its
consequences and seek more information on the underlying problem. In that case, also
consider using the additional code —45 (health education, advice).
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Use of ICPC for recording reason for encounter 23

Examples
‘I need the results of my blood test’. If the test was for anaemia code B60, if for lipids
T60, if the patient cannot specify A60.
‘I want to know what they found on the X-rays of my stomach that were taken last
week’ (D60).
‘I am supposed to pick up the result of my urine test and take it to the urologist. I also
want to know what he will do and which examinations and treatment I can expect’
(U60, U45).

5. Administrative
Administrative reasons for encounter with the health care system include such things as
examinations required by a third party (someone other than the patient), insurance
forms which require completion, and discussions regarding the transfer of records.

Examples
‘I need this medical insurance form completed’ (A62).
‘My fracture is healed and I need a certificate to go back to work’ (L62).

6. Referrals and other reasons for encounter

If the patient’s reason for encounter is to be referred to another provider —66, —67, and
—68 can be used for this purpose. If the patient states his/her reason for the encounter is
‘being sent by someone else’, use —65.
When a provider initiates a new episode or takes the initiative for the follow-up of an
already existing episode of a health problem such as hypertension, obesity, alcoholism,
or a smoking habit, it will be appropriate to code the reason for encounter as —64.

Example
A patient presenting with a blocked ear due to earwax, which is removed, has his blood
pressure measured and found to be high, and also receives advice about smoking. The
patient’s reasons for encounter and the related problems and treatment would be recorded
as follows:
H13 (blocked feeling in ear), H81 (earwax), H51 (removal of earwax).
K64 (provider initiated), K85 (raised blood pressure), K31 (checking of blood pressure).
P64 (provider initiated), PI7 (tobacco abuse), P45 (advice to stop smoking).

7. Diagnosis/disease
Only when the patient expresses the reason for encounter as a specific diagnosis or
disease should it be coded in Component 7. The reason for encounter of a patient who is
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24 WONCA International Classification of Primary Care

known to be a diabetic but comes in complaining of weakness should not be coded

to diabetes but to the problem expressed: weakness (A04). However, if the patient states
that he has come about his diabetes the diagnosis ‘diabetes’ should be coded as his rea-
son for encounter (T90).
If the patient names a reason for encounter in the form of a diagnosis which the
provider knows is not correct, the ‘wrong’ RFE of the patient is coded rather than the
‘correct’ one of the physician; for example a patient presenting with a reason for
encounter of ‘migraine’, when the provider knows it is tension headache, or a patient
who is known to have nasal polyps presenting with ‘hayfever’.

Examples
‘I am here because of my hypertension’ (K86).
‘I come every month for the arthritis of my hip’ (L89).

Rules for components

The following rules for the use of each component will reinforce the description of the
components.

Rule 1
Whenever a code is shown preceded by a dash (—), select the chapter code (alpha). Use
A when no specific chapter can be selected, or when multiple chapters are involved. All
codes must begin with an alpha code to be complete.

Example
Biopsy will be coded —52, for digestive system D52, for skin S52. Medication
prescribed will be coded as —50. A patient requesting medication for asthma R50.

Rule 2
Rubrics from more than one component, or more than one rubric from the same compo-
nent, can be used for the same encounter if more than one reason is presented by the
patient.

Example
‘I’ve had abdominal pain since last night and I vomited several times’ D01, D10.
‘I have some abdominal pain and I think that I may have appendicitis’ D06, D88.
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5 Use of ICPC for recording

health problems and process
of care (interventions)

Health problems
ICPC can be used to record the provider’s assessment of the patient’s health problems.
This can be done in terms of symptoms and complaints, or diagnoses, so can be derived
from Component 1 or Component 7. The latter is based on the lists of diseases, injuries,
and related health problems in the International Classification of Diseases (ICD), but
includes as separate rubrics only those that are common or important in primary care.
Many of the health problems which are managed in primary care cannot be designated
in terms of disease or injury. They include symptoms and complaints, which are listed
in Component 1. Sometimes there is no apparent health problem involved in an episode
of care, as when it relates to need for immunization or a Pap smear or advice. These
episodes can be labelled using rubrics such as A97 No Disease, or A98 Health
Maintenance/Preventive Medicine.
In Components 1 and 7 the corresponding ICD-10 codes are listed for each rubric.
Sometimes these are an exact one-to-one match, but more often there are several ICD
codes for an ICPC-2 rubric, and sometimes there are several ICPC-2 codes for a single
ICD-10 rubric. A full conversion structure is given in Chapter 10.
In order to improve reliability of coding health problems using ICPC-2, many of the
rubrics in Component 7 have inclusion criteria specified. These are explained in
Chapter 6.
Rubrics in Components 1 and 7 often have additional information as a guide to their use:
lists of synonyms and alternative descriptions as inclusion terms; lists of similar con-
ditions which should be coded elsewhere as exclusion terms; and lists of less specific
codes which might be considered if the particular patient’s condition does not meet the
inclusion criteria. There are no such guidelines for rubrics in the process Components 2 to 6.

General rules for coding health problems

Users are encouraged to record during each encounter, the full spectrum of problems
managed, including organic, psychological, and social health problems, in the form of
episode(s) of care. Recording should be at the highest level of diagnostic refinement for
which the user can be confident, and which meets the inclusion criteria for that rubric.
In any data system it is necessary to have clear and specific criteria for the way in
which health problems or episodes of care are recorded. This applies particularly to the
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26 WONCA International Classification of Primary Care

relationship between the underlying condition and manifestations when both may be
available as rubrics in the classification, and is best illustrated by an example. A patient
with ischaemic heart disease may also have atrial fibrillation and resulting anxiety. It
should be policy to include as separate episodes of care manifestations which require
different management, and in the above example the atrial fibrillation and anxiety
would be recorded as additional episodes of care.
Some systems require that problems be coded only from components 1 and 7; others
also accept codes from other components, so that if, for example, the patient attends for
a tetanus immunization without a current injury, the problem could be coded as N44.
In ICPC localization within a body system takes precedence over aetiology, so that
when coding a condition which because of its aetiology can be found in several chapters
(for example, trauma) the appropriate chapter should be used. Chapter A (general) should
be considered only if the site is not specified or if the disease affects more than two
body systems. All chapters provide specific rubrics based on the body system or organ
involved in the disease and the aetiology. Conditions accompanying and affecting preg-
nancy or the puerperium are usually coded to Chapter W, but a condition is not coded to
Chapter W merely because the patient is pregnant; it should be coded to the appropriate
rubric in the chapter representing the body system involved. All social problems,
whether identified as a reason for encounter or as a problem, are listed in the first
component of Chapter Z.

Specific rules for coding health problems using

inclusion criteria (see also Chapter 6)
1. Coding of diagnoses should occur at the highest level of specificity possible for that
patient encounter.
2. Inclusion criteria contain the minimum number of criteria necessary to permit coding
with that rubric.
3. Consult the criteria after the diagnosis has been formulated. They are NOT guide-
lines for diagnosis, NOR are they intended to be used as a guide to therapeutic
decisions.
4. If the criteria cannot be fulfilled, consult other less specific rubrics suggested by the
term ‘consider’.
5. For those rubrics without inclusion criteria, consult the list of inclusion terms in the
rubric, and take into account any exclusion terms.

Process of care, interventions

ICPC can be used to classify the interventions used in the process of medical care with
Components 2, 3, 5, and part of Component 6; however, Component 4 and some rubrics
of Component 6, namely, —63, —64, —65, and —69, cannot be used in this way.
These process rubrics are broad and general, rather than specific. For instance,
a blood test (—34), even if relating to only one body system (e.g. cardiovascular,
K34), may encompass a great variety of different tests such as enzymes, lipids, or
electrolytes.
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Health problems and process of care (interventions) 27

The process codes in Components 2, 3, and 5 follow the major headings to be found
in the far more detailed IC-Process-PC, which was developed by the WONCA
Classification Committee.25 ICPC and IC-Process-PC are, therefore, compatible one
with the other. The details found in IC-Process-PC may be applied to the three-digit
ICPC codes by expanding to four or five digits.
In Components 2, 3,5, and the part of Component 6 which can be used to classify the
process of care, the rubric codes are standard throughout the chapters at the two-digit
level. The alpha code of the correct chapter has to be added by the provider who is
doing the coding. A limited number of rubrics in the first and seventh components of
Chapters W, X, and Y also contain procedures such as delivery, abortion, and family
planning.
The most important principle in the coding process is to code all those interventions
which take place during that particular encounter and which have a logical relation to
the episode of care. A fourth or fifth digit may be necessary for increased specificity, as
in the following examples:

Example 1
—54 Repair/fixation/suture/cast/prosthetic device
L54.1 Application of casts
L54.2 Removal of casts

Example 2
—40 Diagnostic endoscopy
—D40 Diagnostic endoscopy of the digestive system
—D40.1 Gastroscopy
More than one process code may be used for each encounter, but it is extremely impor-
tant to be consistent. For instance, measuring the blood pressure, which is routine for
hypertension, can be coded as K31 on every occasion. Routine examinations, complete
or partial, both for body systems or for the general chapter must also be coded with
consistency. Below are examples of definitions for complete and partial examinations
which have been used in one setting. However, it is essential that each country develops
a definition of what constitutes a ‘complete examination—general’ and a ‘complete
examination—body system’ for that culture and that these definitions are used
consistently. This will ensure that what is contained in each ‘partial examination—
general’ or ‘partial examination—body system’, in that country will also have consistency.

Complete examination
The term ‘complete examination’ refers to an examination which contains those ele-
ments of professional assessment which by consensus of a group of local professionals
reflects the usual standard of care. This examination will be complete with regard to
either the body system (e.g. eye, Chapter F) or as a complete general examination
(Chapter A).
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28 WONCA International Classification of Primary Care

Partial examination
The term ‘partial examination’ in any chapter refers to a partial examination directed to
the appropriate specific organ system or function. When more than two systems are
involved in a limited or incomplete examination it is designated general (Chapter A).
Most encounters will include a partial examination to evaluate acute and simple illnesses
or return visits for chronic illnesses. The following are examples:
Complete examination—general, general check-up = A30
Complete neurological examination = N30
Partial examination—general, limited check on several body systems such as respiratory
and cardiovascular = A31
Partial examination—body system, measuring blood pressure = K31
The following procedures are regarded by the WONCA Classification Committee as
included in routine examinations to be coded in rubrics —30 and —31 rather than
coded separately:
● inspection, palpation, percussion, auscultation
● visual acuity and fundoscopy
● otoscopy
● vibration sense (tuning fork examination)
● vestibular function (excluding calormetric tests)
● digital rectal and vaginal examination
● vaginal speculum examination
● blood pressure recording
● indirect laryngoscopy
● height/weight.
All other examinations are to be included in other rubrics.

Component 2—diagnostic, screening and preventive procedures

Diagnostic and preventive procedures cover a wide range of health care activities
including immunizations, screening, risk appraisal, education, and counselling.

Component 3—medications, treatment, procedures

This component is designed to classify those procedures done on site by the primary
care provider. It is not intended that it be used to document procedures done by
providers to whom the patient has been referred, for which a much more extensive list
of procedures would be required. Immunizations are coded in Component 2.

Component 4—test results

Component 4 does not relate to process or interventions.
06_Wonca-[Link] 06/04/2005 7:59 AM Page 29

Health problems and process of care (interventions) 29

Component 5—administrative
This component is designed to classify those instances where the provision of a written
document or form by the provider for the patient or other agency is warranted by exist-
ing regulations, laws, or customs. Writing a referral letter is only considered to be an
administrative service when it is the sole activity performed during the encounter,
otherwise it is included in Component 6.

Component 6—referrals, and other reasons for encounter

Referrals to other primary care providers, physicians, hospitals, clinics, or agencies for
therapeutic or counselling purposes, are to be coded in this component. Referrals for an
X-ray or a laboratory investigation should be coded in Component 2.
For more specificity, a fourth digit can be added, for example:
—66 Referral to other provider/nurse/therapist/social worker.
—66.1 Nurse
—66.2 Physiotherapist
—66.3 Social worker
—67 Specialist
—67.1 Internist
—67.2 Cardiologist
—67.3 Surgeon.
07_Wonca-[Link] 06/04/2005 1:47 PM Page 30

6 Inclusion criteria in ICPC

Introduction
It has always been clear to the WONCA Classification Committee that an internationally
agreed list of rubrics to classify problems met in primary care would not in itself ensure
the highest level of statistical comparability. In the International Classification of
Health Problems in Primary Care (ICHPPC-2-Defined) published in 1983 inclusion
criteria for the use of each rubric were introduced to improve consistency of coding.5
Inclusion criteria are not the same as definitions. They should be considered in relation to
their purpose, to improve consistency of coding, rather than as definitions for delineating
health problems. We have, however, tried to ensure that they are compatible with accepted
definitions, such as those in the International Nomenclature of Diseases (IND).
In this publication many of the inclusion criteria originating in ICHPPC-2-Defined have
been updated and are directly related to ICPC rubrics. In some instances, new or extensively
modified inclusion criteria have been created based on the theoretical framework described
in the next section. Although this publication marks an advance in the taxonomy of general/
family practice, it is not yet ideal. ICPC is a classification very much in evolution, and
experience with the inclusion criteria presented in this volume will undoubtedly lead to
further refinement in the years to come. We welcome comments from users.

Theoretical framework for assignment

of inclusion criteria
The theoretical framework used to assign inclusion criteria in this classification is based on
the presence of four general categories of diagnosis in primary care: aetio-logical and
pathological disease entities, pathophysiological conditions, nosological diagnoses
(syndromes), and symptom diagnoses. It was decided to apply different principles to
each category based on its characteristics:
● Aetiological and pathological: the diagnosis has proven pathology or aetiology;
inclusion criteria are based on standard disease definition, with modification where
necessary to allow application to general/family practice. Examples: appendicitis,
acute myocardial infarction.
● Pathophysiological: the diagnosis has a proven pathophysiological substrate; inclu-
sion criteria include symptoms, complaints, and characteristic objective findings.
Examples: presbyacusis, hypertension.
● Nosological: the diagnosis depends on a symptom complex based on consensus
between physicians, without a proven pathological or pathophysiological base or
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Inclusion criteria in ICPC 31

aetiology, and is often called a syndrome; inclusion criteria include only symptoms
and complaints. Examples: depression, irritable bowel syndrome.
● Symptom: a symptom or complaint is the best medical label for the episode.
Examples: fatigue, eye pain.

The criteria
The underlying principle used was to provide THE MOST CONCISE INCLUSION
CRITERIA POSSIBLE WHICH WOULD MINIMIZE VARIABILITY IN CODING.
Adherence to this principle led to the use of minimal inclusion criteria for each rubric.
This requires further explanation.
For most diagnostic rubrics, the reader will find one or more criteria which must be
fulfilled to code a problem under that title. Sometimes there is a choice of criteria;
at other times criteria from a list must be met. When ‘or’ is used in a list it is with its
inclusive meaning, which is the same as ‘and/or’. ‘Multiple’ in this book means three
or more.
Attempts were made to specify the minimum criteria needed in order to reduce the
complexity of coding and thus minimize miscoding. In addition, we have only included
those criteria which have sufficient discriminatory value to distinguish one rubric from
another with which it might be confused. In some cases, the available criteria may be
too few to exclude all other possible conditions which might be coded mistakenly to a
particular rubric, but they will exclude the common ones.
The criteria have whenever possible been based on clinical criteria, rather than
requiring the results of tests and investigations. They are as far as possible independent
of technology, which varies considerably throughout the world, and is rapidly changing.
This makes them appropriate for primary care use throughout the world.
This approach is very different from that seen in classic disease-oriented textbooks,
which usually list all signs and symptoms, or all potential criteria, associated with a
particular diagnostic title. We believe that in order to maximize the utility of criteria-
based problem coding in general practice, brevity must supersede exhaustiveness.
Sometimes the rubric title is itself adequately specific. In these cases, no inclusion
criteria are given. To avoid errors, each rubric, with inclusion and exclusion terms, and
inclusion criteria, should be read in its entirety.
Attempts were not made to provide criteria for every rubric, particularly residual
rubrics, which contain too many disparate diagnoses for useful definition. In these cases,
the reader should consult the list of diagnoses included in the rubric title and inclusion
terms, or refer to the more complete list given for the relevant rubrics in ICD-10.

Cross-referencing
As well as inclusion criteria, each rubric may have the following information:
● includes: a list of synonyms and alternative descriptions which are included in
the rubric
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32 WONCA International Classification of Primary Care

● excludes: a list of similar conditions which should be coded elsewhere, with the
appropriate code for each
● consider: a list of rubrics with their codes, usually less specific, which might be
considered if the particular patient’s condition does not meet the inclusion criteria

Advantages of this framework

The use of this framework results in clear and generally accepted inclusion criteria for
problems which are common in general/family practice, and which require inclusion
criteria if they are to be coded consistently.
Another major advantage of this framework is that employing minimal inclusion
criteria results in coding procedures which are easy to learn and apply in the real world
of general/family practice. This will reduce the magnitude of the problem of intercoder
variation.

Using inclusion criteria

Inclusion criteria SHOULD NOT be used when recording reasons for encounter, since
these should be coded in terms of what the doctor understands the patient to say, irre-
spective of whether or not the patient is ‘correct’.
Inclusion criteria SHOULD be used when coding the diagnoses or problems the doctor
manages. Even when the problem has to be coded only as a symptom or complaint, some
guidance may be needed in order to select the most appropriate code. For example, feel-
ing faint (N17) is not coded in the same rubric as actual fainting (A06); and abdominal
pain may be generalized (D01), epigastric (D02), or localized in other regions (D06). The
options need to be clear to users so that the most appropriate alternative is used.

Applying the criteria at different stages

of the problem
The inclusion criteria are primarily designed to code the early presentation of a problem.
If the problem is to be coded during a later encounter (after its modification by time or
therapy) the coder should consider the historical information (e.g. blood pressure may
well be normal at later consultations in a patient with hypertension receiving therapy
but the condition would still be coded as hypertension).

Disadvantages of the system

Clearly, this system of inclusion criteria is not without hazard. In order to improve the
accuracy and reliability of statistics from general/family practice, hard edges have been
put to diagnostic concepts, many of which seem, in reality, to have blurred borders.
07_Wonca-[Link] 06/04/2005 1:47 PM Page 33

Inclusion criteria in ICPC 33

Although sharp borders may not be needed for therapy or management, accurate data
are needed for purposes of research. The use of hard-edged inclusion criteria may
increase the content of residual less specific rubrics, but this is preferred to making
most rubrics non-specific. For coding problems which do not fully meet the given criteria,
less specific alternatives are suggested following ‘Consider:’. These suggestions are in
addition to those items which are listed as exclusions in the rubric.

Some possible misconceptions

It is important that the reader clearly understand several things which the criteria are
NOT intended to do.
1. They do not serve as a guide to diagnosis. The primary purpose of the classification
is to reduce chances of miscoding after a diagnosis has been made, and not to elimi-
nate the possibility of diagnostic error. The assumption is that the user will have con-
sidered the differential diagnosis prior to the time of coding. In most cases good
practice of medicine requires far more information than is given in the inclusion cri-
teria to make accurate diagnoses.
2. They do not set standards for care. Although information derived from the use of the
classification may change medical concepts and ultimately impact on standards of care,
these inclusion criteria are intended solely to improve the quality of data recording.
3. They do not act as a guide for therapy. The criteria given for inclusion or exclusion
for a condition do not necessarily relate to the criteria for use of various therapies.
For example, the practitioner may well decide that therapy for migraine is indicated
in a patient whose findings were insufficient to fulfil the criteria listed under that
diagnostic title, and whose condition is coded as ‘headache’.

Sources
The Committee felt no compulsion to devise new definitions and based inclusion criteria
on existing ones, if appropriate for the objectives given above. In fact, few existing defini-
tions did meet those requirements because most had been prepared for research projects
rather than for clinical practice and so tended to be rather cumbersome. However, the
inclusion criteria included here are compatible with most standard definitions of diseases.
If someone else’s work has been used inadvertently without acknowledgement,
apologies are given: imitation is the sincerest form of flattery.
08_Wonca-[Link] 06/04/2005 8:04 AM Page 34

7 Severity of illness coding

Development of severity of illness coding

Since 1993 the WONCA Classification Committee has been developing the Duke
Severity of Illness Checklist (DUSOI) system26 for international use. The WONCA
Severity of Illness Field Trial (WONCA-SIFT) was conducted to test the system in
16 countries.27 The committee recognized that a method is needed to enable doctors to
code not only the name of each health problem, but also the level of severity of each
problem. This is applicable to problems whether in respect of episode of care, or for
each encounter (see Fig. 2).
The ICPC is now unique among international classification systems in that it can be used
to classify health problems by their level of severity in the individual patient with the health
problem. The severity coding system, the Duke/WONCA Severity of Illness Checklist
(DUSOI/WONCA), is an extension that enables the physician or other health worker not
only to give the problem a standardized title and classification code, but also a standardized
severity code that indicates which patients with the same health problem have the more or
less severe problem. Since the severity parameters and criteria of the system are generic, not
health problem specific, they can be applied to any health problem. This generic quality also
allows comparison of the severity of different health problems based upon the same stan-
dards for assessment. The system is feasible for use by family/general practitioners in the
clinical setting as demonstrated in the WONCA-SIFT field trial.27

Coding severity of illness

The DUSOI/WONCA severity of illness coding system allows ICPC to be used to clas-
sify health problems in terms of severity. To code severity, the health care provider
identifies each problem at the time of patient encounter and determines how severe each
problem is for that particular patient at that particular time. Severity is based upon the
following four generic parameters:
1. Symptoms during the past week.
2. Complications during the past week.
3. Prognosis during the next six months if no treatment were to be given for the health
problem.
4. Treatability, or the need for treatment and the expected response to treatment by this
patient.
An example of a completed form is shown in Fig. 4, in which the provider, John Smith,
has listed the current health problems which he addressed during the encounter for
 DUKE/WONCA SEVERITY OF ILLNESS CHECKLIST: DUSOI/WONCA* Patient: Mary Jones
08_Wonca-[Link]

Birthdate:Nov. 6, 1925 Female: Male: Provider: John Smith Date of Encounter: Oct. 5, 1995

Total Severity ICPC

Health Problems Raw Scores (Enter 0-4)** Raw Score Code*** Code
(Addressed during this encounter) Symptoms Complications Prognosis Treatability (0-16) (0-4)
EXAMPLE: Gout 3 1 3 2 9 3 T92:3
06/04/2005

Ischaemic Heart Disease

1. without Angina 2 0 4 2 8 2 K76:2
2. Diabetes Mellitus 0 0 2 2 4 1 T90:1
3. Acute Bronchitis 3 0 2 2 7 2 R78:2
8:04 AM

4.
5.
6.
Page 35

(Use additional pages if more than six health problems.)

**RAW SCORES *** SEVERITY CODES

None Questionable Mild Moderate Major Total
1. Symptoms (past week):
Severity of illness coding

0 1 2 3 4 Raw Severity
2. Complications (past week): 0 1 2 3 4 Score Code Severity

Disability 0 = 0 None
3. Prognosis (next 6 months, None Mild Moderate Major Threat to Life 1-4 = 1 Mild
without treatment): 0 1 2 3 4 5-8 = 2 Intermediate
9-12 = 3 Moderate
Need for Treatment Expected Response to Treatment 13-16 = 4 Maximum
No Questionable IF YES Good Questionable Poor
4. Treatability: 0 1 2 3 4

*Copyright  1996, Department of Community and Family Medicine, Duke University Medical Center, Curham, NC, USA

Fig. 4. Duke/WONCA severity of illness checklist: DUSOI/WONCA.

35
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36 WONCA International Classification of Primary Care

patient Mary Jones on 5 October 1995. Gout is printed on all forms as an example; it
does not apply to this patient. If patient Jones had had gout, the provider would have
listed gout again and scored its severity according to its specific effects on Mary Jones.
Actually, at this encounter this patient had ischaemic heart disease without angina, diabetes
mellitus, and acute bronchitis.

Raw scores
The raw severity scores that are possible for each of the four severity parameters are
shown in the large box at the bottom of the DUSOI/WONCA form. In the example of
ischaemic heart disease without angina (K76) in Fig. 4, the severity of symptoms was
rated ‘2’ on a scale of 0 to 4, because the patient was considered to have mild symptoms
at that time. Severity in terms of complications was rated ‘0’ because no complications
for ischaemic heart disease were evident clinically. For DUSOI/WONCA ratings, the
definition of a complication is ‘a health problem which is secondary to another health
problem, but which is not listed and rated as a separate problem’. If a complication is
recorded on the form as a separate health problem, the effects of this separately recorded
complication should not be included in the severity rating of the health problem of
origin, in order to avoid assigning double weight to a complication in the scoring.
Prognosis for ischaemic heart disease with angina in Fig. 4 was scored ‘4’ because the
provider made a clinical judgment that this patient would be expected to die during the
next six months following the encounter if no treatment were given, thereby allowing
the heart disease to have full effect on the untreated patient. If Dr Smith had predicted
that Mary Jones would not die without treatment, but rather would experience major
disability, then a rating of ‘3’ for prognosis would have been appropriate. Disability is
defined as ‘any limitation of a person’s ability to function in everyday life’. Major dis-
ability (raw score 3) is defined as ‘much restriction of usual activity and much care
needed from others’. Mild disability (raw score 1) is defined as ‘little restriction of
usual activities’, and moderate disability (raw score 2) is defined as ‘much restriction of
usual activity but little care needed from others’. Treatability was rated ‘2’ in the example
because the provider decided that this particular patient needed treatment and would be
expected to have a good response to that treatment.

Severity codes
To determine the single-digit DUSOI/WONCA severity code, the raw scores for each
health problem are summed, and the total raw score is converted to a severity code
using the conversion table in the small box at the bottom of the form. In the example of
ischaemic heart disease without angina in Fig. 4, the total raw score = 8(2 + 0 + 4 + 2),
and the severity code = 2. (The conversion table shows that raw scores of 5 to 8 = a
severity code of 2.) The severity code of 2 indicates that ischaemic heart disease without
angina in this particular patient at this particular encounter is of intermediate severity, on
a scale of 0 to 4 from ‘none’ to ‘maximum’ severity.
The severity code can be added to the problem code as an extension, using ‘:’ as the link,
a convention which distinguishes the severity extension from other extensions which may
be used. Hence the code for the ischaemic heart disease without angina in Fig. 4 is K76:2.
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Severity of illness coding 37

Results of the severity of illness field trial

(WOIMCA-SIFT)
The international study was conducted during a two-year period (1993–5) to test the
reliability, feasibility, and potential clinical usefulness of the DUSOI/WONCA. Initially
47 general/family practitioners from 16 different countries participated. Of these,
22 practitioners from 9 countries (Belgium, Germany, Hong Kong, Israel, Japan,
The Netherlands, Spain, The United Kingdom, and The United States) completed data
collection.27
The 22 practitioners performed DUSOI/WONCA ratings on 1191 patients. The study
group had a mean age of 59.2 years; 59.6% were females; and they had a total of 2488
health problems. Reliability of the DUSOI/WONCA was estimated from ratings on a
series of standardized health problems. The intraclass correlation coefficient (ICC)28 for
interrater reliability was 0.45 and the ICC for intrarater reliability ranged from a low of
0.39 for the social problem of partner being ill (ICPC code Z14), to 0.78 for obesity
(ICPC code T82) and 0.68 for anxiety (ICPC code P74). Feasibility for use in practice
was good, as indicated by an average of only 1.9 minutes required to rate the
DUSOI/WONCA on each patient (ranging from less than 1 to 10 minutes). The physi-
cians experienced no difficulty in using the system in 71.1% of patients. They found it
quite useful in 14.7% of patients, somewhat useful in 53.6%, and of no use in 31.7%.
Usefulness was higher in patients with higher severity of illness scores.
The mean DUSOI/WONCA severity score for all 2488 health problems was 39.1
(scale = 0–100 from lowest to highest severity), and the problems were distributed
among the five severity classification codes as follows: Code 0 (no severity) = 1.6%,
Code 1 (mild severity) = 29.9%, Code 2 (intermediate severity) = 45.9%, Code 3 (mod-
erate severity) = 19.3%, and Code 4 (maximum severity) = 3.3%. Wide variations in
severity were shown, both between different diagnoses and within each diagnosis. For
example, mean severity for respiratory health problems varied between 26.4 for upper
respiratory infection (URI, ICPC code R74) to 53.2 for chronic obstructive pulmonary
disease (COPD, ICPC code R95). For URI, the frequency of severity codes ranged from
61.1% for Code 1 to 0% for Code 4, in contrast to COPD with the range from 8.4% for
Code 1 to 10.6% with Code 4.
When surveyed at the end of the field trial concerning their future anticipated personal
use of the DUSOI/WONCA, 41.2% of the 22 participants reported they might use it in
patient care, 71.2% might use it in research, 43.8% in teaching, and 52.9% in practice
management.
It was concluded that the DUSOI/WONCA is feasible and potentially useful clinically
in family/general practice.27 Although the practitioners were not queried about the use-
fulness of the system for disease severity classification, the empirical findings of the
field trial indicate that it is well suited for this purpose.
09_Wonca-[Link] 06/04/2005 8:05 AM Page 38

8 Functional status assessment:

the COOP/WONCA charts

In 1987 the WONCA Classification Committee began to develop a way of classifying

and recording the overall functional status of the patient as distinct from the status of
severity of their health problem(s).29 Over a number of years this work, later conducted
in cooperation with the WONCA Research Committee, resulted in production of the
COOP/WONCA Functional Status Assessment Charts.30,31
Functional status is a measure of an individual’s overall well-being. It is one of the
set of global measures of health status, which also include assessments of clinical status
and quality of life. The International Glossary for General/Family Practice defines
functional status as ‘the ability of a person to perform and adapt to his/her environment,
measured both objectively and subjectively over a stated period of time’.19 Implicit in any
definition of functional status is the importance of factors other than disease in the health
of patients. As the complexity and chronicity of medical problems increase, general/
family practitioners will become more reliant on indicators of functioning as well as
disease status to monitor their interventions and measure health outcomes.
Functional status relates to the patient, not to the health problem, disease, or episode
of care. It thus relates less directly to the ICPC codes than does severity of illness.
However, its importance in general/family practice warrants its inclusion in this book.
For some time general practitioners have recognized the integral importance of
health promotion and the measurement of functional status in consultations. These
measurements are particularly important in dealing with ageing and those with chronic
problems. The addition of functional status measures to the recording of reason for
encounter, diagnosis, and therapeutic interventions is a logical step for the process of
classification in general/family practice.

Instruments for measuring functional status

One of the first instruments to be recognized by WONCA as a reliable and practical
measure of functional status in the family practice setting was the Dartmouth COOP
Functional Assessment Charts.32 These charts were modified by the classification com-
mittee and promoted for use in conjunction with ICPC. The revised charts are known as
the COOP/WONCA charts.
The COOP/WONCA charts, whilst specifically developed for general/family practice,
are not the only instruments available for assessing functional status. There are a plethora
of indicators currently available. Several have been used in general practice settings.
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Functional status assessment: the COOP/WONCA charts 39

The Medical Outcomes Trust Short Form 36-item inventory and derivatives of this
instrument have been widely used in primary care settings. Similarly, the Duke Health
Profile has been used successfully in North American settings.33 In Europe, several other
instruments have been used. The Sickness Impact Profile (SIP) and the Nottingham Health
Profile (NHP) are the two most widely cited. Some of these instruments were designed for
research not clinical purposes, (e.g. the Sickness Impact Profile34).
To date, the COOP/WONCA charts have been tested most extensively in general/
family practice settings.35 Internationally, they have been found to have good face
validity and clinical utility in general practice.36 General practitioners have found the
charts easy to use within the consultation and helpful as measures of overall patient status
and as outcomes of care.
With any measure of functional status, cultural and context issues need to be
explored. Some studies of the charts have suggested that they do not exhibit cross-cultural
stability. As a research instrument the test-retest reliability will always be an issue for
indicators that are global and influenced by so many variables. Several studies have
looked at these issues. Standardization of test conditions and assessment of intrarater
reliability may improve the results for research projects.

COOP/WONCA charts
The current form of the COOP/WONCA charts was determined through extensive testing
in general/family practice settings. There are now six charts: physical fitness; feelings;
daily activities; social activities; change in health; and overall health. An example of the
Daily Activities Chart is shown in Fig. 5. Additional charts for pain and sleep are under
development.
Each chart consists of a lead sentence with five options for response. Pictorial depic-
tions of the five possible responses accompany the text. These drawings have enhanced
the applicability of these charts in settings where there is variability of literacy amongst
the general practice patient population.
To date the charts have been published in the following languages: Chinese, Danish,
Dutch, Finnish, French, German, Hebrew, Italian, Japanese, Korean, Norwegian,
Portuguese, Spanish (Catalan, Castilian, and Callego), Slovak, Swedish, and Urdu.31

Use of the charts

The charts can be used independently or in groups. When more than one chart is used it
is recommended that they are administered in the following order: physical fitness, feel-
ings, daily activities, social activities, change in health, overall health. The preferred
method of use of these charts is self-administration. However, one study has shown a
correlation between self-assessment and provider assessment.31 The average time for
completion of the six charts is less than five minutes.
When the charts are used in new cultural settings, it is important to establish that the con-
cepts measured are appropriate and specific to that environment. Appropriate translation
is the first step.
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40 WONCA International Classification of Primary Care

Daily activities

During the past 2 weeks...

How much difficulty have you had doing our usual activities or
tasks, both inside and outside the house, because of your physical
and emotional health?

No difficulty at all

A little bit of difficulty

Some difficulty

Much difficulty

Could not do

Fig. 5. COOP/WONCA Functional Health Status Chart: daily activities.

Measuring functional health status with the COOP/WONCA Charts: a Manual,31

provides further information about the development and use of the charts, how to trans-
late the charts, and a contact list for further assistance, including authors of the various
translations.
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Functional status assessment: the COOP/WONCA charts 41

Relationship between ICPC and the

COOP/WONCA charts
Together with ICPC the COOP/WONCA charts can be used to explore the relationship
between functionality and health problems. For example, Rubric 28 of Component 1
(symptoms and complaints) of all chapters of ICPC refers to limited function and
disabilities. Functional status could be coded in this component with the addition of an
extra digit. However, since functional status relates to the patient as a whole and not to
the health problem, the relationship becomes difficult to interpret when there is more
than one active problem, because comorbidity complicates the interpretation. For example,
hypertension and diabetes in one patient can both impact on functional status, but their
relative importance and effects cannot be determined from routine recording. Even with
only one problem, functional status measures go beyond assessing problem status and
therefore their relationship to a particular ICPC code may not be straightforward.
10_Wonca-[Link] 06/04/2005 1:46 PM Page 42

9 References

1. International classification of diseases (9th revision). Geneva, World Health

Organization, 1977.
2. International Statistical Classification of Diseases and Related Health Problems
(10th revision). Geneva, World Health Organization, 1992.
3. International Classification of Health Problems in Primary Care (ICHPPC).
Chicago, World Organization National Colleges, Academies and Academic
Associations of General Practitioners/Family Physicians (WONCA)/American
Hospital Association (AHA), 1975.
4. ICHPPC-2 (International Classification of Health Problems in Primary Care).
Oxford, Oxford University Press, 1979.
5. ICHPPC-2-Defined: International Classification of Health Problems in Primary
Care, 3rd edition. Oxford, Oxford University Press, 1983.
6. Report of the International Conference on Primary Care, Alma Ata, USSR, 6–12
September 1978; WHO/Alma Ata/78.10.
7. Meads S. The WHO Reason for Encounter classification. WHO Chronicle 1983;
37(5): 159–162.
8. Lamberts H, Meads S, and Wood M. Classification of reasons why persons seek
primary care: pilot study of a new system. Public Health Rep. 1984; 99: 597–605.
9. Lamberts H, Meads S, and Wood M. Results of the international field trial with the
Reason for Encounter Classification (RFEC). Med. Sociale Preventive 1985;
30: 80–87.
10. Working party to develop a classification of the ‘Reasons for Contact with Primary
Health Care Services’. Report to the World Health Organization, Geneva,
Switzerland, 1981.
11. Wood M. Family medicine classification systems in evolution. J. Fam. Pract. 1981;
12: 199–200.
12. Lamberts H, Meads S, and Wood M. Results of the field trial with the Reason for
Encounter Classification (RFEC). In: Cote R A, Protti A J, and Schemer J R (ed.)
Role of Informatics in Health Data Coding and Classification Systems. Amsterdam,
Elsevier/JFIP-JMIA, 1985.
13. Bentsen B G. International Classification of Primary Care. Scand. J. Prim. Health
Care 1986; 4: 43–56.
14. Lamberts H, Wood M, Hofmans-Okkes I (ed.). The International Classification of
Primary Care in the European Community: with Multi-Language Layer. Oxford,
Oxford University Press, 1993.
15. Lamberts H and Wood M (ed.). ICPC: International Classification of Primary Care.
Oxford, Oxford University Press, 1987.
16. Bridges-Webb C, Britt H, Miles D A, Neary S, Charles J, and Traynor V. Morbidity
and treatment in general practice in Australia 1990–1991. Med. J. Aust. 1992; 157,
Suppl. 19 Oct: S1–S56.
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References 43

17. Hofmans-Okkes I M and Lamberts H. The International Classification of Primary

Care (ICPC): new applications in research and computer based patient records in
family practice. Fam. Pract. 1996; 13: 294–302.
18. Wood M, Lamberts H, Meijer J S, and Hofmans-Okkes I M. The conversion
between ICPC and ICD-10: requirements for a family of classification systems in
the next decade. In: Lamberts H, Wood M, and Hofman-Okkes I (ed.) The
International Classification of Primary Care in the European Community: with
Multi-Language Layer. Oxford, Oxford University Press, 1993: 18–24.
19. Bentzen N (ed.). An international glossary for general/family practice. Fam. Pract.
1995; 12: 341–369.
20. Jamoulle M and Roland M. Classification Internationale des Soins Primaires
(traduction francaise de 1’ICPC). Edition Alexandre Lacassagne, Lyon, 1992.
21. Jamoulle M and Roland M. Approches taxonomiques en medicine de famille,
assorties d’une terminologie medicale normalisee et classifiee a usage
informatique en soins de sante primaires. CARE Editions, Brussels, 2 vol., 1996.
22. Donaldson M S, Yordy K D, Lohr K N, and Vanselow N A (ed.). Primary care:
America’s health in a new era. Washington DC, National Academy Press, 1996.
23. Hofmans-Okkes I M. An international study into the concept and validity of the
‘reason for encounter’. In: Lamberts H, Wood M, and Hofmans-Okkes I M (ed.)
The International Classification of Primary Care in the European Community.
Oxford, Oxford University Press, 1993: 34–44.
24. Nylenna, M. Why do our patients see us? A study of reasons for encounter in
general practice. Scand. J. Prim. Health Care 1985; 3: 155–162.
25. International Classification of Process in Primary Care (IC-Process-PC). Oxford,
Oxford University Press, 1986.
26. Parkerson G R Jr, Broadhead W E, and Tse C-K J. The Duke Severity of Illness
Checklist (DUSOI) for measurement of severity and comorbidity. J. Clin.
Epidemiol. 1993; 46: 379–393.
27. Parkerson G R Jr, Bridges-Webb C, Gervas J, Hofmans-Okkes I, Lamberts H,
Froom J, Fischer G, Meyboom-de Jong B, Klinkman M, and Maeseneer J.
Classification of severity of health problems in family/general practice: an
international field trial. Fam. Pract. 1996; 13: 303–309.
28. Shrout P E and Fleiss J L. Intraclass correlations: uses in assessing rater reliability.
Psychol. Bull. 1979; 86: 420–428.
29. WONCA Classification Committee. Functional status in primary care. New York,
Springer, 1990.
30. Scholten J H G and van Weel C. Functional Status Assessment in Family Practice.
MEDITekst CIP-Gegevens Koninklikje Bibliotheek, The Hague, 1992.
31. van Weel C, Konig-Zahn C, Touw-Otten F W M M, van Duijn N P, and
Meyboom-de Jong B. Measuring functional health status with the COOPAVONCA
Charts: a manual. CIP-Gegevens Koninklijke Bibiliotheek, The Hague, 1995.
32. Nelson E C, Wasson J, Kirk J, et al. Assessment of function in routine clinical
practice. Description of the COOP chart method and preliminary findings.
J. Chron. Dis. 1987; 40 (Suppl. 1): 55s–64s.
33. Parkerson G R Jr, Broadhead W E, and Tse C-K J. The Duke Health
Profile, a 17-item measure of health and dysfunction. Med. Care 1990; 28:
1056–1072.
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44 WONCA International Classification of Primary Care

34. Bergner M, Bobbin R A, Carter W B, et al. The Sickness Impact Profile. Conceptual
formulation and methodology for the development of a health status measure. Int. J.
Health Serv. 1976; 6: 393.
35. Hutchinson A, Bentzen N, Konig-Zahn C (eds.). Cross cultural health outcome
assessment: a user’s guide. European Research Group on Health Outcomes
(ERGHO), 1997; 1–184.
36. Bentsen B, Natvig B, Winnem M. Assessment of own functional capacity.
COOP-WONCA charts in clinical work and research (in Norwegian, English
summary). Tiddsk. Nor. Laegeforen. 1997; 117: 1790–93.
11_Wonca-[Link] 06/04/2005 8:06 AM Page 45

10 International Classification
of Primary Care-2-Revised:
tabular list

This tabular list consists of details of all the rubrics in ICPC-2-Revised and is a major
revision of the tabular list of the ICPC-2, published in 1998.1 It includes the revisions of
ICPC-2 in 20002 and 20023 and more recent unpublished revisions decided upon in
WICC meetings in 2003 and 2004. The editors of this revision are Inge Okkes, Henk
Becker, Sibo Oskam, and Henk Lamberts of the Department of Family Practice,
University of Amsterdam, The Netherlands.
Chapter 11 includes the revised conversion with ICD-10.
The process components 2–6, which are standard in all chapters, are set out first,
followed by components 1 and 7 in which each rubric is specific in each chapter.
1. WONCA International Classification Committee. International Classification for
Primary Care, 2nd edn. (ICPC-2). Oxford, Oxford University Press, 1998.
2. Okkes I M, Jamoulle M, Lamberts H, Bentzen N. ICPC-2-E. The electronic version
of ICPC-2. Differences with the printed version and the consequences. Fam. Pract.
2000; 17: 101–106.
3. Okkes I M, Becker H W, Bernstein R M, Lamberts H. The March 2002 update of the
electronic version of ICPC-2. A step forward to the use of ICD-10 as a nomenclature
and a terminology for ICPC-2. Fam. Pract. 2002; 19: 543–546.

Standard process components of ICPC:

components 2–6
The dash (—) shown in first position must be replaced with the appropriate alpha code
for each chapter.

Component 2—Diagnostic and preventive procedures

—30 Medical examination/health evaluation—complete
—31 Medical examination/health evaluation—partial
—32 Sensitivity test
—33 Microbiological/immunological test
—34 Blood test
—35 Urine test
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46 WONCA International Classification of Primary Care

—36 Faeces test

—37 Histological/exfoliative cytology
—38 Other laboratory test NEC
—39 Physical function test
—40 Diagnostic endoscopy
—41 Diagnostic radiology/imaging
—42 Electrical tracings
—43 Other diagnostic procedures
—44 Preventive immunizations/medications
—45 Observation/health education/advice/diet
—46 Consultation with primary care provider
—47 Consultation with specialist
—48 Clarification/discussion of patient’s RFE/demand
—49 Other preventive procedures

Component 3—Medication, treatment, therapeutic

procedures
—50 Medication-prescription/request/renewal/injection
—51 Incision/drainage/flushing/aspiration/removal body fluid (excl. catheterization—53)
—52 Excision/removal tissue/biopsy/destruction/debridement/cauterization
—53 Instrumentation/catheterization/intubation/dilation
—54 Repair/fixation–suture/cast/prosthetic device (apply/remove)
—55 Local injection/infiltration
—56 Dressing/pressure/compression/tamponade
—57 Physical medicine/rehabilitation
—58 Therapeutic counselling/listening
—59 Other therapeutic procedures/minor surgery, NEC

Component 4—Results
—60 Results tests/procedures
—61 Results examination/test/record/letter from other provider

Component 5—Administrative
—62 Administrative procedure

Component 6—Referrals and other reasons for encounter

—63 Follow-up encounter unspecified
—64 Encounter/problem initiated by provider
—65 Encounter/problem initiated by other than patient/provider
—66 Referral to other provider/nurse/therapist/social worker (excl. medical)
—67 Referral to physician/specialist/clinic/hospital
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International Classification of Primary Care-2-Revised 47

—68 Other referrals NEC

—69 Other reason for encounter NEC

Layout of rubrics in components 1 and 7

Rubrics are set out in the following format:

Code Title ICD-10 code(s)

incl: terms included

excl: terms excluded, with their ICPC codes
criteria: criteria for inclusion in this rubric
consider: rubrics to be considered if the criteria are not met

Example:
A73 Malaria B50 to B54

incl: complications of malaria

criteria: intermittent fever with chills and rigors in a resident of, or recent visitor
to, a malarial region; or demonstration of malarial parasite forms in the
peripheral blood
consider: fever A03

Summary of main changes to Components 1 and 7

from ICPC-1 to ICPC-2
Only major changes are listed here: additions, change in meaning of the rubric, or transfer
or deletion of a rubric. There are many other changes of detail to the titles of the rubrics
that do not change the meaning, and are not listed here.
CODE TITLE ICPC-1 TITLE ICPC-2
(some abbreviated)
A05 GENERAL DETERIORATION FEELING ILL
A11 (omitted by mistake from ICPC) CHEST PAIN NOS
A12 ALLERGY/ALLERGIC (transferred to A92)
REACTION
A13 CONCERN ABOUT DRUG CONCERN/FEAR
REACTION ABOUT TREATMENT
A14 INFANTILE COLIC (deleted, included in D01)
A15 EXCESSIVE CRYING INFANT (deleted, included in A16)
A17 OTHER GEN SYMPT INFANT (deleted, included in A16)
A18 (new rubric in ICPC-2) CONCERN ABOUT
APPEARANCE
A21 (new rubric in ICPC-2) RISK FACTOR FOR MALIGNANCY
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48 WONCA International Classification of Primary Care

A23 (new rubric in ICPC-2) RISK FACTOR NOS

A92 TOXOPLASMOSIS ALLERGY/ALLERGIC
(deleted, included with A78) REACTION NOS
(transferred from A12)
A98 (new rubric in ICPC-2) HEALTH MAINTENANCE/
PREVENTIVE MEDICINE
B03 OTHER SYMPT (deleted, included in B02)
LYMPH GLANDS
B85 UNEXPLAINED ABNORMAL (deleted, included in A91)
BLOOD TEST
B86 OTHER HAEMATOLOGICAL (deleted, included in B99)
ABNORMALITY
D07 (new rubric in ICPC-2) DYSPEPSIA/INDIGESTION
D22 WORMS/PINWORMS/OTHER (transferred to D96)
PARASITES
D23 (transferred from D96) HEPATOMEGALY
D96 HEPATOMEGALY (transferred to D23)
D96 (changed rubric in ICPC-2) WORMS/OTHER PARASITES
K22 (new rubric in ICPC-2) RISK FACTOR FOR CAR-
DIOVASCULAR DISEASE
K74 ANGINA PECTORIS ISCHAEMIC HEART
DISEASE WITH ANGINA
K76 OTHER AND CHRONIC ISCHAEMIC HEART
ISCHAEMIC HEART DISEASE, NO ANGINA
K80 ECTOPIC BEATS, ALL TYPES CARDIAC ARRHYTHMIA NOS
K81 HEART MURMER, NOS HEART/ARTERIAL
MURMER, NOS
K91 ATHEROSCLEROSIS (included with K92 in ICPC-2)
(EXCL. HEART/BRAIN)
K91 (altered rubric in ICPC-2) CEREBROVASCULAR DISEASE
K92 OTHER ARTERIAL ATHEROSCLEROSIS/
OBSTRUCTION/PER PERIPH VASC DIS
L05 FLANK SYMPTOMS/ FLANK/AXILLA
COMPLAINTS SYMPTOMS/COMPLAINTS
L06 AXILLA SYMPTOMS/ (deleted, included in L05)
COMPLAINTS
L71 NEOPLASMS MALIGNANT NEOPLASM
L83 SYNDROMES RELATED NECK SYNDROME
TO CERVICAL SPINE
L84 OSTEOARTHRITIS OF BACK SYNDROME
SPINE (ANY R) WITHOUT RADIATION
L86 LUMBAR DISC LESION, DISC LESION/BACK PAIN
BACK PAIN WITH RADIATION
L87 GANGLION JOINT/ BURSITIS/TENDONITIS/
TENDON SYNOVITIS NOS
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International Classification of Primary Care-2-Revised 49

L97 CHRONIC INTERNAL KNEE NEOPLASM, BENIGN/

DERANGEM UNCERTAIN
(included with L99 IN ICPC-2) (split from L71 in ICPC-2)
N02 TENSION HEADACHE (transferred to N95)
N08 (new rubric in ICPC-2) ABNORMAL INVOLUNTARY
MOVEMENTS (split from N06)
N80 OTHER HEAD INJURY WITHOUT HEAD INJURY, OTHER
SKULL FRACTURE
N95 (new rubric in ICPC-2) TENSION HEADACHE
(transferred from N02)
P21 OVERACTIVE CHILD, (transferred to P81)
HYPERKINETIC
P75 HYSTERICAL/ SOMATIZATION DISORDER
HYPOCHONDRIACAL DIS
P81 (new rubric in ICPC-2) HYPERKINETIC DISORDER
(transferred from P21)
P82 (new rubric in ICPC-2) POST-TRAUMATIC STRESS
DISORDER (split from P02)
P86 (new rubric in ICPC-2) ANOREXIA NERVOSA,
BULIMIA (transferred from T06)
R22 SYMPTOM/COMPLAINT TONSILS (deleted, included in R21)
R70 TUBERCULOSIS (deleted, included in A70)
R72 STREP-THROAT/SCARLET STREP THROAT
FEVER (scarlet fever included in A78)
R79 (new rubric in ICPC-2) CHRONIC BRONCHITIS
(transferred from R91)
R80 INFLUENZA WITHOUT INFLUENZA
PNEUMONIA
R82 PLEURISY PLEURISY/PLEURAL
EFFUSION (includes pleural
effusion from R93)
R91 CHRONIC BRONCHITIS (transferred to R79)
R92 (new rubric in ICPC-2) NEOPLASM RESPIRATORY,
UNCERTAIN NATURE
R93 PLEURAL EFFUSION (deleted, included in R82)
S11 OTHER LOCALIZED WOUNDINFECTION,
SKIN INFECTION POST-TRAUMATIC
S79 OTHER BENIGN NEOPLASMS NEOPLASM SKIN,
OF SKIN BENIGN/UNCERTAIN
S80 OTHER UNSPECIFIED SOLAR KERATOSIS/SUNBURN
NEOPLASM SKIN
T06 ANOREXIA NERVOSA (transferred to P82)
W/WO BULIMIA
T15 THYROID LUMP/MASS (deleted, included in T81)
T88 RENAL GLYCOSURIA (deleted, included in T99)
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50 WONCA International Classification of Primary Care

T89 (new rubric in ICPC-2) DIABETES, INSULIN

DEPENDENT
T90 DIABETES MELLITUS DIABETES, NON-INSULIN
DEPENDENT
U08 (new rubric in ICPC-2) URINARY RETENTION
W20 OTHER SYMPTOMS/COMPLAINTS (deleted, included in W19)
OF BREAST
W21 (new rubric in ICPC-2) CONCERN ABOUT BODY
IMAGE IN PREGNANCY
W77 OTHER NON-OBSTETRICAL (deleted)
CONDITION
W85 (new rubric in ICPC-2) GESTATIONAL DIABETES
X22 (new rubric in ICPC-2) CONCERN ABOUT
BREAST APPEARANCE
X92 (new rubric in ICPC-2) CHLAMYDIA INFECTION,
GENITAL

A General and unspecified

Component 1—Symptoms and complaints

Note: In this classification general or multiple refers to three or more body sites or systems.
Conditions affecting one or two sites should be coded to the appropriate sites.

A01 Pain, general/multiple sites R52

incl: chronic general pain, multiple aches

A02 Chills R68.8

incl: rigors, shivers

excl: fever A03

A03 Fever R50

incl: pyrexia
excl: fever with rash A76; heat exhaustion/stroke A88

A04 Weakness/tiredness, general G93.3, R53

incl: chronic fatigue syndrome, exhaustion, fatigue, lassitude, lethargy, postviral

fatigue
excl: malaise/feeling ill A05; drowsy A29; heat exhaustion A88; jetlag A88;
somnolence P06
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International Classification of Primary Care-2-Revised 51

A05 Feeling ill R53

incl: malaise
excl: senescence/senility P05; cachexia T08; malnutrition T91

A06 Fainting/syncope R55

incl: blackout, collapse, vasovagal attack

excl: coma A07; feeling faint/giddiness/dizziness N17

A07 Coma R40

incl: stupor
excl: syncope A06

A08 Swelling R68.8

incl: lump, mass NOS

excl: enlarged lymph gland B02; oedema K07; swelling joint L20; swelling breast
X19, Y16

A09 Sweating problem R61

incl: hyperhidrosis, night sweats, perspiration problem

excl: sweat gland disease S92

A10 Bleeding/haemorrhage NOS R58

A11 Chest pain NOS R07.4

excl: pain attributed to heart K01; pain attributed to chest wall L04; pain attributed
to respiratory system R01

A13 Concern about/fear of medical treatment Z71.1

incl: concern about/fear of the consequences of drug/medical treatment

excl: adverse effect of drug A85; complication of medical/surgical treatment A87

A16 Irritable infant R68.1

incl: excessively crying/restless infant

excl: infantile colic D01; restless child/adult P04

A18 Concern about appearance R46.8

excl: concern about appearance of ears H15; concern about appearance in

pregnancy W21; concern about appearance of breasts X22
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52 WONCA International Classification of Primary Care

A20 Euthanasia request/discussion Z71.8

A21 Risk factor for malignancy Z80, Z85

incl: personal/family history of malignancy, past treatment, other risk factor for
malignancy

A23 Risk factor NOS

Z20, Z28, Z72.0 to Z72.5, Z73.2, Z81, Z82.0 to Z82.2, Z82.5 to Z82.8,
Z83, Z84, Z86.0 to Z86.6, Z87, Z88, Z91, Z92
incl: contact with infectious disease, personal/family history, previous episode,
other risk factor for other disease
excl: risk factor for malignancy A21; risk factor for cardiovascular disease K22

A25 Fear of death/dying Z71.1

A26 Fear of cancer NOS Z71.1

excl: if the patient has cancer, code the disease

criteria: concern about/fear of cancer not related to a specific chapter in a patient
without the disease/until the diagnosis is proven

A27 Fear of other disease NOS Z71.1

excl: fear of cancer NOS A26; if the patient has the disease, code the disease
criteria: concern about/fear of an other disease not related to a specific chapter in a
patient without the disease/until the diagnosis is proven

A28 Limited function/disability NOS

Z73.6, Z74, Z99.0, Z99.3, Z99.8, Z99.9

excl: falls A29

criteria: limitation of function/disability not related to a problem in any other chapter
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

A29 General symptom/complaint, other R26.8, R68.0, R68.8

incl: clumsiness, drowsy, falls

Component 7—diagnoses/diseases
A70 Tuberculosis A15 to A19, B90, N74.0, N74.1

incl: tuberculosis infection of any body site, late effect of tuberculosis

criteria: conversion to a positive tuberculin skin test; or demonstration of
Mycobacterium tuberculosis on microscopy or culture; or characteristic
(cont.)
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International Classification of Primary Care-2-Revised 53

chest X-ray appearance; or characteristic histological appearance on

biopsy
consider: fever A03; cough R05

A71 Measles B05

incl: complications of measles

criteria: prodrome with injected conjunctivae, fever, and cough; plus white specks on
a red base in the mucous membranes of the cheek (Koplik’s spots), or conflu-
ent maculopapular eruption spreading over the face and body, or an atypical
exanthem in a partially immune person during an epidemic of measles; or
serological evidence of acute measles
consider: fever A03; other viral exanthem A76; generalized rash S07

A72 Chickenpox B01

incl: complications of chickenpox

excl: herpes zoster S70
criteria: a vesicular exanthem that appears in successive crops, with the lesions
evolving rapidly from superficial papules to vesicles and eventually to scabs
consider: fever A03; other viral exanthem A76; generalized rash S07

A73 Malaria B50 to B54

incl: complications of malaria

criteria: intermittent fever with chills and rigors in resident of/recent visitor to a
malarial region; or demonstration of malarial parasite forms in the peripheral
blood
consider: fever A03

A74 Rubella B06

incl: complications of rubella

excl: congenital rubella A94; roseola infantum A76
criteria: an acute exanthem with enlarged lymph nodes, most often suboccipital and
post-auricular, with a macular rash on the face, spreading to the trunk and
proximal portions of the limbs; or serological evidence of rubella infection
consider: fever A03; other viral exanthem A76; generalized rash S07

A75 Infectious mononucleosis B27

incl: glandular fever, M. Pfeiffer

criteria: inflammation of the tonsils/pharynx with lymphadenopathy not confined to the
anterior cervical nodes, and either atypical lymphocytes on blood smear or
splenomegaly; or abnormal heterophile antibody titre or Epstein–Barr virus titre
consider: fever A03; enlarged lymph nodes B02; acute upper respiratory tract
infection R74
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54 WONCA International Classification of Primary Care

A76 Viral exanthem, other

A88.0, B03, B04, B08.0, B08.2 to B08.4, B08.8, B09

incl: cowpox, hand foot and mouth disease, fever with rash, fifth disease, roseola
infantum
excl: measles A71; chickenpox A72; rubella A74; infectious mononucleosis A75

A77 Viral disease, other/NOS

A82, A90 to A96, A98, A99, B00.7, B25, B33.0, B33.1, B33.3, B33.8, B34, B97
incl: adenovirus, Coxsackie diseases, dengue fever, Ross River fever
excl: other viral exanthem A76; influenza R80

A78 Infectious disease, other/NOS

A20 to A28, A30, A31, A32, A38, A39.1 to A39.9, A40 to A44, A48.0, A48.2 to
A48.4, A48.8, A49, A59.8, A59.9, A64, A68, A69.2, A69.8, A69.9, A70, A74.8,
A74.9, A75, A77 to A79, B37.7 to B37.9, B38 to B43, B45 to B49, B55 to
B57, B58.8, B58.9, B59, B60, B64, B89, B92, B94.8, B94.9, B95, B96, B99
incl: brucellosis, infection unspecified site, Lyme disease, mycoplasma, Q fever,
rickettsial disease, scarlet fever, sexually transmitted disease NOS, thrush
NOS, toxoplasmosis
excl: meningococcal meningitis N71

A79 Malignancy NOS

C38.1 to C38.3, C38.8, C45.7, C45.9, C46.7 to C46.9, C76,
C78 to C80, C97, D09.7, D09.9
incl: secondary/metastatic neoplasm where primary site is unknown, carcino-
matosis (unknown primary)
criteria: histological evidence of malignancy
consider: disease/condition of unspecified nature/site A99

A80 Trauma/injury NOS

S11, S15, S21, S25, S26, S27, S35, S37.9, S38.1, S38.3, S39.0, S39.8, S39.9, S45,
S55, S65, S75, S85, S95, T11.4, T13.4, T14.5, T14.7 to T14.9, T28.4, T28.9
incl: road traffic accident
excl: multiple trauma A81; late effect of trauma A82

A81 Multiple trauma/injuries

S17.8, S17.9, S18, S19, S28, S29, S31.7, S36.7, S37.7, S37.8,
S39, T00 to T05, T06.5, T06.8, T07, T29
incl: multiple internal injuries NOS
Note: In this classification ‘general’ or ‘multiple’ refers to three or more body sites or
systems. Conditions affecting one or two sites should be coded to these sites.
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A82 Secondary effect of trauma

T79.0 to T79.2, T79.4, T79.5, T79.7 to T79.9, T90 to T98

incl: deformity/scarring resulting from previous injury, old amputation

excl: effects related to specific body systems: code to system chapter; psychological
effects of trauma/acute stress reaction P02; post-traumatic stress disorder
P82; wound infection S11; scar of skin S99

A84 Poisoning by medical agent T36 to T50

incl: toxic effect of overdose medical agent

excl: medication abuse P18; suicide attempt P77; insulin coma T87
criteria: toxicity/impairment produced by accidental/deliberate overdose of an agent
that has remedial properties in its usual dosage

A85 Adverse effect medical agent

D61.1, D64.2, G44.4, I95.2, L27.0, L27.1, T88.6, T88.7

incl: side effects/allergy/anaphylaxis due to medication in proper dose

excl: poisoning by medical agent A84; reaction to immunization/transfusion A87;
parkinsonism N87; medication abuse P18; contact dermatitis S88; insulin
coma T87; analgesic nephropathy U88
criteria: symptom/complaint attributed to the proper use of medication, rather than
due to disease or injury
Note: May also code the nature of the adverse effect.

A86 Toxic effect non-medicinal substance D61.2, D64.2, T51 to T65

incl: general/local toxic effect carbon monoxide, industrial materials, lead, poi-
sonous animals/insects/plants/snakes
excl: poisoning/adverse effect medical agent A84, A85; chronic/acute alcohol
abuse P15, P16; tobacco abuse P17; medication abuse P18; drug abuse P19;
respiratory toxic effects R99; non-toxic bites S12, S13; external chemical
burns S14; contact dermatitis S88

A87 Complication of medical treatment

E89, G97, H59, H95, I97, J95, K91.0, K91.3, M96, N99, O29, O74, O86.0, O89,
O90.0 to O90.2, T80, T81, T86, T87, T88.0 to T88.5, T88.8, T88.9
incl: anaesthetic shock, immunization/transfusion reaction, postoperative infection/
haemorrhage/wound disruption, problems due to radiation for diagnosis/
treatment
excl: poisoning by medical agent A84; adverse effects of medication A85; other
hernia abdominalis D91; hypoglycaemia T87
criteria: an unexpected disorder resulting from surgical/medical/X-ray treatment/
other medical management
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A88 Adverse effect of physical factor

T33 to T35, T66 to T69, T70.2 to T70.4, T70.8, T70.9, T71, T73, T75, T78.8, T78.9

incl: adverse effect cold/heat/lightning/motion/pressure/radiation, chilblains,

drowning, jetlag
excl: effect of medical radiation A87; snow blindness F79; effect of alcohol P15,
P16; effect of tobacco P17; burn due to radiation S14; sunburn S80

A89 Effect of prosthetic device

K91.4, T82 to T85, Z43 to Z45, Z46.1 to Z46.9, Z93 to Z97

incl: discomfort/handicap/pain/limitation of function resulting from the fitting/

wearing of a device for supplying/amending deficiencies: catheter, colostomy,
gastrostomy, heart valve, joint replacement, organ transplant, pacemaker
excl: effect denture/false teeth D19

A90 Congenital anomaly NOS/multiple

Q85 to Q87, Q89.3, Q89.4, Q89.7, Q89.9, Q90 to Q93, Q95 to Q99

incl: Down’s syndrome, Marfan’s syndrome, other chromosome abnormality,

neurofibromatosis
excl: anomaly related to a specific body system to be coded to system chapter;
congenital rubella A74

A91 Abnormal result investigation NOS

R73, R74, R76 to R79, R83 to R94

incl: abnormal unexplained pathology/imaging test, electrolyte disorder,

hyperglycaemia
excl: unexplained abnormal white cells B84; other haematological abnormality
B99; vitamin/nutritional deficiency T91; abnormal urine test U98; abnormal
cervix smear X86
criteria: abnormal result not attributed to known disease

A92 Allergy/allergic reaction NOS T78.0 to T78.4

incl: allergic oedema, anaphylactic shock, angioneurotic oedema, food allergy

excl: allergy resulting from medication A85; allergic rhinitis R97; urticaria S98

A93 Premature newborn P07

criteria: live birth under 37 weeks’ gestation

A94 Perinatal morbidity, other

P00 to P05, P08, P10 to P15, P20 to P29, P35 to P39, P50 to P61, P70 to P72,
P74 to P78, P80, P81, P83, P90 to P94, P96
excl: congenital condition NOS A90; premature newborn A93; failure to thrive T10
criteria: morbidity originating in utero or within 7 days of birth
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A95 Perinatal mortality P95, R95

criteria: death in utero or within 7 days of birth

A96 Death R95, R96, R98, R99

excl: perinatal death A95

A97 No disease Z00, Z02

incl: no illness/disease dealt with at encounter

excl: health maintenance/preventive medicine A98
Note: Sometimes a patient has a reason for encounter that the family doctor cannot
interpret as a diagnosis within the domain of family practice. In these cases the
FP/GP will use the code A97, indicating that the patient’s reason for encounter refers to
something the FP/GP cannot professionally respond to, except by explaining that this is
the case.

A98 Health maintenance/preventive medicine

Z01, Z10 to Z13, Z23 to Z27, Z29, Z31.5, Z40, Z70

incl: medical procedure/counselling with a preventive purpose, including genetic

counselling
excl: no disease A97

A99 Disease/condition of unspecified nature/site

D15.7, D15.9, D36.7, D36.9, D48.9, R69, Z03, Z04, Z08, Z09, Z22,
Z41, Z42, Z47 to Z54, Z71.0, Z71.2 to Z71.9, Z76.0 to Z76.4,
Z76.8, Z76.9, Z90.0, Z90.8, Z98.8
incl: disease carrier NOS, surveillance of ongoing problem NOS

B Blood, blood-forming organs,

and immune mechanism

Component 1—Symptoms and complaints

B02 Lymph gland(s) enlarged/painful R59

incl: lymphadenopathy with/without pain/tenderness, other symptom/complaint

lymph gland(s)
excl: acute lymphadenitis B70; chronic/non-specific lymphadenitis B71

B04 Blood symptom/complaint R68.8

excl: anaemia B82; pallor S08

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58 WONCA International Classification of Primary Care

B25 Fear of AIDS/HIV Z71.1

excl: if the patient has the disease, code the disease

criteria: concern about/fear of AIDS/HIV in a patient without the disease/until the
diagnosis is proven

B26 Fear of cancer blood/lymph Z71.1

excl: if the patient has the disease, code the disease

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

B27 Fear of blood/lymph disease, other Z71.1

excl: fear of cancer blood/lymph B26; if the patient has the disease, code the disease
criteria: concern about/fear of other blood/lymph disease in a patient without the
disease/until the diagnosis is proven

B28 Limited function/disability (B) Z73.6

incl: disability due to bleeding disorders

criteria: limitation of function/disability due to a problem of blood/blood-forming
organs/immune mechanism
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

B29 Lymph/immune mechanism symptom/complaint, other R68.8

excl: splenomegaly B87

Component 7—Diagnoses/diseases
B70 Lymphadenitis, acute L04

incl: abscess of lymph node

excl: chronic/non-specific/mesentric lymphadenitis B71; acute lymphangitis S76
criteria: one/more inflamed/enlarged and tender/painful lymph nodes in the same
anatomical location, of recent onset (less than 6 weeks) and with unknown
primary source of infection
consider: enlarged lymph node B02

B71 Lymphadenitis, chronic/non-specific I88

incl: mesenteric lymphadenitis

excl: acute lymphadenitis B70; acute lymphangitis S76 (cont.)
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criteria: enlarged tender lymph nodes present for more than 6 weeks; or demonstration
of enlarged inflamed mesenteric lymph nodes by surgery/sonography/
lymphography/otherwise
consider: enlarged lymph node B02

B72 Hodgkin’s disease/lymphoma C81 to C85

criteria: characteristic histological appearance

consider: other malignant neoplasm blood/lymph B74; benign/unspecified neoplasm
blood/lymph B75

B73 Leukaemia C91 to C95

incl: all types of leukaemia

criteria: characteristic histological appearance
consider: benign/unspecified neoplasm blood/lymph B75

B74 Malignant neoplasm blood, other C37, C46.3, C77, C88, C90, C96

incl: myeloproliferative disease, multiple myeloma

excl: Hodgkin’s disease/lymphoma B72

B75 Neoplasm blood, benign/unspecified D15.0, D36.0, D45, D47

incl: benign neoplasm blood, neoplasm blood not specified as benign or malignant/
when test is not available, polycythaemia rubra vera

B76 Ruptured spleen traumatic S36.0

B77 Injury blood/lymph/spleen, other T14.9

excl: ruptured spleen traumatic B76

B78 Hereditary haemolytic anaemia D56 to D58

incl: sickle cell anaemia, sickle cell trait, spherocytosis, thalassaemia

criteria: characteristic findings by test such as haemoglobin electrophoresis, blood
smear, or increased osmotic fragility of red cells
consider: other congenital anomaly blood/lymph B79

B79 Congenital anomaly blood/lymph, other

D61.0, D64.0, D64.4, Q89.0, Q89.8

incl: congenital anaemia

excl: hereditary haemolytic anaemia B78; haemophilia B83; haemangioma/
lymphangioma S81
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B80 Iron deficiency anaemia D50

incl: anaemia due to blood loss

excl: iron deficiency without anaemia T91
criteria: decrease in haemoglobin or haematocrit below levels appropriate for age
and sex; plus evidence of blood loss, or microcytic hypochromic red cells
by appearance or indices in the absence of thalassaemia, or decreased
serum iron and increased iron-binding capacity, or decreased serum
ferritin, or reduced haemosiderin in bone marrow, or good response to iron
administration
consider: other/unspecified anaemia B82

B81 Anaemia, vitamin B12/folate deficiency D51, D52

incl: macrocytic anaemia, pernicious anaemia

excl: vit B12 deficiency without anaemia T91
criteria: macrocytic anaemia by smear/indices plus decreased vit B12/folate
level/positive Schilling test

B82 Anaemia other/unspecified

D46, D53, D55, D59, D60, D61.3, D61.8, D61.9, D62, D63, D64.1,
D64.3, D64.8, D64.9
incl: acquired haemolytic anaemia, aplastic anaemia, blood autoimmune disease,
megaloblastic anaemia NOS, protein deficiency anaemia
excl: iron deficiency anaemia B80; vit B12/folate deficiency anaemia B81;
anaemia of pregnancy W84

B83 Purpura/coagulation defect D65 to D69

incl: abnormal platelets, haemophilia, thrombocytopenia

B84 Unexplained abnormal white cells D70 to D72, R72

incl: unexplained agranulocytosis, unexplained eosinophilia, unexplained leuko-

cytosis, unexplained lymphocytosis, unexplained neutropenia
excl: leukaemia B73

B87 Splenomegaly R16.1, R16.2

excl: hypersplenism B99

B90 HIV infection/AIDS B20 to B24, R75, Z21

criteria: HIV infection proven in serological test in a patient with/without

symptoms
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B99 Blood/lymph/spleen disease, other

D73 to D77, D80 to D84, D86, D89, I89.1 to I89.9, R70, R71

incl: complement defect, hypersplenism, immunodeficiency disorder, other/

unspecified haematological abnormality, raised ESR, red cell abnormality,
sarcoidosis, secondary polycythaemia
excl: lymphadenitis B70, B71; primary polycythemia B75; HIV/AIDS B90; lym-
phoedema K99

D—Digestive

Component 1—Symptoms and complaints

D01 Abdominal pain/cramps, general R10.0, R10.4

incl: abdominal colic, abdominal cramps/discomfort/pain NOS, infant colic

excl: epigastric ache D02; heartburn D03; other localized abdominal pain D06;
dyspepsia/indigestion D07; flatulence/gas/belching D08; biliary colic D98;
renal colic U14; dysmenorrhoea X02

D02 Abdominal pain, epigastric R10.1

incl: epigastric discomfort, fullness, stomach ache/pain

excl: dyspepsia/indigestion D07; flatulence/gas/belching D08

D03 Heartburn R12

incl: acidity, waterbrash

excl: epigastric pain D02; dyspepsia/indigestion D07; oesophagitis/reflux D84

D04 Rectal/anal pain K59.4, K62.8, R10.2, R10.3

incl: anal spasm, proctalgia fugax
excl: impacted faeces D12

D05 Perianal itching L29.0, L29.3

incl: perianal pruritus

excl: pruritus vulvae X16

D06 Abdominal pain, localized, other R10.1 to R10.3

incl: colonic pain

excl: generalized abdominal pain D01; epigastric pain D02; heartburn D03; dyspepsia/
indigestion D07; flatulence/gas/belching D08; irritable bowel syndrome
D93; biliary colic D98; renal colic U14; dysmenorrhoea X02
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D07 Dyspepsia/indigestion K30

excl: epigastric pain D02; heartburn D03; flatulence/gas/belching D08

D08 Flatulence/gas/belching R14

incl: bloating, eructation, gas pains, gaseous distension, passing wind

excl: dyspepsia/indigestion D07; change in abdominal size D25

D09 Nausea R11

excl: feelings of over-eating D02; vomiting D10; alcohol-induced nausea P16;

loss of appetite T03; nausea in pregnancy W05
Note: Code for nausea and vomiting as a diagnosis: D10

D10 Vomiting F50.5, R11

incl: emesis, hyperemesis, retching

excl: haematemesis D14; vomiting in pregnancy W05
Note: Code for diarrhoea and vomiting as a diagnosis: D11

D11 Diarrhoea K52.9, K59.1

incl: frequent/loose bowel movements, watery stools

excl: melaena D15; change in faeces/bowel movements D18

D12 Constipation K56.4, K59.0

incl: faecal impaction

excl: ileus D99

D13 Jaundice R17

incl: icterus

D14 Haematemesis/vomiting blood K92.0

excl: haemoptysis R24

D15 Melaena K92.1

incl: black/tarry stools

excl: fresh blood in stool D16

D16 Rectal bleeding K62.5

incl: fresh blood in stool

excl: melaena D15
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D17 Incontinence of bowel R15

incl: faecal incontinence

excl: encopresis P13

D18 Change in faeces/bowel movements R19.4, R19.5

excl: diarrhoea D11; constipation D12; incontinence of bowel D17

D19 Teeth/gum symptom/complaint K00.7, K08.8

incl: denture problem, gingival inflammation/bleeding, teething, toothache

excl: caries D82

D20 Mouth/tongue/lip symptom/complaint

K13.1, K13.7, K14.5 to K14.9, R19.6, R68.2

incl: bad breath, coated tongue, cracked lips, dribbling, dry mouth, halitosis, sore
mouth, swollen lips
excl: dental/gum problem D19; cheilosis D83; disturbance of taste N16; dehydra-
tion T11

D21 Swallowing problem R13

incl: choking feeling, dysphagia

D23 Hepatomegaly R16.0, R16.2

D24 Abdominal mass NOS R19.0

incl: lump abdomen

excl: splenomegaly B87; hepatomegaly D23; renal mass U14

D25 Abdominal distension R19.0

incl: abdominal swelling without mass

excl: flatulence/gas/belching D08; abdominal mass D24; ascites D29

D26 Fear of cancer of digestive system Z71.1

excl: if the patient has the disease, code the disease

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

D27 Fear of digestive disease, other Z71.1

excl: fear of cancer of digestive system D26; if the patient has the disease, code
the disease (cont.)
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64 WONCA International Classification of Primary Care

criteria: concern about/fear of other digestive disease in a patient without the

disease/until the diagnosis is proven

D28 Limited function/disability (D) Z73.6

excl: colostomy/gastrostomy A89; post-surgery disorder D99; dumping

syndrome D99
criteria: limitation of function/disability due to a digestive problem
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

D29 Digestive symptom/complaint, other

K03.8, R11, R18, R19.1 to R19.3, R19.8

incl: ascites, teeth grinding

Component 7—Diagnosis/diseases
D70 Gastrointestinal infection A00 to A08

incl: gastrointestinal infection/dysentery with specified organisms including

campylobacter, giardia, salmonella, shigella, typhoid, cholera
excl: contact with/carrier of infective/parasitic disease A99; gastroenteritis pre-
sumed infection D73
criteria: a symptomatic patient with isolation or serological evidence of patho-
genic bacterium, virus, or protozoan from either the stool or from food
ingested
consider: gastroenteritis presumed infection D73

D71 Mumps B26

incl: mumps meningitis/orchitis/pancreatitis

criteria: acute non-suppurative, non-erythematous, diffuse tender inflammation of
one or more salivary glands; or acute mumps infection demonstrated by culture
or serology; or orchitis in a person exposed to mumps following appropriate
incubation period
consider: swelling A08

D72 Viral hepatitis B15 to B19

incl: all hepatitis presumed viral, chronic active hepatitis

excl: hepatitis NOS D97
criteria: evidence of viral infection with inflammation of the liver with/without jaun-
dice; or serological evidence of an infection with a hepatitis virus
consider: jaundice D13; hepatomegaly D23
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D73 Gastroenteritis, presumed infection A09

incl: diarrhoea/vomiting presumed to be infective, dysentery NOS, food poison-

ing, gastric flu
excl: irritable bowel syndrome D93; non-infective enteritis and gastroenteritis
D94, D99

D74 Malignant neoplasm stomach C16

incl: carcinoma stomach

criteria: characteristic histological appearance
consider: other malignant digestive neoplasm (when primary site is unknown) D77;
benign/unspecified digestive neoplasm D78

D75 Malignant neoplasm colon/rectum C18 to C21

criteria: characteristic histological appearance

consider: other digestive malignant neoplasm (when primary site is unknown) D77;
benign/unspecified digestive neoplasm D78

D76 Malignant neoplasm pancreas C25

incl: carcinoma pancreas

criteria: characteristic histological appearance
consider: other malignant digestive neoplasm (when primary site is unknown) D77;
benign/unspecified digestive neoplasm D78

D77 Malignant digestive neoplasm, other/NOS

C00 to C08, C14.8, C15, C17, C22 to C24, C26, C45.1, C46.2, C48

incl: all other primary malignancies of digestive system, gallbladder cancer, liver
cancer
excl: malignancy of stomach, colon/rectum, pancreas D74–D76; secondary malig-
nancy of known site (code to site); secondary malignancy of unknown site A79
consider: benign/unspecified digestive neoplasm D78

D78 Neoplasm digestive system, benign/unspecified

D00, D01, D10 to D13, D20, D37, D48.3, D48.4, K31.7, K62.0, K62.1

incl: benign digestive neoplasm, digestive neoplasm not specified as benign or

malignant/when histology is not available, polyp of stomach, duodenum,
colon, rectum

D79 Foreign body digestive system T18

incl: foreign body swallowed/in digestive tract, including mouth, oesophagus, rectum
excl: foreign body in throat/inhaled R87
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D80 Injury digestive system, other

S00.5, S01.5, S02.5, S03.2, S09.9, S10.0, S36.1 to S36.6, S36.8, S36.9,
T28.0 to T28.2, T28.5 to T28.7
incl: injury to abdominal organ, teeth, tongue
excl: multiple organ injuries A81; injury pelvic organs X82, Y80

D81 Congenital anomaly digestive system Q18, Q35 to Q45

incl: biliary anomaly, cleft lip/palate, Meckel’s diverticulum, megacolon,

Hirschsprung’s disease, oesophageal atresia, pyloric stenosis, tongue-tie
excl: haemangioma/lymphangioma S81; congenital metabolic disorder T80

D82 Teeth/gum disease K00.0 to K00.6, K00.8, K00.9, K01 to K10

incl: caries, dental abscess, gingivitis, malocclusion, temporomandibular joint

disorder
excl: teething/denture problem D19; injury to teeth/gum D80; Vincent’s angina D83

D83 Mouth/tongue/lip disease

A69.0, A69.1, B37.0, K11, K12, K13.0, K13.2 to K13.7, K14.0 to K14.4, K14.8, K14.9

incl: aphthous ulcer, cheilosis, glossitis, mucocoele, oral thrush, parotitis, salivary
calculus, stomatitis, Vincent’s angina
excl: mumps D71; other injury digestive system D80; herpes simplex S71

D84 Oesophagus disease K20 to K23

incl: achalasia, oesophagial diverticulum, Mallory–Weiss syndrome, oesophagitis,

oesophagus ulceration, reflux
excl: cancer of oesophagus D77; hiatus hernia D90; oesophageal varices K99

D85 Duodenal ulcer K26

incl: bleeding/obstructing/perforated ulcer

criteria: characteristic imaging findings; or characteristic endoscopy findings; or
exacerbation of symptoms in a patient with a previously proven duodenal
ulcer
consider: heartburn D03; dyspepsia/indigestion D07

D86 Peptic ulcer, other E16.4, K25, K27, K28

incl: gastric/gastrojejunal/marginal ulcer, acute erosion, Zollinger–Ellison syndrome

excl: oesophageal ulcer D84; duodenal ulcer D85
criteria: characteristic imaging/endoscopy findings; or exacerbation of symptoms in
a patient with a previously proven ulcer
consider: heartburn D03; dyspepsia/indigestion D07
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D87 Stomach function disorder K29, K31.0 to K31.6, K31.8, K31.9

incl: acute dilatation stomach, duodenitis, gastritis

excl: gastrointestinal infection D70; gastroenteritis presumed infection D73
criteria: disorder of stomach function proven by investigation
consider: abdominal pain D01, D06; epigastric pain D02; heartburn D03; indigestion/
dyspepsia D07; gas problems (wind) D08; nausea D09; vomiting D10;
oesophagitis D84

D88 Appendicitis K35 to K37

incl: appendix abscess/perforation

criteria: objective evidence of inflammation of the appendix, such as demonstrated at
operation or pathological examination
consider: abdominal pain D01, D06; vomiting D10

D89 Inguinal hernia K40

excl: femoral hernia D91

criteria: swelling in the inguinal region and transmitted impulse with cough, or
enlargement on straining, or swelling reducible into the abdomen, or intes-
tinal obstruction
consider: abdominal mass D24

D90 Hiatus hernia K44

incl: diaphragmatic hernia

excl: oesophagitis/reflux D84
criteria: characteristic findings on imaging/endoscopy/intraluminal pressure studies/
surgery
consider: epigastric pain D02; heartburn D03; dyspepsia/indigestion D07

D91 Abdominal hernia, other K41 to K43, K45, K46

incl: femoral/umbilical/ventral hernia

excl: post-surgical hernia A87; hiatus inguinalis D89; hiatus hernia D90
criteria: demonstration at surgery; or swelling in the specified area and transmitted
impulse with cough, or enlargement on straining, or reducible into the
abdomen, or intestinal obstruction
consider: abdominal mass D24

D92 Diverticular disease K57

incl: diverticulitis/diverticulosis of intestine

excl: Meckel’s diverticulum D81; oesophageal diverticulum D84
criteria: imaging demonstration of diverticula; or demonstration of diverticula at surgery;
or acute abdominal pain with fever and palpable tender descending/sigmoid colon
consider: abdominal pain D01, D06
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D93 Irritable bowel syndrome K58

incl: mucous colitis, spastic colon

excl: gastrointestinal infection D70; gastroenteritis presumed infection D73;
regional enteritis D94; vascular insufficiency of gut, allergic/dietetic/toxic
gastroenteritis/colitis D99; psychogenic diarrhoea P75
criteria: continuous/intermittent abdominal pain and variable bowel pattern over a
period of time; and increased gas, or tender and palpable colon, or history of
mucous without blood in stool
consider: abdominal pain D01, D06; flatulence D08; diarrhoea D11; constipation D12

D94 Chronic enteritis/ulcerative colitis K50, K51, K52.0

incl: Crohn’s disease, regional enteritis, ulcerative colitis

criteria: characteristic endoscopic/imaging/histological findings
consider: abdominal pain D01, D06; diarrhoea D11; mucous colitis D93

D95 Anal fissure/perianal abscess K60, K61

incl: anal fistula, ischiorectal abscess

excl: pilonidal abscess S85

D96 Worms/other parasites B65 to B83

incl: cestodes, creeping eruption, intestinal parasites unspecified, trichiniasis,

hydatid disease
criteria: either demonstration of helminth in adult form, larvae, or ova; or positive
skin tests; or positive serology

D97 Liver disease NOS B58.1, B94.2, K70 to K77

incl: alcohol hepatitis, cirrhosis, fatty liver, hepatitis NOS, liver failure, portal
hypertension
excl: viral hepatitis D72; hydatid disease D96

D98 Cholecystitis/cholelithiasis K80 to K83, K87.0

incl: biliary colic, cholangitis, gallstones

criteria: cholecystitis: demonstration of typical pathology by ultrasonography or
surgery; or localized right upper quadrant tenderness and jaundice or fever
or history of gallstones;
cholelithiasis: imaging or surgical demonstration of gallstones;
acute biliary colic: acute colicky right upper quadrant abdominal pain
without fever; and jaundice or right upper quadrant abdominal tenderness, or
history of gallstones
consider: localized abdominal pain D06
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D99 Disease digestive system, other

K38, K52.1, K52.2, K52.8, K52.9, K55, K56.0 to K56.3, K56.5 to K56.7, K59.2, K59.3,
K59.8, K59.9, K62.2 to K62.4, K62.6 to K62.9, K63, K65 to K67, K85, K86, K87.1,
K90, K91.1, K91.2, K91.5 to K91.9, K92.2, K92.8, K92.9, K93, Z90.3, Z90.4, Z98.0
incl: abdominal adhesions, coeliac disease, dumping syndrome, food intoler-
ance, allergic/toxic/dietetic gastroenteropathy, ileus, intestinal obstruction,
intussusception, lactose intolerance, malabsorption syndrome, mesenteric
vascular disease, pancreatic disease, peritonitis, secondary megacolon,
sprue
excl: antibiotic-associated colitis A85; malignancy digestive system D74–D77

F Eye

Component 1—Symptoms and complaints

F01 Eye pain H57.1

excl: abnormal eye sensations F13

F02 Red eye H57.8

incl: bloodshot/inflamed eye

F03 Eye discharge H04.2

incl: lacrimation, purulent discharge, watery eye

F04 Visual floaters/spots H53.1

incl: fixed/floating spots in the visual field

excl: other visual disturbance F05

F05 Visual disturbance, other H53.1 to H53.3, H53.8, H53.9, H54.7

incl: blurred vision, difficulty reading, diplopia, eye strain, photophobia, scotoma
and dazzle when symptoms confined to eyes, temporary blindness NOS,
visual loss, weak eyes
excl: blindness one eye F28; snow blindness F79; refractive errors F91; permanent
blindness F94; colour/night blindness F99

F13 Eye sensation abnormal H57.8

incl: burning/dry/itchy eye

excl: eye pain F01
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F14 Eye movements abnormal H55

incl: abnormal blinking, lazy eye, nystagmus

excl: squint F95; twitching N08; tic of eye P10

F15 Eye appearance abnormal H57.8

incl: change eye colour, swollen eye

excl: red eye F02

F16 Eyelid symptom/complaint H02.2 to H02.9

incl: ptosis eyelid

excl: inflamed eyelid F72

F17 Glasses symptom/complaint Z46.0

incl: problems due to spectacles affecting structure, function, or sensations of

eye(s)
excl: contact lens symptom/complaint F18

F18 Contact lens symptom/complaint Z46.0

incl: problems due to contact lens affecting structure, function, or sensations of

eye(s)

F27 Fear of eye disease Z71.1

incl: fear of blindness

excl: if the patient has the disease, code the disease
criteria: concern about/fear of eye disease in a patient without the disease/until the
diagnosis is proven

F28 Limited function/disability (F) H54.4 to H54.6, Z73.6

incl: blindness one eye

excl: blindness F94
criteria: limitation of function/disability due to a problem with vision/eye(s)
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

F29 Eye symptom/complaint, other H57.9

Component 7—Diagnosis/diseases
F70 Conjunctivitis, infectious
A74.0, B30, H10.0, H10.2 to H10.5, H10.8, H10.9, H13

incl: bacterial/viral conjunctivitis, conjunctivitis NOS (cont.)

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excl: allergic conjunctivitis with/without rhinorrhoea F71; flash burn F79;

trachoma F86
criteria: presumed or proven infectious inflammation of conjunctiva

F71 Conjunctivitis, allergic H10.1

incl: allergic conjunctivitis with/without rhinorrhoea

excl: bacterial/viral conjunctivitis F70; flashburn F79; trachoma F86
criteria: presumed or proven hyperaemia of conjunctiva, excess watering of eyes,
itching/oedema of conjunctiva

F72 Blepharitis/stye/chalazion H00, H01

incl: dermatitis/dermatosis of eyelids, eyelid infection, hordeolum, meibomian

cyst, tarsal cyst
excl: dacryocystitis F73
criteria: generalized/localized inflammation/swelling of eyelid/tarsal gland

F73 Eye infection/inflammation, other

B00.5, B58.0, H03, H04.3, H04.4, H05.0, H05.1, H16.1 to H16.4, H16.8,
H16.9, H20 to H22, H30, H32
incl: dacryocystitis, herpes simplex of eye without corneal ulcer, inflammation of
the orbit, iritis, iridocyclitis, keratitis
excl: measles keratitis A71; corneal ulcer (herpes) F85; trachoma F86; herpes
zoster S70

F74 Neoplasm of eye/adnexa C69, D09.2, D31, D48.7

incl: benign/malignant neoplasm of eye/adnexa

F75 Contusion/haemorrhage, eye H11.3, H57.8, S00.1, S05.1

incl: black eye, hyphaema, subconjunctival haemorrhage

excl: corneal ulcer F85

F76 Foreign body in eye T15

excl: corneal abrasion F79

F79 Injury eye, other H16.1, H44.6, H44.7, S00.2, S01.1, S05.0,
S05.2 to S05.9, S09.9, T26
incl: corneal abrasion, flash burn, snow blindness
excl: contusion/haemorrhage eye F75; foreign body in eye F76

F80 Blocked lacrimal duct of infant Q10.5

excl: dacryocystitis F73; blocked lacrimal duct in older person F99

criteria: overflow of tears without crying, beginning before the age of 3 months
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F81 Congenital anomaly eye, other Q10.0 to Q10.4, Q10.6, Q10.7, Q11 to Q15

F82 Detached retina H33

F83 Retinopathy H35.0 to H35.2, H35.4, H36

incl: diabetic/hypertensive retinopathy

Note: Double code known causative disease, e.g. diabetes T89, T90 or hypertension K87.

F84 Macular degeneration H35.3

excl: retinopathy F83

F85 Corneal ulcer H16.0, H19

incl: dendritic ulcer, viral keratitis

excl: corneal abrasion/other eye injury F79

F86 Trachoma A71, B94.0

criteria: either proven infection with Chlamydia trachomatis, or typical clinical fea-
tures including chronic inflammation and hypertrophy of the conjunctiva
with formation of yellowish/greyish granules
consider: red eye F02; discharge from eye F03

F91 Refractive error H52

incl: astigmatism, hypermetropia, long-sightedness, myopia, presbyopia, short-

sightedness
excl: partial/complete blindness F94
criteria: visual deficit correctible with an appropriate lens

F92 Cataract H25, H26, H28

excl: congenital cataract F81

criteria: opacity of part/all of the optic lens that reduces/impairs vision

F93 Glaucoma H40, H42

incl: raised intraocular pressure

excl: congenital glaucoma F81

F94 Blindness H54.0 to H54.3

incl: partial/complete blindness of both eyes

excl: blurred vision/temporary blindness F05; blindness one eye F28; snow blind-
ness F79; refractive errors F91; colour/night blindness F99
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F95 Strabismus H49 to H51

incl: cross-eye, squint

criteria: lack of parallelism of visual axis of the eyes demonstrated at medical
examination
consider: abnormal eye movement F14

F99 Eye/adnexa disease, other

H02.0, H02.1, H02.8, H02.9, H04.0, H04.1, H04.5 to H04.9, H05.2 to H05.5,
H05.8, H05.9, H06, H11.0 to H11.2, H11.4, H11.8, H11.9, H15, H17,
H18, H27, H31, H34, H35.5 to H35.9, H43, H44.0 to H44.5,
H44.8, H44.9, H45 to H48, H53.0, H53.4 to H53.6, H53.8,
H57.0, H57.8, H58
incl: amblyopia, arcus senilis, colour blindness, corneal opacity, disorder of orbit,
ectropion, entropion, episcleritis, ingrowing eyelash, night blindness, papil-
loedema, pterygium, scleritis

H Ear

Component 1—Symptoms and complaints

H01 Ear pain/earache H92.0

H02 Hearing complaint H93.2

excl: deafness one ear H86; deafness both ears H86

H03 Tinnitus, ringing/buzzing ear H93.1

incl: echo in ear
excl: ears crackling/popping H29

H04 Ear discharge H92.1

excl: blood in/from ear H05

H05 Bleeding ear H92.2

incl: blood in/from ear

H13 Plugged feeling ear H93.8

incl: blocked ear

excl: excessive ear wax H81
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74 WONCA International Classification of Primary Care

H15 Concern with appearance of ears R46.8

excl: bat ears/congenital anomaly ear H80

H27 Fear of ear disease Z71.1

incl: fear of deafness
excl: in a patient with the disease, code the disease
criteria: concern about/fear of ear disease/deafness in a patient without the
disease/until the diagnosis is proven

H28 Limited function/disability (H) Z73.6

incl: temporary deafness

excl: presbyacusis H84; acoustic trauma H85; deafness H86; dizziness/vertigo N17
criteria: limitation of function/disability due to a problem with ear/hearing
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

H29 Ear symptom/complaint, other H93.9

incl: ears crackling/popping, itchy ears, pulling at ears

excl: dizziness/loss of balance/vertigo N17

Component 7—Diagnosis/diseases
H70 Otitis externa H60, H62

incl: abscess/eczema/furuncle external auditory meatus, swimmer’s ear

criteria: inflammation/desquamation of the external auditory canal

H71 Acute otitis media/myringitis

H66.0, H66.4, H66.9, H67, H70.0, H73.0

incl: acute suppurative otitis media, otitis media NOS, acute mastoiditis, acute
tympanitis
excl: serous otitis media H72; chronic otitis media H74
criteria: recent perforation of the tympanic membrane discharging pus; or inflamed
and bulging tympanic membrane; or one ear drum more red than the other; or
red tympanic membrane, with ear pain; or bullae on the tympanic membrane
consider: ear pain H01; ear discharge H04

H72 Serous otitis media H65

incl: glue ear, otitis media with effusion (OME) (cont.)

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International Classification of Primary Care-2-Revised 75

excl: acute otitis media H71; chronic otitis media H74

criteria: visible fluid behind the tympanic membrane, without inflammation; or dull-
ness of the tympanic membrane with either retracting, bulging, or with related
impairment of hearing
consider: plugged feeling ear H13; eustachian salpingitis/block H73

H73 Eustachian salpingitis H68, H69

incl: eustachian block/catarrh/dysfunction

excl: serous otitis media H72
consider: plugged feeling ear H13

H74 Chronic otitis media H66.1 to H66.3, H70.1 to H70.9, H71, H73.1, H75

incl: cholesteatoma, chronic suppurative otitis media, chronic mastoiditis

excl: serous otitis media H72

H75 Neoplasm of ear C30.1, D14.0, D38.5, D48.1, D48.5

incl: benign/malignant neoplasm of ear

excl: polyp ear H99; acoustic neuroma N75

H76 Foreign body in ear T16

H77 Perforation, ear drum H72

excl: perforation ear drum with infection H71, H74; traumatic/pressure rupture
ear drum H79

H78 Superficial injury of ear S00.4

incl: external meatus/pinna injury

excl: injury of tympanic membrane H79

H79 Ear injury, other S01.3, S07.0, S08.1, S09.2, S09.8, S09.9, T70.0

incl: traumatic/pressure rupture of ear drum

H80 Congenital anomaly of ear Q16, Q17

incl: accessory auricle, bat ears

excl: congenital deafness H86

H81 Excessive ear wax H61.2

criteria: symptom/complaint due to wax in ear canal

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H82 Vertiginous syndrome A88.1, H81, H82, H83.0

incl: benign paroxysmal/positional vertigo, labyrinthitis, Ménière’s disease,

vestibular neuronitis
criteria: true rotational vertigo
consider: vertigo/giddiness/dizziness N17

H83 Otosclerosis H80

H84 Presbyacusis H91.1

excl: deafness H86

criteria: gradual onset with ageing of symmetrical, bilateral deafness, particularly
involving high-frequency sounds
consider: hearing impairment H28

H85 Acoustic trauma H83.3

incl: noise deafness

excl: perforation of ear drum H77
criteria: deafness in the high-frequency range with a definite history of exposure to
loud noise
consider: hearing impairment H28; deafness H86

H86 Deafness H90, H91.0, H91.2 to H91.9

incl: congenital deafness, deafness one ear, partial/complete deafness both ears
excl: temporary deafness H28; otosclerosis H83; presbyacusis H84; noise deaf-
ness H85

H99 Ear/mastoid disease, other

H61.0, H61.1, H61.3 to H61.9, H73.8, H73.9, H74, H83.1, H83.2, H83.8,
H83.9, H93.0, H93.3, H93.8, H94
incl: polyp of middle ear
excl: mastoiditis H74

K Circulatory

Component 1—Symptoms and complaints

K01 Heart pain R07.2

incl: pain attributed to the heart

excl: chest pain NOS A11; fear of heart attack K24; angina pectoris K74; chest
tightness R29
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K02 Pressure/tightness of heart R07.2

incl: heaviness of heart

excl: chest pain NOS A11; fear of heart attack K24; angina pectoris K74; shortness
of breath/dyspnoea R02

K03 Cardiovascular pain NOS R09.8

excl: pain attributed to the heart K01; claudication K92; migraine N89

K04 Palpitations/awareness of heart R00.0 to R00.2

incl: tachycardia
excl: paroxysmal tachycardia K79

K05 Irregular heartbeat, other R00.8

excl: palpitations K04

K06 Prominent veins I78.1, I87.8

incl: unusually prominent veins, spider naevus

excl: varicose veins K95; haemangioma S81

K07 Swollen ankles/oedema R60

incl: dropsy, fluid retention, swollen feet/legs

excl: ankle symptom L16; localized swelling S04

K22 Risk factor for cardiovascular disease Z82.3, Z82.4, Z86.7

incl: personal/family history, previous episode, other risk factor for cardiovascular
disease

K24 Fear of heart disease Z71.1

incl: fear of heart attack
excl: if the patient has the disease, code the disease
criteria: concern about/fear of heart attack/disease in a patient without the disease/
until the diagnosis is proven

K25 Fear of hypertension Z71.1

excl: if the patient has the disease, code the disease

criteria: concern about/fear of hypertension in a patient without the disease/until the
diagnosis is proven
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K27 Fear of cardiovascular disease, other Z71.1

excl: fear of cardiovascular diseases K24, K25; if the patient has the disease, code
the disease
criteria: concern about/fear of other disease of the circulatory system in a patient
without the disease/until the diagnosis is proven

K28 Limited function/disability (K) Z73.6

criteria: limitation of function/disability due to a cardiovascular problem

Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

K29 Cardiovascular symptom/complaint, other R03.1, R09.8

incl: heart trouble, low blood pressure, weak heart

excl: fluid in chest R82; cyanosis S08

Component 7—Diagnosis/diseases
K70 Infection of circulatory system A39.5, B33.2, B37.6, I30, I32, I33, I38 to I41

incl: acute/subacute endocarditis, bacterial endocarditis, myocarditis, pericarditis

(other than rheumatic)
excl: rheumatic heart disease K71; phlebitis/thrombophlebitis K94; arteritis K99

K71 Rheumatic fever/heart disease I00 to I02, I05 to I09

incl: chorea, mitral stenosis

criteria: Acute rheumatic fever: two major, or one major, and two minor manifesta-
tions, plus evidence of preceding streptococcal infection;
Major manifestations: migratory polyarthritis; carditis; chorea; erythema
marginatum; subcutaneous nodules of recent onset;
Minor manifestations: fever; arthralgia; raised ESR or positive C-reactive
protein; prolonged P-R interval on ECG;
Chronic rheumatic heart disease: either physical findings consistent with
a valve lesion of the heart in a patient with a history of rheumatic fever;
or physical findings consistent with mitral stenosis, even in the absence
of a history of rheumatic fever, but without any other demonstrable
cause
consider: heart valve disease K83; other heart disease K84

K72 Neoplasm cardiovascular C38.0, C45.2, D15.1, D15.2, D48.7

incl: benign/malignant cardiovascular neoplasm

excl: haemangioma S81
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K73 Congenital anomaly cardiovascular I42.4, Q20 to Q28

incl: atrial/ventricular septal defect, Fallot’s tetralogy, patent ductus arteriosus

excl: haemangioma S81

K74 Ischaemic heart disease with angina I20, I24.0, I24.8, I24.9

incl: angina of effort, angina pectoris, angina with spasm, ischaemic chest pain,
unstable angina
excl: ischaemic heart disease without angina K76
criteria: history plus ECG or imaging evidence of old myocardial infarction; or
demonstration of myocardial ischaemia by resting or exercise ECG; or
investigatory evidence of coronary artery narrowing or ventricular aneurysm
consider: heart pain K01

K75 Acute myocardial infarction I21 to I23, I24.1

incl: myocardial infarction specified as acute or within 4 weeks (28 days) of onset
excl: old/healed myocardial infarction K74, K76
criteria: chest pain characteristic of myocardial ischaemia, lasting more than 15 min,
and/or abnormal ST-T changes or new Q waves in electrocardiogram or
raised blood cardiac enzymes
consider: heart pain K01; angina pectoris K74; chronic ischaemic heart disease K76
Note: Double code K74 or K76 as well.

K76 Ischaemic heart disease without angina I25

incl: aneurysm of heart, arteriosclerotic/atherosclerotic heart disease, coronary

artery disease, ischaemic cardiomyopathy, old myocardial infarction, silent
myocardial ischaemia
excl: ischaemic heart disease with angina K74
criteria: history plus ECG, or imaging evidence of old myocardial infarction; or
demonstration of myocardial ischaemia by resting or exercise ECG; or
investigation evidence of coronary artery narrowing; or ventricular aneurysm

K77 Heart failure I50

incl: cardiac asthma, congestive heart failure, heart failure NOS, left ventricular
failure, pulmonary oedema, right ventricular failure
excl: cor pulmonale K82
criteria: multiple signs including dependent oedema, raised jugular venous pressure,
hepatomegaly in the absence of liver disease, pulmonary congestion, pleural
effusion, enlarged heart

K78 Atrial fibrillation/flutter I48

excl: paroxysmal tachycardia K79 (cont.)

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80 WONCA International Classification of Primary Care

criteria: characteristic findings on electrocardiogram; or totally irregular heart rate

with a pulse deficit
consider: palpitations K04; abnormal irregular heartbeat K05

K79 Paroxysmal tachycardia I47

incl: supraventricular/ventricular tachycardia

excl: tachycardia NOS K04; atrial fibrillation K78
criteria: history of recurrent episodes of rapid heart rate (over 140/min) with both
abrupt onset and termination
consider: palpitations K04; abnormal irregular heartbeat K05

K80 Cardiac arrhythmia NOS I49

incl: atrial/junctional/ventricular premature beats, bradycardia, bigeminy, ectopic

beats, extrasystoles, premature beats, sick sinus syndrome, ventricular
fibrillation/flutter
excl: paroxysmal tachycardia K79
criteria: one or more heart beats that occur at times other than the regular beats of the
underlying rhythm
consider: palpitations K04, abnormal irregular heartbeat K05

K81 Heart/arterial murmur NOS R01, R09.8

incl: cardiac/carotid/renal artery bruit, innocent murmur of childhood

excl: rheumatic heart disease K71; valve disease K83; cerebrovascular disease K90

K82 Pulmonary heart disease I27, I28

incl: chronic cor pulmonale, disease of pulmonary vessels, primary pulmonary

hypertension
excl: pulmonary embolism K93
criteria: presence of a chronic disease of the lungs, pulmonary vasculature, or respira-
tory gas exchange; plus presence of right ventricular enlargement or right
heart failure
consider: right heart failure K77

K83 Heart valve disease NOS I34 to I37

incl: chronic endocarditis, mitral valve prolapse, non-rheumatic aortic/mitral/pul-

monary/tricuspid valve disorder
excl: rheumatic valve disease K71
criteria: absence of criteria for chronic rheumatic heart disease K71; plus evidence of
valvular dysfunction by either characteristic heart murmur, or by
imaging/echocardiographic evidence of abnormal valve
consider: hypertensive heart disease K87; cardiac murmur NOS K81
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International Classification of Primary Care-2-Revised 81

K84 Heart disease, other I31, I42.0 to I42.3, I42.5 to I42.9, I43 to I46, I51, I52, O90.3

incl: bundle branch block, cardiac arrest, cardiomegaly, disease of pericardium,

cardiomyopathy, heart block, left bundle-branch block, other conduction
disorders
excl: cardiac arrhythmia K80

K85 Elevated blood pressure R03.0

incl: elevated blood pressure not meeting criteria for K86 and K87, transient/
labile hypertension

K86 Hypertension, uncomplicated I10

incl: essential hypertension, hypertension NOS, idiopathic hypertension

excl: hypertension with complications K87; hypertension in pregnancy W81
criteria: either two or more readings per encounter, taken at two or more encounters,
with blood pressures that average over 95 mmHg diastolic or over 160 mmHg
systolic in adult patients; or two or more readings at a single encounter with an
average diastolic blood pressure of 120 mmHg or more; plus absence of evi-
dence of secondary involvement of heart, kidney, eye, or brain
consider: elevated blood pressure K85
Notes: (1) For children, consult appropriate paediatric blood pressure tables. (2) If
secondary hypertension, code also the underlying cause.

K87 Hypertension, complicated I11 to I13, I15, I67.4

incl: malignant hypertension

excl: uncomplicated hypertension K86
criteria: either two or more readings per encounter, taken at two or more encounters,
with blood pressures that average over 95 mmHg diastolic or over
160 mmHg systolic in adult patients; or two or more readings at a single
encounter with an average diastolic blood pressure of 120 mmHg or more;
plus evidence of abnormalities of the heart (enlargement, failure), kidney
(albuminuria, azotaemia), eye, or brain attributed to hypertension
Note: (1) For children, consult appropriate paediatric blood pressure tables. (2) If
secondary hypertension, code also the underlying cause.

K88 Postural hypotension I95.0, I95.1, I95.8, I95.9

incl: idiopathic/orthostatic hypotension

excl: hypotension due to drugs A85
criteria: signs or symptoms of cerebrovascular insufficiency (dizziness, syncope) on
changing from the supine to the upright position; and a fall in mean blood
pressure of 15 mmHg on two or more occasions when changing from the
supine to the upright position
consider: low blood pressure K29
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K89 Transient cerebral ischaemia G45

incl: basilar insufficiency, drop attacks, transient ischaemic attack (TIA), transient
global amnesia
excl: carotid bruit K81; cerebrovascular accident K90; migraine N89
criteria: symptoms of transient (less than 24 h) hypofunction of the brain, with sudden
onset, presumed of vascular origin, without sequelae, and with exclusion of
migraine/migraine equivalent/epilepsy
consider: fainting/syncope A06
Note: Double code with K91.

K90 Stroke/cerebrovascular accident G46, I60 to I64

incl: apoplexy, cerebral embolism/infarction/thrombosis/occlusion/stenosis/

haemorrhage, cerebrovascular accident (CVA), subarachnoid haemorrhage
excl: transient cerebral ischaemia K89; traumatic intracranial haemorrhage N80
criteria: signs and symptoms of a disturbance of cerebral function, presumed of
vascular origin, lasting more than 24 h or causing death, and within 4 weeks
(28 days) of onset
Note: Double code with K91.

K91 Cerebrovascular disease I65, I66, I67.0 to I67.3, I67.5 to I67.9, I68, I69

incl: cerebral aneurysm, sequelae of stroke

criteria: previous transient cerebral ischaemia/stroke; or investigation evidence of
cerebrovascular disease

K92 Atherosclerosis/peripheral vascular disease I70, I73, I74, R02

incl: arteriosclerosis, arterial embolism/thrombosis/stenosis, atheroma, endarteritis,

gangrene, intermittent claudication, limb ischaemia, Raynaud’s syndrome,
vasospasm
excl: mesenteric atherosclerosis D99; ophthalmic/retinal atherosclerosis F99;
coronary atherosclerosis K74 to K76; pulmonary atherosclerosis K82; cere-
bral atherosclerosis K89, K90; aneurysm K99; renal atherosclerosis U99

K93 Pulmonary embolism I26

incl: pulmonary (artery/vein) infarction, thromboembolism, thrombosis

criteria: sudden onset of dyspnoea/tachypnoea and either clinical or imaging evidence
of pulmonary infarction, or ECG evidence of acute right ventricular strain
consider: dyspnoea R02

K94 Phlebitis/thrombophlebitis I80 to I82, I87.0, I87.8

incl: superficial/deep vein thrombosis, phlebothrombosis, portal thrombosis

excl: cerebral thrombosis K89, K90
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K95 Varicose veins of leg I83.1, I83.9, I87.2

incl: varicose eczema, venous insufficiency, venous stasis

excl: varicose ulcer S97
criteria: presence of dilated superficial veins in lower extremities; or demonstration
of valve incompetence of veins
consider: prominent veins K06

K96 Haemorrhoids I84

incl: internal haemorrhoids with/without complications, perianal haematoma,

piles, residual haemorrhoidal skin tag, thrombosed external haemorrhoids,
varicose veins of anus/rectum
criteria: visualization of varicosities of the venous plexus of the anus or canal; or tender,
painful, blue-coloured localized swelling of acute onset, in the perianal area; or
skin tags in the perianal area
consider: anal pain D04; rectal bleeding D16; anal lump D29

K99 Cardiovascular disease, other

I71, I72, I77, I78.0, I78.8, I78.9, I79, I85, I86, I87.1, I87.9,
I89.0, I98, I99, M30, M31, R57, T06.3
incl: aortic aneurysm, arteriovenous fistula, arteritis, lymphoedema, oesophageal
varices, other aneurysm, polyarteritis nodosa, vasculitis, varicose veins of
sites other than lower extremities
excl: chronic/non-specific lymphadenitis B71; cerebral aneurysm K91; gangrene K92

L Musculoskeletal

Component 1—Symptoms and complaints

L01 Neck symptom/complaint M54.0, M54.2

incl: pain attributed to cervical spine/musculoskeletal system

excl: headache N01; pain in face N03

L02 Back symptom/complaint M54.0, M54.6, M54.8, M54.9

incl: backache NOS, thoracic back pain

excl: low back pain L03

L03 Low back symptom/complaint M53.3, M54.0, M54.5

incl: back pain (lumbar/sacroiliac), coccydynia, lumbago, lumbalgia

excl: thoracic back pain L02; sciatica L86
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L04 Chest symptom/complaint R07.3, R29.8

incl: chest pain attributed to musculoskeletal system

excl: chest pain NOS A11; pain attributed to the heart K01; painful respiration/
pleuritic pain/pleurodynia R01

L05 Flank/axilla symptom/complaint R29.8

incl: loin pain

excl: kidney symptom U14

L07 Jaw symptom/complaint K07.6, R25.2, R29.8

incl: temporomandibular joint symptom

excl: teeth/gum symptom/complaint D19

L08 Shoulder symptom/complaint M25.4 to M25.6

L09 Arm symptom/complaint M79.6, R25.2, R29.8

excl: muscle pain/myalgia L18

L10 Elbow symptom/complaint M25.4 to M25.6

L11 Wrist symptom/complaint M25.4 to M25.6

L12 Hand/finger symptom/complaint M25.4 to M25.6, M79.6, R25.2, R29.8

L13 Hip symptom/complaint M25.4 to M25.6, R29.4

L14 Leg/thigh symptom/complaint M79.6, R25.2, R29.8

incl: leg cramps
excl: muscle pain/myalgia L18; restless legs N04

L15 Knee symptom/complaint M25.4 to M25.6

L16 Ankle symptom/complaint M25.4 to M25.6

L17 Foot/toe symptom/complaint

M25.4 to M25.6, M77.4, M77.5, M79.6, R25.2, R29.8

incl: metatarsalgia

L18 Muscle pain M60.1, M60.2, M60.8, M60.9, M79.0, M79.1, M79.3, M79.6, R25.2

incl: fibromyalgia, fibrositis, myalgia, panniculitis, rheumatism

excl: pain in spine L01, L02, L03; leg cramps L14
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L19 Muscle symptom/complaint NOS M62.5, M62.6, M79.9

incl: atrophy/wasting/weakness of muscle, muscle stiffness/strain

excl: pain in spine L01, L02, L03; leg cramps L14; ‘growing pains’ in child L29;
restless legs N04

L20 Joint symptom/complaint NOS M25.4 to M25.6, M25.8, M25.9

incl: arthralgia, effusion/swelling of joint, pain/stiffness/weakness in joint

excl: symptoms/complaints specified in L07, L08, L10–13, L15–17

L26 Fear of cancer, musculoskeletal Z71.1

excl: if the patient has the disease, code the disease

criteria: concern about/fear of cancer of musculoskeletal system in a patient without
cancer/until the diagnosis is proven

L27 Fear of musculoskeletal disease, other Z71.1

excl: fear of musculoskeletal cancer L26; if the patient has the disease, code the
disease
criteria: concern about/fear of a musculoskeletal disease in a patient without the
disease/until the diagnosis is proven

L28 Limited function/disability (L) Z73.6

excl: falls A29; limping/walking difficulties/gait problems N29

criteria: limitation of function/disability due to a musculoskeletal problem
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

L29 Musculoskeletal symptom/complaint, other R26.8, R29.3, R29.8

incl: ‘growing pains’ in a child

excl: clubbing of fingernails S22

Component 7—Diagnosis/disease
L70 Infection of musculoskeletal system
M00, M01, M46.2 to M46.5, M60.0, M65.0,
M65.1, M71.0, M71.1, M86
incl: infective tenosynovitis, osteomyelitis, pyogenic arthritis
excl: Reiter’s disease L99; late effect of polio N70
criteria: infection localized in musculoskeletal system
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L71 Malignant neoplasm musculoskeletal C40, C41, C46.1, C49

incl: fibrosarcoma, osteosarcoma

excl: secondary neoplasms (code to original site), benign/unspecified musculo-
skeletal neoplasm L97
criteria: characteristic histological appearance

L72 Fracture: radius/ulna S52

incl: Colles’ fracture

excl: pathological fracture L95, L99; non-union L99
criteria: imaging evidence of a fracture; or trauma plus visible/palpable deformity or
crepitus involving the bone
consider: arm symptom L09; musculoskeletal injury NOS L81

L73 Fracture: tibia/fibula S82.1 to S82.9

incl: Pott’s fracture

excl: fracture patella L76; pathological fracture L95, L99; non-union L99
criteria: imaging evidence of a fracture; or trauma plus visible/palpable deformity or
crepitus involving the bone
consider: leg symptom L14; ankle symptom L16; musculoskeletal injury NOS L81

L74 Fracture: hand/foot bone S62, S92

incl: fracture carpal/metacarpal bone, fracture phalange hand/foot, fracture

tarsal/metatarsal bone
excl: pathological fracture L95, L99; non-union L99
criteria: imaging evidence of a fracture; or trauma plus visible/palpable deformity or
crepitus involving the bone
consider: arm symptom L09; leg symptom L14; musculoskeletal injury NOS L81

L75 Fracture: femur S72

incl: fracture neck of femur

excl: pathological fracture L95, L99; non-union L99
criteria: imaging evidence of a fracture; or trauma plus visible/palpable deformity or
crepitus involving the bone
consider: leg symptom L14; musculoskeletal injury NOS L81

L76 Fracture: other

S02.2 to S02.4, S02.6 to S02.9, S12, S22, S32, S42, S82.0, T08, T10, T12, T14.2

excl: fractures specified in L72, L73, L74, and L75; pathological fracture L95,
L99; non-union L99; skull fracture N80
criteria: imaging evidence of a fracture; or trauma plus visible/palpable displacement
of the bone surface
consider: symptoms in Component 1
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L77 Sprain/strain of ankle S93.4

criteria: stretch injury of the affected part plus pain aggravated by stretching or tens-
ing the affected structure
consider: ankle symptom L16

L78 Sprain/strain of knee S83.4, S83.6

excl: acute damage of meniscus/internal ligament of knee L96

criteria: stretch injury of the affected part plus pain aggravated by stretching or tensing
the affected structure

L79 Sprain/strain of joint NOS

S03.4, S03.5, S13.4 to S13.6, S23.3 to S23.5, S33.6, S43.4 to S43.7, S53.2 to
S53.4, S63.3 to S63.7, S73.1, S93.2, S93.5, S93.6, T09.2, T11.2, T13.2, T14.3
incl: sprain/strain of other joint/ligament, whiplash
excl: sprain/strain ankle L77; sprain/strain knee L78; back strain L84
criteria: stretch injury of the affected part plus pain aggravated by stretching or tens-
ing the affected structure
consider: symptoms in Component 1

L80 Dislocation/subluxation
M22.0, M22.1, S03.0, S03.3, S13.0 to S13.3, S23.0 to S23.2, S33.0 to S33.3,
S43.0 to S43.3, S53.0, S53.1, S63.0 to S63.2, S73.0, S83.0, S83.1,
S93.0, S93.1, S93.3, T09.2, T11.2, T13.2, T14.3
incl: dislocation/subluxation any site, including spine
criteria: trauma to the joint plus either imaging evidence of a dislocation/subluxa-
tion, or palpable/visible dislocation deformity
consider: symptoms in Component 1
Note: Code fracture dislocations to the fracture.

L81 Injury musculoskeletal NOS

M79.5, S09.1, S09.9, S16, S20.2, S30.0, S30.1, S33.4, S39.0, S39.8, S39.9,
S40.0, S46 to S49, S50.0, S50.1, S56 to S59, S60.0 to S60.2, S66 to S69,
S70.0, S70.1, S76 to S79, S80.0, S80.1, S86 to S89, S90.0 to S90.3,
S96 to S99, T06.4, T09.0, T09.5 to T09.9, T11.0, T11.5 to T11.9,
T13.0, T13.5 to T13.9, T14.6, T14.7
incl: deep foreign body, haemarthrosis, traumatic amputation
excl: internal injury of chest/abdomen/pelvis, multiple trauma A81; late effect
trauma/deformity/disability/scarring A82; injury teeth D80; injury eardrum
H77; traumatic arthropathy L91; non/mal-union of fracture L99; head
injury/concussion/intracranial injury/skull fracture N80; laceration/other
injury to nerve N81; insect bite/sting S12; animal bite S13; bruise/contusion
S16; laceration/open wound S18
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L82 Congenital anomaly musculoskeletal Q65 to Q79

incl: bow leg, clubfoot (talipes), congenital dislocation of hip, genu recurvatum, con-
genital malformation of skull and face, other congenital deformity of the foot
excl: scoliosis L85; pes planus (acquired) L98; spina bifida N85

L83 Neck syndrome

M43.0, M43.1, M43.3 to M43.6, M46.0, M47.1, M47.2, M47.8, M47.9,
M48, M50, M53.0, M53.1, M53.8, M53.9
incl: syndromes with/without radiation of pain: cervical disc lesion, cervico-
brachial syndrome, cervicogenic headache, osteoarthritis of neck, radicular
syndrome of upper limbs, spondylosis, torticollis

L84 Back syndrome without radiating pain

M43.0, M43.1, M43.5, M46.0, M46.1, M46.8, M46.9, M47.0, M47.8, M47.9,
M48, M51.2 to M51.9, M53.2 to M53.9, S33.5, S33.7
incl: back strain, collapsed vertebra NOS, facet joint degeneration, osteoarthrosis/
osteoarthritis of spine, spondylolisthesis, spondylosis
excl: coccydynia L03; syndrome related to the neck L83; back pain with radiation/
sciatica L86; psychogenic backache P75
criteria: back pain without radiation plus limitation of movement confirmed at medical
examination
consider: symptom/complaint back L02; symptom/complaint low back L03

L85 Acquired deformity of spine M40, M41, M43.8, M43.9

incl: kyphoscoliosis, kyphosis, lordosis, scoliosis

excl: congenital deformity L82; ankylosing spondylitis L88; spondylolisthesis L84

L86 Back syndrome with radiating pain M47.1, M47.2, M51, M54.3, M54.4
incl: disc prolapse/degeneration, sciatica
excl: cervical disc lesion L83; spondylolisthesis L84; recent back strain L84
criteria: pain in the lumbar/thoracic region of the spine, accompanied by pain radiating
to, or a neurological deficit of an appropriate area; or sciatica, pain radiating
down the back of the leg, aggravated by coughing, movement, or posture; or
demonstration of a prolapsed lumbar or thoracic disc by appropriate imaging
technique, or at surgery
consider: back pain L02; low back pain L03
Note: Exclude referred pain that is diffuse.

L87 Bursitis/tendinitis/synovitis NOS

M65.2 to M65.4, M65.8, M65.9, M67.3, M67.4, M70, M71.2 to M71.9,
M72, M76, M77.0, M77.2, M77.3, M77.8, M77.9
incl: bone spurs, calcified tendon, Dupuytren’s contracture, fasciitis, ganglion,
synovial cysts, tenosynovitis, trigger finger (cont.)
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International Classification of Primary Care-2-Revised 89

excl: bursitis/tenditis/synovitis of shoulder L92; tennis elbow/lateral epicon-

dylitis L93

L88 Rheumatoid/seropositive arthritis M05, M06, M08, M45

incl: allied conditions: ankylosing spondylitis, juvenile arthritis

excl: psoriatic arthropathy L99

L89 Osteoarthrosis of hip M16

incl: osteoarthritis of hip secondary to dysplasia/trauma

criteria: either characteristic imaging appearance; or joint disorder of at least
3 months’ duration, with no constitutional symptoms and three or more of the
following: intermittent swelling; crepitation; stiffness/limitation of move-
ment; normal ESR, rheumatoid tests, and uric acid; over 40 years of age
consider: joint symptom L20; arthritis NOS L91

L90 Osteoarthrosis of knee M17

incl: osteoarthritis of knee secondary to dysplasia/trauma

criteria: either characteristic imaging appearance; or joint disorder of at least 3
months’ duration, with no constitutional symptoms and three or more of the
following: intermittent swelling; crepitation; stiffness/limitation of move-
ment; normal ESR, rheumatoid tests, and uric acid; over 40 years of age
consider: joint symptom L20; arthritis NOS L91

L91 Osteoarthrosis, other M13, M15, M18, M19

incl: arthritis NOS, osteoarthritis, traumatic arthropathy

excl: osteoarthrosis of neck L83; osteoarthrosis of spine L84; osteoarthrosis of
hip L89; osteoarthrosis of knee L90; osteoarthrosis of shoulder L92
criteria: characteristic imaging appearance; or Heberden’s nodes or joint disorder of
at least 3 months’ duration, with no constitutional symptoms and three or more
of the following: intermittent swelling; crepitation; stiffness/limitation of
movement; normal ESR, rheumatoid tests, and uric acid; over 40 years of age
consider: joint symptom L20

L92 Shoulder syndrome M19, M75

incl: bursitis of shoulder, frozen shoulder, osteoarthrosis/synovitis of shoulder,

rotator cuff syndrome, tendinitis around shoulder
criteria: shoulder pain with limitation of movement/local tenderness/crepitus; or
periarticular calcification on imaging

L93 Tennis elbow M77.1

incl: lateral epicondylitis

excl: other tendinitis L87
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L94 Osteochondrosis M42, M91 to M93

incl: Legg–Calvé–Perthes disease, Osgood–Schlatter disease, osteochondritis

dissecans, Scheuermann’s disease, slipped femoral epiphysis

L95 Osteoporosis M80 to M82

incl: pathological fracture due to osteoporosis

criteria: characteristic imaging appearance

L96 Acute internal damage knee S83.2, S83.3, S83.5, S83.7

incl: acute damage to meniscus/cruciate ligaments

excl: acute damage to collateral ligaments L78; dislocation of patella L80; chronic
internal damage to knee L99
criteria: an initial injury that occurred no longer than 1 month previously and demon-
stration of ligament/meniscus tear by surgery/arthroscopy/imaging, or by
locking/giving way, pain, and swelling of knee
consider: knee symptom L15; sprain of knee L78

L97 Neoplasm musculoskeletal benign/unspecified D16, D21, D48.0, D48.1

incl: benign musculoskeletal neoplasm, musculoskeletal neoplasm not specified

as benign or malignant/when histology is not available
excl: malignant musculoskeletal neoplasm L71

L98 Acquired deformity of limb M20, M21

incl: bunion, genu valgum-varum, hallux valgus/varus, mallet finger, pes planus
(flatfoot)
excl: general congenital deformity/anomaly A90; musculoskeletal genital deformity/
anomaly L82

L99 Musculoskeletal disease, other

M02, M03, M07, M09, M12, M14, M22.2 to M22.9, M23, M24, M25.0 to
M25.3, M25.7 to M25.9, M32 to M36, M43.2, M49, M54.1, M61,
M62.0 to M62.4, M62.8, M62.9, M63, M66, M67.0 to M67.2,
M67.8, M67.9, M68, M73, M79.4, M79.8, M84, M85,
M87 to M90, M94, M95, M99, T79.6, Z89, Z98.1
incl: arthrodesis, chronic internal derangement of knee, contractures, costochondritis,
dermatomyositis, disorder of patella, mal-union/non-union of fracture, myositis,
Paget’s disease of bone, pathological fracture N0S, polymyalgia rheumatica,
psoriatic arthritis (code also S91), Reiter’s disease, scleroderma, Sjögren’s
syndrome, spontaneous rupture tendon, systemic lupus erythematosus
excl: hyperuricaemia A91; pathological fracture due to osteoporosis L95; post-
polio paralysis N70; post-stroke paralysis N81; gout T92; pseudogout/crystal
arthropathy, osteomalacia T99
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International Classification of Primary Care-2-Revised 91

N Neurological

Component 1—Symptoms and complaints

N01 Headache G44.3, G44.8, R51

incl: post-traumatic headache

excl: cervicogenic headache L83; face pain N03; migraine N89; cluster headache
N90; tension headache N95; atypical facial neuralgia N99; sinus pain R09;
post-herpetic pain S70

N03 Pain, face G50.1, R51

excl: toothache D19; headache N01; migraine N89; trigeminal neuralgia N92;
sinus pain R09; post-herpetic pain S70

N04 Restless legs G25.8

excl: leg cramps L14; intermittent claudication K92

N05 Tingling fingers/feet/toes R20.2

incl: burning sensation, prickly feeling fingers/feet/toes, paraesthesia

excl: pain/tenderness of skin S01

N06 Sensation disturbance, other R20.0, R20.1, R20.3, R20.8

incl: anaesthesia, numbness

excl: tingling fingers/feet/toes N05; pain/tenderness of skin S01

N07 Convulsion/seizure R56

incl: febrile convulsion, fit

excl: fainting A06; transient ischaemic attack K89

N08 Abnormal involuntary movements G25, R25.0, R25.1, R25.3, R25.8, R29.0

incl: dystonic movements, jerking, myoclonus, shaking, tetany, tremor, twitching

excl: chorea K71; cramps/spasm L07, L09, L12, L14, L17, L18; restless legs
N04; convulsion N07; tic douloureux N92; dystonia/organic tic N99;
psychogenic tic P10

N16 Disturbance of smell/taste R43

incl: anosmia
excl: halitosis D20
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N17 Vertigo/dizziness R42

incl: giddiness, feeling faint/lightheaded, loss of balance, woozy

excl: syncope/blackout A06; motion sickness A88; specific vertiginous syndrome H82

N18 Paralysis/weakness G98

incl: paresis
excl: general weakness A04

N19 Speech disorder R47

incl: aphasia, dysphasia, dysarthria, slurred speech

excl: stammering/stuttering P10; speech delay P22; hoarseness R23

N26 Fear of cancer of neurological system Z71.1

excl: if the patient has the disease, code the disease

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

N27 Fear of neurological disease, other Z71.1

excl: fear of neurological cancer N26; if the patient has the disease, code the disease
criteria: concern about/fear of other neurological disease in a patient without the
disease/until the diagnosis is proven

N28 Limited function/disability (N) Z73.6

incl: disability due to neurological diseases and disorders

criteria: limitation of function/disability due to a neurological problem
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

N29 Neurological symptom/complaint, other

M79.2, R26, R27, R29.0 to R29.2, R29.8
incl: ataxia, gait abnormality, limping, meningism

Component 7—Diagnosis/diseases
N70 Poliomyelitis A80, A85.0, B91

incl: late effect of poliomyelitis, post-polio syndrome, other neurological

enterovirus infection
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N71 Meningitis/encephalitis
A32.1, A39.0, A83, A84, A85.1, A85.2, A85.8, A86, A87, B00.3, B00.4,
B37.5, B58.2, B94.1, G00 to G05
criteria: an acute febrile illness with abnormal findings in the cerebrospinal fluid
consider: fever A03; meningism N29

N72 Tetanus A33 to A35

excl: tetany N08

criteria: rigidity, hypertonic contractions or tetanic spasticity and a history of preceding
injury

N73 Neurological infection, other A81, A88.8, A89, G06 to G09

incl: cerebral abscess, slow virus infection

excl: poliomyelitis N70; meningitis/encephalitis N71; acute polyneuritis N94

N74 Malignant neoplasm nervous system C47, C70 to C72

criteria: characteristic histological appearance

consider: unspecified neoplasm nervous system N76

N75 Benign neoplasm nervous system D32, D33, D36.1

incl: acoustic neuroma, meningioma

N76 Neoplasm nervous system, unspecified D42, D43, D48.2

incl: neoplasm nervous system not specified as benign or malignant/when histology

is not available
excl: neurofibromatosis A90

N79 Concussion S06.0

incl: late effect of concussion

excl: psychological effect of concussion P02
criteria: trauma to the head with a temporary loss of consciousness and/or neurological
sequela
consider: other head injury N80

N80 Head injury, other

S02.0, S02.1, S02.9, S06.1 to S06.9, S07, S08.0, S08.8, S08.9, S09.0, S09.7 to S09.9

incl: cerebral contusion, cerebral injury with/without skull fracture, extradural

haematoma, subdural haematoma, traumatic intracranial haemorrhage (cont.)
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94 WONCA International Classification of Primary Care

excl: concussion N79

criteria: trauma to the head, complicated by cerebral damage

N81 Injury nervous system, other

S04, S09.9, S14, S24, S34, S44, S54, S64, S74, S84, S94, T06.0 to T06.2,
T09.3, T09.4, T11.3, T13.3, T14.4
incl: nerve injury, spinal cord injury

N85 Congenital anomaly neurological Q00 to Q07

incl: hydrocephalus, spina bifida

N86 Multiple sclerosis G35

incl: disseminated sclerosis

criteria: exacerbations/remissions of multiple neurological manifestation with
deficits/derangements disseminated in both time and site (any combination
of neurological signs and symptoms is possible)
consider: other neurological symptom N29

N87 Parkinsonism G20 to G22

incl: drug-induced parkinsonism, paralysis agitans, Parkinson’s disease

criteria: poverty and slowness of voluntary movements, resting tremor improving
with active purposeful movement, and muscular rigidity
consider: abnormal involuntary movements N08; disorder of speech N19

N88 Epilepsy G40, G41

incl: all types of epilepsy: focal seizures, generalized seizures, grand mal, petit mal,
status epilepticus
criteria: recurrent episodes of sudden altered consciousness, with/without
tonic/clonic movements/seizure, plus either eyewitness account of the attack,
or characteristic abnormality of electroencephalogram (EEG)
consider: convulsion N07; other neurological symptom N29

N89 Migraine G43, G44.1

incl: vascular headache with/without aura

excl: cervicogenic headache L83; cluster headache N90; tension headache N95
criteria: recurrent episodes of headache with three or more of the following: unilateral
headache; nausea/vomiting; aura; other neurological symptoms; family history
of migraine
consider: headache N01
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N90 Cluster headache G44.0

excl: migraine N89

criteria: attacks of severe, often excruciating unilateral pain peri-orbitally and/or
temporally, occurring up to eight times a day, sometimes associated with
conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, sweating,
miosis, ptosis, or eyelid oedema. Attacks occur in cluster periods lasting
weeks/months separated by remissions lasting months/years

N91 Facial paralysis/Bell’s palsy G51, G53

criteria: acute onset of unilateral paralysis of muscles of facial expression without

sensory loss
consider: paralysis/weakness N18

N92 Trigeminal neuralgia G50.0, G50.8, G50.9

incl: tic douloureux

excl: post-herpetic neuralgia S70
criteria: unilateral paroxysms of burning facial pain aggravated by touching trigger-
points, blowing nose or yawning, without sensory or motor paralysis
consider: neuralgia NOS N99

N93 Carpal tunnel syndrome G56.0

criteria: loss/impairment of superficial sensation affecting the thumb, index and middle
finger, that may or may not split the ring finger. Dysaesthesia and pain worsen
usually during the night, and may radiate to the forearm
consider: sensation disturbance N06

N94 Peripheral neuritis/neuropathy

G54, G55, G56.1 to G56.4, G56.8, G56.9, G57 to G64, M79.2
incl: acute infective polyneuropathy, diabetic neuropathy (double code with T89,
T90), Guillain–Barré syndrome, nerve lesion, neuropathy, phantom limb
excl: post-herpetic neuropathy S70
criteria: sensory, reflex and motor changes confined to the territory of individual
nerves, sometimes without apparent cause, sometimes secondary to a specific
disease, e.g. diabetes

N95 Tension headache G44.2

excl: migraine N89; cluster headache N90

criteria: pressing, generalized headache associated with stress and muscle tension
with/without increased tenderness of pericranial muscles
consider: headache N01
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96 WONCA International Classification of Primary Care

N99 Neurological disease, other

E51.2, G10 to G13, G23, G24, G26, G31.0, G31.1, G31.8, G31.9, G32, G36,
G37, G52, G70 to G73, G80 to G83, G90 to G92, G93.0 to G93.2, G93.4 to
G93.9, G94 to G96, G98, G99, M79.2, Z98.2
incl: cerebral palsy, dystonia, motor neuron disease, myasthenia gravis, neuralgia
NOS
excl: sleep apnoea P06

P Psychological

Component 1—Symptoms and complaints

P01 Feeling anxious/nervous/tense R45.0

incl: anxiety NOS, feeling frightened

excl: anxiety disorder P74
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

P02 Acute stress reaction F43.0, F43.2, F43.8, F43.9

incl: adjustment disorder, culture shock, feeling stressed/grief/homesick, immedi-

ate post-traumatic stress, shock (psychic)
excl: feeling depressed P03; depressive disorder P76; post-traumatic stress disor-
der P82
criteria: a reaction to a stressful life event or significant life change requiring a major
adjustment, either as an expected response to the event or as a maladaptive
response interfering with daily coping and resulting in impaired social func-
tioning, with recovery within a limited period of time

P03 Feeling depressed R45.2, R45.3

incl: feeling inadequate, unhappy, worried

excl: 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

P04 Feeling/behaving irritable/angry R45.1, R45.4 to R45.6

incl: agitation NOS, restlessness NOS

excl: overactive child P22; irritability in partner Z13 (cont.)
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International Classification of Primary Care-2-Revised 97

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, to those that are so troublesome that
professional help is sought

P05 Senility, feeling/behaving old R54

incl: concern with aging, senescence

excl: dementia P70
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, to feelings that are so
troublesome to the patient that professional help is sought

P06 Sleep disturbance F51, G47

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

excl: jetlag A88
criteria: sleep disturbance as a diagnosis requires that the sleeping problem forms a
major complaint that, 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 that is unsatisfactory, in
the patient’s opinion, over a considerable period of time. In hypersomnia
excessive daytime sleepiness and sleep attacks exist that limit the patient’s
performance

P07 Sexual desire reduced F52.0

incl: frigidity, loss of libido

excl: 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

P08 Sexual fulfilment reduced F52.1 to F52.9

incl: non-organic impotence or dyspareunia, premature ejaculation, vaginismus

of psychogenic origin
excl: 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 disor-
der 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
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98 WONCA International Classification of Primary Care

P09 Sexual preference concern F64 to F66

excl: 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

P10 Stammering/stuttering/tic F95, F98.4 to F98.6

excl: tic douloureux N92
criteria: stammering and stuttering: disorder of speech characterized by frequent rep-
etitions/prolongations of sounds, or by frequent hesitations/pauses
disrupting speech

P11 Eating problem in child F98.2, F98.3

incl: feeding problem, problem with eating behaviour of child

excl: anorexia nervosa P86; eating problem in adult T05
Note: Behavioural problems in children are particularly difficult to classify, as 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 perhaps annoying) behaviour and behaviour that is considered
worrying or ‘pathological’.

P12 Bedwetting/enuresis F98.0

excl: bedwetting due to organic disorder U04

criteria: involuntary voiding of urine by day/night not determined to be related to any
organic disorder
Note: Behavioural problems in children are particularly difficult to classify, as 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 perhaps annoying) behaviour and behaviour that is considered
worrying or ‘pathological’.

P13 Encopresis/bowel training problem F98.1

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

P15 Chronic alcohol abuse F10.1 to F10.9, G31.2

incl: 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 syn-
drome; withdrawal state; psychotic disorder (cont.)
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International Classification of Primary Care-2-Revised 99

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 agree to any medical intervention.

P16 Acute alcohol abuse F10.0

incl: drunk
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.

P17 Tobacco abuse F17

incl: smoking problem

criteria: a disorder due to the use of tobacco resulting in one or more of the follow-
ing: acute intoxication; harmful use with clinically important damage to
health; dependence syndrome; withdrawal state
consider: risk factor NOS A23
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 patient’s agree-
ment, and consequently also without the patient’s willingness to agree to any medical
intervention.

P18 Medication abuse F13, F19, F55

incl: abuse of any prescribed drug

Note: Substance abuse problem definitions should take into account the considerable
differences between countries and cultures. Some patients request and use tranquilliz-
ers, 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
patient’s agreement, and consequently also without the patient’s willingness to agree to
any medical intervention.

P19 Drug abuse F11 to F16, F18, F19

incl: addiction to drug, drug withdrawal

criteria: a disorder due to the use of a dependence-producing psychoactive substance,
resulting in one or more of the following conditions:
acute intoxication;
harmful use with clinically important damage to health;
dependence syndrome;
(cont.)
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100 WONCA International Classification of Primary Care

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 agree-
ment, and consequently also without the patient’s willingness to agree to any medical
intervention.

P20 Memory disturbance R41

incl: amnesia, disorientation, disturbance of concentration

P22 Child behaviour symptom/complaint

F91 to F94, F98.8, F98.9, R62.0

incl: delayed milestones, jealousy, overactive child, speech delay, temper tantrum
excl: behaviour symptom/complaint adolescent, adult P23, P80; concern about
physical development/growth delay T10

P23 Adolescent behaviour symptom/complaint F91, F92, F94, F98.8, F98.9

incl: delinquency
excl: behaviour symptom/complaint child, adult P22, P80, P81

P24 Specific learning problem F80 to F83, R48

incl: dyslexia
excl: 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 sponta-
neous remissions or relapses, although the deficit may diminish as the child
grows older

P25 Phase of life problem, adult Z60.0

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

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

P27 Fear of mental disorder Z71.1

incl: concern about mental disease, fear of attempting suicide

excl: if the patient has the disease, code the disease
criteria: concern about/fear of mental disease in a patient without the disease/until
the diagnosis is proven
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International Classification of Primary Care-2-Revised 101

P28 Limited function/disability (P) Z73.6

incl: low self-esteem

criteria: limitation of function/disability due to a psychological problem
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

P29 Psychological symptom/complaint, other

F50.8, F50.9, F63.3, F98.8, F98.9, R44, R45.7, R45.8, R46
Z64.2, Z64.3, Z73.0, Z73.1, Z73.3
incl: delusions, eating disorders NOS, hallucinations, multiple psychological
symptoms/complaints, poor hygiene, strange behaviour, suspiciousness
excl: tension headache N95

Component 7—Diagnosis/diseases
Note: A mental disorder is a clinically significant psychological syndrome or
pattern, with or without an association with stressors (such as disability, increased
risk, or an important loss), that cannot be considered an expected response to a particu-
lar event, but rather a manifestation of a behavioural, psychological, or biological
dysfunction.

P70 Dementia F00 to F03, G30

incl: Alzheimer’s disease, senile dementia

criteria: a syndrome due to a disease of the brain, usually of a chronic and/or pro-
gressive 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

P71 Organic psychosis, other F04 to F07, F09

incl: delirium
excl: psychosis caused by alcohol P15; psychosis NOS P98
criteria: organic psychiatric disorders as a diagnosis require psychological syndromes,
patterns or behaviour due to organic disease

P72 Schizophrenia F20 to F22, F24, F25, F28

incl: all types of schizophrenia, paranoia

excl: acute/transient psychosis P98
criteria: fundamental and characteristic distortions of thinking, perception, and affect
that are inappropriate or blunted (e.g. thought-echo, -insertion, -withdrawal,
(cont.)
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102 WONCA International Classification of Primary Care

delusional perceptions, hallucinatory voices, delusions of control), together

with a clear consciousness and unaffected intellectual capacity
consider: psychosis NOS P98

P73 Affective psychosis F30, F31, F34.0

incl: bipolar disorder, hypomania, mania, manic depression

excl: depression P76
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
consider: psychosis NOS P98

P74 Anxiety disorder/anxiety state F41.0, F41.1, F41.3 to F41.9

incl: anxiety neurosis, panic disorder

excl: anxiety with depression P76; anxiety NOS P01
criteria: clinically significant anxiety that is not restricted to any particular environ-
mental situation. It manifests as a panic disorder (recurrent attacks of severe
anxiety not restricted to any particular situation, with/without physical
symptoms) or as a disorder in which generalized and persistent anxiety, not
related to any particular situation, occurs with variable physical symptoms
consider: feeling anxious/nervous/tense P01

P75 Somatization disorder F44, F45.0 to F45.2

incl: 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 1 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 1 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 physiolog-
ical 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 con-
trolling the production of these symptoms in dealing with the psychological factors.
Physical symptoms and complaints including pain that are presented as if they were due
to a physical disorder of a system/organ under autonomic nervous control, or that consist
of persistent, severe/distressing pain that cannot be explained by a physiological
(cont.)
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International Classification of Primary Care-2-Revised 103

process/disorder, are coded with a symptom/complaint diagnosis representing the phys-

ical 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 practice.

P76 Depressive disorder F32, F33, F34.1, F34.8, F34.9, F38, F39, F41.2, F53.0

incl: depressive neurosis/psychosis, mixed anxiety and depression, reactive

depression, puerperal/postnatal depression
excl: acute stress reaction P02
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
consider: feeling depressed P03

P77 Suicide/suicide attempt Z91.5

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

excl: fear of committing suicide P27

P78 Neuraesthenia, surmenage F48.0

criteria: increased fatiguability with unpleasant associations, difficulties in concen-

tration, 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

P79 Phobia/compulsive disorder F40, F42

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

P80 Personality disorder F60 to F62, F63.0 to F63.2, F63.8, F63.9, F68, F69

incl: psychopathy, compensation neurosis, Munchausen’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
(cont.)
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104 WONCA International Classification of Primary Care

significant/extreme deviations from the way an average individual in a given

culture perceives, feels, and behaves. This pattern is deeply ingrained and
longlasting

P81 Hyperkinetic disorder F90

incl: attention deficit disorder (ADD), hyperactivity

excl: hyperkinetic disorder with adolescent onset P23; learning disorder P24
criteria: early onset of a lack of persistence in activities requiring cognitive involve-
ment, with a tendency to move from one activity to another without completing
any one, with disorganized and ill regulated behaviour, and excessive activity
consider: overactive child P22

P82 Post-traumatic stress disorder F43.1

incl: persistent adjustment disorder

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

P85 Mental retardation F70 to F73, F78, F79

excl: 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

P86 Anorexia nervosa/bulimia F50.0 to F50.4

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 contours;
Bulimia: repeated bouts of overeating and an excessive preoccupation with
bodyweight, 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

P98 Psychosis NOS, other F23, F29, F53.1

incl: acute/transient/reactive/puerperal psychosis

P99 Psychological disorders, other

F48.1, F48.8, F48.9, F53.8, F53.9, F54, F59, F84, F88, F89, F99

incl: autism, neurosis NOS

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International Classification of Primary Care-2-Revised 105

R Respiratory

Component 1—Symptoms and complaints

R01 Pain, respiratory system R07.1

incl: painful respiration, pleuritic pain, pleurodynia

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

R02 Shortness of breath/dyspnoea R06.0

incl: orthopnoea
excl: wheezing R03; stridor R04; hyperventilation R98

R03 Wheezing R06.2

incl: inspiratory wheeze, rhonchi

excl: dyspnoea R02; stridor R04; hyperventilation R98

R04 Breathing problem, other R06.1, R06.3, R06.5, R06.8

incl: abnormal breathing, apnoea, holding breath, respiratory distress, snoring,

stridor, tachypnoea
excl: sleep apnoea P06; respiratory pain R01; dyspnoea R02; wheezing R03;
cough R05; hyperventilation R98

R05 Cough R05

incl: cough (dry or moist)

excl: abnormal sputum/phlegm R25

R06 Nose bleed/epistaxis R04.0

R07 Sneezing/nasal congestion J34.8, R06.7

incl: blocked nose, rhinorrhoea, running nose

R08 Nose symptom/complaint, other J34.8

incl: pain in nose, postnasal drip, prominent nose, red nose

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

R09 Sinus symptom/complaint J34.8

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

excl: headache N01; face pain N03; nasal congestion R07
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106 WONCA International Classification of Primary Care

R21 Throat symptom/complaint R07.0, R09.8

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

excl: voice symptom R23; tonsillar hypertrophy R90

R23 Voice symptom/complaint R49

incl: absence of voice, aphonia, hoarseness

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

R24 Haemoptysis R04.2

incl: coughing blood

R25 Sputum/phlegm abnormal R09.3

excl: cough with sputum R05; haemoptysis R24

R26 Fear of cancer of respiratory system Z71.1

excl: if the patient has the disease, code the disease

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

R27 Fear of respiratory disease, other Z71.1

excl: fear of respiratory cancer R26; if the 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

R28 Limited function/disability (R) Z73.6, Z99.1

incl: disability due to hypoxia, hypercapnia, reduced lung function, respiratory

disease, disease of nose/larynx/throat
excl: dyspnoea R02; wheezing R03
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

R29 Respiratory symptom/complaint, other

R04.1, R04.8, R04.9, R06.6, R09.0, R09.2, R09.8

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

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International Classification of Primary Care-2-Revised 107

Component 7—Diagnosis/diseases
R71 Whooping cough A37

incl: parapertussis, pertussis

excl: croup R77
criteria: respiratory infection with a characteristic staccato paroxysmal cough ending
with a high-pitched inspiratory whoop; or respiratory infection with cough
of at least 3 weeks’ duration in contact with known pertussis; or demonstra-
tion of Bordetella pertussis or parapertussis
consider: cough R05; upper respiratory infection R74

R72 Strep throat J02.0, J03.0

incl: proven streptococcal pharyngitis/tonsillitis
excl: scarlet fever A78; erysipelas/strep skin infection S76
criteria: acute inflammation of the throat, plus demonstration of beta-haemolytic
streptococci
consider: tonsillitis R76

R73 Boil/abscess nose J34.0

incl: localized nose infection

excl: acute sinusitis R75

R74 Upper respiratory infection, acute B00.2, B08.5, J00, J02.8, J02.9, J06

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

excl: 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

R75 Sinusitis acute/chronic J01, J32

incl: sinusitis affecting any paranasal sinus

criteria: purulent nasal/postnasal 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
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108 WONCA International Classification of Primary Care

R76 Tonsillitis, acute J03.8, J03.9, J36

incl: peritonsillar abscess, quinsy

excl: 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

R77 Laryngitis/tracheitis, acute J04, J05.0

incl: croup
excl: laryngotracheobronchitis R78; epiglottitis R83
criteria: hoarseness/stridor with/without respiratory distress, or deep dry painful
cough (barking in children), and normal chest signs
consider: upper respiratory tract infection R74

R78 Acute bronchitis/bronchiolitis J20 to J22, J40

incl: acute lower respiratory infection NOS, bronchitis NOS, chest infection
NOS, laryngotracheobronchitis, tracheobronchitis
excl: influenza R80; chronic bronchitis R79; allergic bronchitis R96
criteria: in children and adults: cough and fever with scattered or generalized abnor-
mal 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

R79 Chronic bronchitis J41, J42

excl: 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

R80 Influenza J10.1, J10.8, J11.1, J11.8

incl: influenza-like illness, para-influenza

excl: 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 h); 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
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International Classification of Primary Care-2-Revised 109

R81 Pneumonia A48.1, J10.0, J11.0, J12 to J18

incl: bacterial/viral pneumonia, bronchopneumonia, influenzal pneumonia,

Legionnaire’s disease, pneumonitis
excl: aspiration pneumonia R99
criteria: evidence of pulmonary consolidation
consider: cough R05; acute bronchitis R78

R82 Pleurisy/pleural effusion J90, J91, J94, R09.1

incl: pleural inflammatory exudate, pleuritis

excl: tuberculosis R70; 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
consider: pleuritic pain R01

R83 Respiratory infection, other

A36, B37.1, B44, B58.3, J05.1, J31, J37, J85, J86

incl: chronic nasopharyngitis, chronic pharyngitis, chronic rhinitis NOS, diphtheria,

empyema, epiglottitis, fungal respiratory infection, lung abscess, protozoal
infection (without pneumonia)
excl: cystic fibrosis T99

R84 Malignant neoplasm bronchus/lung C33, C34

incl: malignancy of trachea/bronchus/lung

excl: malignancy of unknown site A79; a secondary malignancy from known site
to be coded to site
criteria: characteristic histological appearance
consider: unspecified respiratory neoplasm R92

R85 Malignant neoplasm respiratory, other

C09 to C13, C14.0, C14.2, C30.0, C31, C32, C38.4, C39, C45.0

incl: malignancy of larynx/mediastinum/nose/pharynx/pleura/sinus, mesothelioma

excl: Hodgkin’s disease B72; malignancy of trachea/bronchus/lung R84
criteria: characteristic histological appearance
consider: unspecified respiratory neoplasm R92

R86 Benign neoplasm respiratory D14, D19

excl: unspecified respiratory neoplasm R92; nasal polyp R99

criteria: characteristic clinical or histological appearance
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R87 Foreign body nose/larynx/bronchus T17

incl: foreign body in lung

excl: 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

R88 Injury respiratory, other

S00.3, S01.2, S03.1, S09.9, S10.0, S17.0, S19.8, S27, T27, T70.1

incl: injury/trauma to nose/respiratory system

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

R89 Congenital anomaly respiratory Q30 to Q34

incl: congenital abnormality of nose/pharynx/trachea/larynx/bronchi/lungs/pleura

excl: cleft lip/palate D81; cystic fibrosis T99

R90 Hypertrophy tonsils/adenoids J34.8, J35

incl: chronic tonsillitis

excl: acute tonsillitis R76; allergic rhinitis R97

R92 Neoplasm respiratory, unspecified D02, D38

incl: respiratory neoplasm unspecified as benign or malignant/when histology is

not available
excl: secondary neoplasm unknown site A79; malignant respiratory neoplasm
R84, R85; benign respiratory neoplasm R86

R95 Chronic obstructive pulmonary disease J43, J44

incl: chronic obstructive airways (COAD), lung (COLD), pulmonary (COPD)

disease, chronic airways limitation (CAL), emphysema
excl: chronic bronchitis R79; asthma R96; bronchiectasis R99; cystic fibrosis T99
criteria: objective evidence of airway obstruction, not/only partially relieved by
bronchodilators
consider: other breathing problem R04

R96 Asthma J45, J46

incl: reactive airways disease, wheezy bronchitis

excl: 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
consider: wheezing R03; cough R05
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R97 Allergic rhinitis J30

incl: hay fever, nasal allergy, vasomotor rhinitis

excl: upper respiratory tract infection R74; chronic rhinitis NOS R83

R98 Hyperventilation syndrome R06.4

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

consider: other breathing problem R04

R99 Respiratory disease, other

J33, J34.1 to J34.3, J34.8, J38, J39, J47, J60 to J70, J80 to J82, J84,
J92, J93, J96, J98, J99, Z90.2
incl: aspiration pneumonia, bronchiectasis, deviated nasal septum, lung complica-
tion 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

S Skin

Component 1—Symptoms and complaints

S01 Pain/tenderness of skin R20.8

incl: burning sensation, painful lesion or rash, soreness

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

S02 Pruritus L29.8, L29.9

incl: skin irritation

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

S03 Warts B07

incl: verrucae
excl: molluscum contagiosum S95; genital warts X91, Y76

S04 Lump/swelling, localized R22.0 to R22.4, R22.9, R23.8

incl: papule
excl: insect bite S12; breast lump X19, Y16

S05 Lumps/swellings, generalized R22.7, R23.8

incl: papules/lumps/swellings in multiple sites

excl: swollen ankles/oedema K07
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S06 Rash localized L53.9, R21

incl: blotch, erythema, redness

excl: localized lump/swelling S05

S07 Rash generalized L53.9, R21

incl: blotches/erythema/redness occurring in multiple sites

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

S08 Skin colour change L81.0 to L81.3, R23.0 to R23.2, R23.8

incl: ‘circles under eyes’, cyanosis, flushing, freckles, pallor

excl: bruise S16; vitiligo S99

S09 Infected finger/toe L03.0

incl: paronychia
excl: post-traumatic infection finger/toe S11; tinea S74; monilia/candida S75

S10 Boil/carbuncle L02

incl: abscess, furuncle

excl: 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

S11 Skin infection, post-traumatic T79.3

incl: infected post-traumatic wound/bite

excl: surgical wound infection A87; erysipelas pyoderma S76; impetigo S84

S12 Insect bite/sting

S00.0, S00.2 to S00.9, S10.1 to S10.9, S20.1, S20.3 to S20.8, S30.7 to S30.9,
S40.7, S40.8, S50.7, S50.8, S60.7, S60.8, S70.7, S70.8, S80.7, S80.8,
S90.7, S90.8, T09.0, T11.0, T13.0, T14.0
excl: toxic effects non-medical substance A86; infected bite S11; scabies S72;
pediculosis S73

S13 Animal/human bite T14.1

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

S14 Burn/scald T20 to T25, T30 to T32

incl: burn/scald of all degrees; external chemical burn

excl: sunburn S80
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S15 Foreign body in skin

S00.0, S00.2 to S00.9, S10.1 to S10.9, S20.1, S20.3 to S20.8, S30.7 to S30.9,
S40.7, S40.8, S50.7, S50.8, S60.7, S60.8, S70.7, S70.8, S80.7, S80.8, S90.7,
S90.8, T09.0, T11.0, T13.0, T14.0, T14.1
incl: foreign body under nail

S16 Bruise/contusion
S00.0, S00.8, S00.9, S10.0, S10.8, S10.9, S20.0, S20.2, S30.0, S30.1, S40.0,
S50.0, S50.1, S60.0 to S60.2, S70.0, S70.1, S80.0, S80.1, S90.0 to S90.3,
T09.0, T11.0, T13.0, T14.0
incl: ecchymosis, haematoma
excl: bruise/contusion with broken skin S17
criteria: bruise/contusion with intact skin surface

S17 Abrasion/scratch/blister
S00.0, S00.7 to S00.9, S10.1 to S10.9, S20.1, S20.3 to S20.8, S30.7 to S30.9, S40.7,
S40.8, S50.7, S50.8, S60.7, S60.8, S70.7, S70.8, S80.7, S80.8,
S90.7, S90.8, T09.0, T11.0, T13.0, T14.0
incl: bruise with broken skin, graze

S18 Laceration/cut
S01.0, S01.2, S01.4, S01.7 to S01.9, S11, S21, S31.0, S31.1, S31.8, S41, S51,
S61, S71, S81, S91, T09.1, T11.1, T13.1, T14.1
incl: laceration/cut of skin/subcutaneous tissues
excl: bite S13; bruise with broken skin S17

S19 Skin injury, other

S00.0, S00.7 to S00.9, S10.1 to S10.9, S20.1, S20.3 to S20.8, S30.7 to
S30.9, S40.7 to S40.9, S50.7 to S50.9, S60.7 to S60.9, S70.7 to S70.9,
S80.7 to S80.9, S90.7 to S90.9, T09.0, T11.0, T13.0, T14.0, T14.1
incl: avulsion nail, needle stick, puncture
excl: bite S13

S20 Corn/callosity L84

excl: hyperkeratosis S80

S21 Skin texture symptom/complaint R23.4

incl: dry skin, peeling, scaling, wrinkles

excl: sweating problem A09; scalp symptom/complaint S24; ichthyosis S83;
sweat gland disease S92; vulval symptom/complaint X16
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S22 Nail symptom/complaint L60.1, L60.4, L60.5, L60.9, L62, R68.3

incl: clubbing
excl: paronychia S09; ingrowing nail S94

S23 Hair loss/baldness L63 to L66

incl: alopecia

S24 Hair/scalp symptom/complaint, other L67, L68

incl: dry scalp, hirsutism

excl: tricotillomania P29; folliculitis S10; hair loss/baldness S23; dandruff S86

S26 Fear of cancer of skin Z71.1

excl: if the patient has the disease, code the disease

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

S27 Fear of skin disease, other Z71.1

excl: fear of cancer of skin S26; if the 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

S28 Limited function/disability (S) Z73.6

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

Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

S29 Skin symptom/complaint, other R23.3, R23.8

incl: cellulite, petechiae, problems with umbilicus, sore(s)

excl: scar S99

Component 7—Diagnosis/diseases
S70 Herpes zoster B02

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

criteria: grouped vescicular eruptions, unilateral distribution, over area of a single
dermatome
consider: skin pain S01; localized rash S06
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S71 Herpes simplex B00.0, B00.1, B00.2, B00.8, B00.9

incl: cold sore, fever blister

excl: herpes simplex of eye without corneal ulcer F73; genital herpes X90, Y72
criteria: vesicles with erythematous base in localized area(s); plus past history of
similar lesions, or virological or serological evidence
consider: localized rash S06

S72 Scabies/other acariasis B86, B88.0, B88.2

criteria: intensely pruritic skin lesions plus arrays of burrows on sides of palms, fingers,
penis, or skin folds; or demonstration of parasites or ova in lesions
consider: pruritus S02

S73 Pediculosis/skin infestation, other

B85, B87, B88.1, B88.3, B88.8, B88.9

incl: fleas, lice, mites, ticks

excl: infected insect bites S11; insect bites S12
criteria: demonstration of nits on hair shafts or insects on skin/clothes
consider: pruritus S02; localized rash S06

S74 Dermatophytosis B35, B36

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

excl: monilia/candida S75
criteria: pruritic scaly lesions with central clearing and small vesicles at border; or
demonstration of fungus

S75 Moniliasis/candidiasis skin B37.2

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

excl: oral thrush D83; genital candidiasis X72, Y75

S76 Skin infection, other

A46, A66, A67, L03.1 to L03.3, L03.8, L03.9, L08, L98.0
incl: cellulitis, erysipelas, pyoderma, strep skin infection
excl: boil/carbuncle S10; other localized skin infection S11; impetigo S84;
molluscum contagiosum S95; acne S96

S77 Malignant neoplasm of skin C43, C44, C46.0

incl: basal cell carcinoma, malignant melanoma, rodent ulcer, squamous cell
carcinoma of skin
excl: premalignant lesion of skin S79 (cont.)
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criteria: characteristic histological appearance

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

S78 Lipoma D17

S79 Neoplasm skin, benign/unspecified D03, D04, D23, D48.5

incl: benign skin neoplasm, skin neoplasm not specified as benign or malignant/
when histology is not available, dermoid cyst, premalignant lesion
excl: residual haemorrhoidal skin tag K96; solar keratosis S80; haemangioma
S81; mole/pigmented naevus S82; keloid, hyperkeratosis, seborrhoeic/senile
warts S99

S80 Solar keratosis/sunburn L55 to L59

incl: photosensitivity, radiation skin damage, senile keratosis, solar hyperkerato-

sis, polymorphous light eruption
excl: skin damage due to human-made radiation A87, A88

S81 Haemangioma/lymphangioma D18

incl: angiomatous birthmark, portwine stain

criteria: vascular or lymphatic tumour, elevated above skin and emptying on pressure
consider: localized swelling S04

S82 Naevus/mole D22

S83 Congenital skin anomaly, other Q80 to Q82, Q84

incl: birthmark, ichthyosis

excl: haemangioma/lymphangioma S81

S84 Impetigo L00, L01

incl: impetigo secondary to other dermatosis

criteria: spreading skin lesion consisting of macules, vesicles, pustules, or crust with
underlying raw area
consider: other localized skin infection S11

S85 Pilonidal cyst/fistula L05

incl: pilonidal abscess

excl: dermoid cyst S79

S86 Dermatitis, seborrhoeic L21

incl: cradle cap, dandruff (cont.)

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excl: seborrhoeic warts S99

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

S87 Dermatitis, atopic eczema L20

incl: flexural dermatitis, infantile eczema

excl: dermatitis/atopic eczema affecting external auditory meatus only 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
consider: pruritus S02; localized rash S06; generalized rash S07

S88 Dermatitis, contact/allergic

L23 to L25, L27.2, L27.8, L27.9, L30.0, L30.3, L30.4, L30.8, L30.9

incl: allergic dermatitis, chemical dermatitis, dermatitis NOS, eczema NOS,

intertrigo, plant sting, skin allergy
excl: allergy/allergic reaction unspecified A92; contact/other dermatitis
of eyelid F72; 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
consider: pruritus S02; localized rash S06; generalized rash S07

S89 Diaper rash L22

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

S90 Pityriasis rosea L42

criteria: oval, scaly eruptions along skin tension lines of trunk, with a history of
a solitary lesion preceeding presenting rash
consider: localized rash S06; generalized rash S07

S91 Psoriasis L40

criteria: plaques with silvery scales on knees, elbows, or scalp and/or stippled/pitted nails
Note: Double code psoriatic arthritis L99.

S92 Sweat gland disease L30.1, L73.2, L74, L75

incl: dyshidrosis, heat rash, hydradenitis, miliaria, pompholyx, prickly heat,

sweat rash
excl: hyperhidrosis A09
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S93 Sebaceous cyst L72.1

incl: wen

S94 Ingrowing nail L60.0

excl: paronychia S09

S95 Molluscum contagiosum B08.1

S96 Acne L70

incl: blackheads, comedones, pimples

excl: acne due to medication A85

S97 Chronic ulcer skin I83.0, I83.2, L89, L97, L98.4

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

excl: gangrene K92

S98 Urticaria L50

incl: hives, weals

excl: drug allergy A85; angioedema/allergic oedema A92

S99 Skin disease, other

L10 to L14, L26, L28, L30.2, L30.5, L41, L43 to L45, L51, L52, L53.0 to
L53.3, L53.8, L54, L60.2, L60.3, L60.8, L71, L72.0, L72.2, L72.8, L72.9,
L73.0, L73.1, L73.8, L73.9, L80, L81.4 to L81.9, L82, L83, L85 to L88,
L90 to L95, L98.1 to L98.3, L98.5 to L98.9, L99
incl: dermatitis artefacta, discoid lupus erythematosus, erythema multiforme,
erythema nodosum, folliculitis, granuloma, granuloma annulare, hyper-
keratosis NOS, keloid, keratoacanthoma, lichen planus, neurodermatitis,
onychogryphosis, rosacea, pigmentation, rhinophyma, scar, seborrhoeic or
senile warts, striae atrophicae, vitiligo

T Endocrine, metabolic and nutritional

Component—Symptoms and complaints

T01 Excessive thirst R63.1

incl: polydipsia
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T02 Excessive appetite R63.2

incl: overeating, polyphagia

excl: bulimia P86

T03 Loss of appetite R63.0

incl: anorexia
excl: anorexia nervosa P86

T04 Feeding problem of infant/child R63.3

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

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

T05 Feeding problem of adult R63.3

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

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

T07 Weight gain R63.5

excl: obesity T82; overweight T83

T08 Weight loss R63.4, R64

incl: cachexia
excl: anorexia nervosa P86

T10 Growth delay E34.3, R62.8, R62.9

incl: failure to thrive, physiological delay growth
excl: delayed milestones P22; learning disorder P24; mental retardation P85;
delayed puberty T99

T11 Dehydration E86

incl: water depletion

excl: salt depletion/electrolyte disturbance T99

T26 Fear of cancer of endocrine system Z71.1

excl: if the patient has the disease, code the disease

criteria: concern about/fear of cancer of endocrine system in a patient without the
disease/until the diagnosis is proven
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T27 Fear of endocrine/metabolic disease, other Z71.1

incl: fear of diabetes

excl: fear of cancer of endocrine system T26; if the 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

T28 Limited function/disability (T) Z73.6

criteria: limited function/disability due to a problem of the endocrine/metabolic/

nutritional system
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

T29 Endocrine/metabolic/nutritional symptom/complaint, other R63.8

incl: specific food craving, underweight

excl: hyperglycaemia A91; fluid retention K07

Component 7—Diagnosis/diseases
T70 Endocrine infection E06.0

excl: thyroiditis T99

T71 Malignant neoplasm thyroid C73

criteria: characteristic histological appearance

consider: other/unspecified endocrine neoplasm T73; goitre T81

T72 Benign neoplasm thyroid D34

excl: other/unspecified endocrine neoplasm T73; goitre T81

T73 Neoplasm endocrine, other/unspecified C74, C75, D09.3, D35, D44

T78 Thyroglossal duct/cyst Q89.2

excl: goitre T81

T80 Congenital anomaly endocrine/metabolic E00, Q89.1, Q89.2

incl: cretinism, dwarfism

excl: thyroglossal duct (cyst) T78
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T81 Goitre E04

incl: non-toxic goitre, thyroid nodule

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

T82 Obesity E66

excl: overweight T83

criteria: a body mass index greater than 30

T83 Overweight E66

excl: obesity T82

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

T85 Hyperthyroidism/thyrotoxicosis E05

incl: Graves’ disease, toxic goitre

excl: non-toxic goitre T81
criteria: laboratory evidence of excessive thyroid hormone; or thyroid nodule or
goitre plus tremor, weight loss, and rapid pulse (over 100/min at rest) or eye
signs (exophthalmos, lid lag, or ophthamoplegia)

T86 Hypothyroidism/myxoedema E01 to E03

excl: cretinism T80

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
consider: other complaint of metabolism T29

T87 Hypoglycaemia E15, E16.0 to E16.3, E16.9

incl: hyperinsulism, insulin coma

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

T89 Diabetes, insulin dependent E10

incl: juvenile-onset diabetes, type 1 diabetes

excl: drug-induced hyperglycaemia A85; hyperglycaemia as isolated finding A91;
non-insulin dependent diabetes T90; gestational diabetes W85
(cont.)
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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, polydipsia, and rapid
weight loss, together with unequivocal elevation of plasma glucose
(b) fasting blood glucose levels of 8 mmol/L (140 mg/dL) or more on two or
more occasions
(c) random blood glucose levels of 11 mmol/L (200 mg/dL) or more on two
or more occasions
(d) an oral glucose tolerance test (75 g glucose) with one value of plasma
glucose concentration at between 1 and 2 h of 11 mmol/L (200 mg/dL) or
more, and plasma glucose level at 2 h of 11 mol/L (200 mg/dL) or more;
these WHO criteria may change over time; also, criteria differences may
exist between national health care systems
Note: (1) Double code complications such as retinopathy F83, nephropathy U88; (2) in
pregnancy, double code with W84.

T90 Diabetes, non-insulin dependent E11 to E14

incl: diabetes NOS, late-onset diabetes, type 2 diabetes

excl: 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 classical symptoms of diabetes, such as polyuria, polydipsia, and
rapid weight loss, together with unequivocal increase in plasma glucose
concentration
(b) fasting blood glucose level of 8 mmol/L (140 mg/dL) or more on two or
more occasions
(c) random blood glucose level of 11 mmol/L (200 mg/dL) or more on two
or more occasions
(d) an oral glucose tolerance test (75 g glucose) one value of plasma glucose
concentration at between 1 and 2 h of 11 mmol/L (200 mg/dL) or more
and plasma glucose level at 2 h of 11 mol/L (200 mg/dL) or more; these
WHO criteria may change over time; also, criteria differences may exist
between national health care systems
Note: (1) Double code complications such as retinopathy F83, nephropathy U88; (2) in
pregnancy, double code with W84.

T91 Vitamin/nutritional deficiency

E40 to E46, E50, E51.1, E51.8, E51.9, E52 to E56,
E58 to E61, E63, E64
incl: beri-beri, dietary mineral deficiency, iron deficiency without anaemia, mal-
nutrition, marasmus, scurvy (cont.)
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excl: iron deficiency anaemia B80; pernicious anaemia B81; malabsorption

syndrome/sprue D99

T92 Gout M10

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

T93 Lipid disorder E78

incl: abnormality of lipoprotein level, hyperlipidaemia, raised level of choles-
terol/triglycerides, xanthoma

T99 Endocrine/metabolic/nutritional disease, other

E06.1 to E06.5, E06.9, E07, E16.8, E20 to E32, E34.0 to E34.2, E34.4 to
E34.9, E35, E65, E67, E68, E70 to E77, E79, E80, E83 to
E85, E87, E88, E90, M11, M83
incl: acromegaly, adrenal/ovarian/pituitary/parathyroid/testicular/other endocrine
dysfunction, amyloidosis, crystal arthropathy, Cushing’s syndrome, cystic
fibrosis, diabetes insipidus, Gilbert’s syndrome, hyperaldosteronism, osteo-
malacia, porphyria, precocious/delayed puberty, pseudo-gout, renal glycosuria,
thyroiditis
excl: food allergy A92; food intolerance D99; osteoporosis L95

U Urinary system

Component 1—Symptoms and complaints

U01 Dysuria/painful urination R30

incl: burning urination

excl: frequent/urgent urination U02; urethritis U72

U02 Urinary frequency/urgency R35

incl: nocturia, polyuria

U04 Incontinence urine N39.3, N39.4, R32

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

excl: urine incontinence of psychogenic origin P12

U05 Urination problems, other R34, R39.1

incl: anuria, dribbling urine, oliguria

excl: urinary retention U08
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U06 Haematuria N02, R31

incl: blood in urine

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

U07 Urine symptom/complaint, other R39.8

incl: bad odour of urine, dark urine

excl: abnormal urine test U98

U08 Urinary retention R33

U13 Bladder symptom/complaint, other R39.0, R39.8

incl: bladder pain, irritable bladder

U14 Kidney symptom/complaint N23

incl: kidney pain, kidney trouble, renal colic

excl: loin/flank pain L05

U26 Fear of cancer of urinary system Z71.1

excl: if the patient has the disease, code the disease

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

U27 Fear of urinary disease, other Z71.1

excl: fear of cancer of urinary system U26; if the 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

U28 Limited function/disability (U) Z73.6, Z99.2

incl: renal transplant, slow stream

excl: urinary incontinence U04
criteria: limitation of function/disability due to a urinary problem
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

U29 Urinary symptom/complaint, other R39.8

excl: irritable bladder/bladder pain U13; kidney symptom/complaint U14

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Component 7—Diagnosis/diseases
U70 Pyelonephritis/pyelitis N10 to N12, N15.1, N15.9

incl: infection of kidney, renal/perinephric abscess

criteria: two or more of the following: flank pain, renal tenderness, investigation
evidence of chronic renal damage; plus clinical or laboratory evidence of
urinary tract infection
consider: cystitis/other urinary infection U71

U71 Cystitis/urinary infection, other N30, N39.0

incl: acute/chronic cystitis (non-venereal), asymptomatic bacteriuria, lower urinary

tract infection, urinary tract infection NOS
excl: pyelonephritis U70; urethritis U72; vaginitis X84; balanitis Y75
Note: In pregnancy, also code W84.

U72 Urethritis A56.0, A56.2, A59.0, B37.4, N34

incl: chlamydial urethritis in man, non-specific urethritis, urethral syndrome,

meatitis
excl: gonococcal urethritis female X71; urethritis chlamydial female X92; urethritis
trichomonal female X73; gonococcal urethritis male Y71
criteria: urethral discharge with frequency, burning, pain or urgency on urination
without bacteruria 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

U75 Malignant neoplasm kidney C64, C65

criteria: characteristic histological appearance
consider: neoplasm urinary tract NOS U79

U76 Malignant neoplasm bladder C67

criteria: characteristic histological appearance

consider: neoplasm urinary tract NOS U79

U77 Malignant neoplasm urinary, other C66, C68

incl: malignant neoplasm ureter, malignant neoplasm urethra

excl: malignant neoplasm prostate Y77
criteria: characteristic histological appearance
consider: neoplasm urinary tract NOS U79
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U78 Benign neoplasm urinary tract D30

incl: bladder papilloma, polyp of urinary tract

excl: prostatic hypertrophy Y85
criteria: characteristic histological appearance
consider: neoplasm urinary tract NOS U79

U79 Neoplasm urinary tract, unspecified D09.0, D09.1, D41

incl: neoplasm of bladder/kidney/ureter/urethra not specified as benign or malignant/

when histology is not available
excl: malignant neoplasm kidney U75; malignant neoplasm bladder U76; other
malignant urinary neoplasm U77; benign urinary neoplasm U78

U80 Injury urinary tract S37.0 to S37.3, T19.0, T19.1, T28.3, T28.8

incl: contusion kidney, foreign body in urinary tract

U85 Congenital anomaly urinary tract Q60 to Q64

incl: duplex kidney/ureter, congenital polycystic kidney

U88 Glomerulonephritis/nephrosis
N00, N01, N03 to N05, N07, N08, N14, N15.0, N15.8, N16

incl: acute glomerulonephritis, analgesic nephropathy, chronic glomerulonephritis,

nephritis, nephropathy, nephrosclerosis, nephrotic syndrome
excl: renal failure U99
criteria: three or more of the following: haematuria, proteinuria, renal salt and water
retention, decreased renal function, persistent urinary sediment abnormalities;
or renal biopsy evidence
consider: abnormal urine test result U98; kidney symptom/complaint U14

U90 Orthostatic albuminuria/proteinuria N39.2

incl: postural proteinuria

criteria: albuminuria following ambulation, no albuminuria following overnight
recumbency and no evidence of renal disease
consider: proteinuria NOS U98

U95 Urinary calculus N20 to N22

incl: calculus/stone in bladder/kidney/ureter, urolithiasis

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
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U98 Abnormal urine test NOS N39.1, R80 to R82

incl: glycosuria, proteinuria, pus in urine, pyuria

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

U99 Urinary disease, other

N06, N13, N17 to N19, N25 to N29, N31 to N33, N35 to N37, N39.8,
N39.9, R39.2, T19.8, T19.9, Z90.5, Z90.6
incl: bladder diverticulum, hydronephrosis, hypertrophic kidney, obstruction
bladder neck, renal failure, urethral caruncle, urethral stricture, ureteric
reflux, uraemia

W Pregnancy, childbearing, family planning

Component 1—Symptoms and complaints

W01 Question of pregnancy Z32.0

incl: delayed menstruation, symptoms suggestive of pregnancy

excl: fear of pregnancy W02; pregnancy confirmed W78, W79

W02 Fear of pregnancy Z71.1

incl: concern about possibility of unwanted pregnancy

excl: concern/fear if unwanted pregnancy confirmed W79

W03 Antepartum bleeding O20, O46

W05 Pregnancy vomiting/nausea O21

incl: hyperemesis, morning sickness in confirmed pregnancy

W10 Contraception, post-coital Z30.3

incl: morning after pill

W11 Contraception, oral Z30.4

incl: family planning in woman using oral hormonal therapy

W12 Contraception, intrauterine Z30.1, Z30.5

incl: family planning using IUD

W13 Sterilization female Z30.2

incl: family planning involving female sterilization

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W14 Contraception female, other Z30.0, Z30.8, Z30.9

incl: contraception NOS, family planning NOS

excl: genetic counselling A98; oral contraception W11; IUD W12; family planning
by female sterilization W13

W15 Infertility/subfertility female N97, Z31.0 to Z31.4, Z31.6 to Z31.9

incl: sterility, primary and secondary

criteria: failure to conceive after 2 years of trying
consider: other symptom/complaint about pregnancy W29

W17 Post-partum bleeding O72

criteria: heavy bleeding at or within 6 weeks of parturition

consider: other post-partum complaints W18

W18 Post-partum symptom/complaint, other O90.9

excl: puerperal depression P76; post-partum bleeding W17; lactation complaints

W19; complications of puerperium W96
criteria: complaints related to and within 6 weeks of parturition

W19 Breast/lactation symptom/complaint O92.5 to O92.7

incl: galactorrhoea, suppression of lactation, weaning

excl: puerperal mastitis W94; cracked nipples W95

W21 Concern about body image related to pregnancy R46.8

W27 Fear of complications of pregnancy Z71.1

incl: fear of congenital anomaly in baby

excl: if the patient has the complication, code the complication
criteria: concern about/fear of complications in a patient without them/until they are
proven

W28 Limited function/disability (W) Z73.6

incl: pelvic instability

criteria: limitation of function/disability due to or related to pregnancy
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

W29 Pregnancy symptom/complaint, other O26

incl: family planning symptom/complaint, other

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Component 7—Diagnoses
W70 Puerperal infection/sepsis O85, O86.1, O86.3

excl: obstetric tetanus N72

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

W71 Other infection complicating pregnancy/puerperium

O23, O41.1, O75.2, O75.3, O86.2, O86.4, O86.8, O98
excl: puerperal infection W70; puerperal mastitis W94

W72 Malignant neoplasm related to pregnancy C58

incl: chorioepithelioma, choriocarcinoma

W73 Benign/unspecified neoplasm related to pregnancy O01

incl: benign neoplasm related to pregnancy, neoplasm related to pregnancy

not specified as benign or malignant/when histology is not available, hydati-
diform mole

W75 Injury complicating pregnancy T14.9

incl: results of injury interfering with pregnancy
excl: new injury caused by childbirth W92, W93

W76 Congenital anomaly complicating pregnancy O99.8

incl: maternal anomaly that could affect pregnancy/childbirth

W78 Pregnancy Z32.1, Z33, Z34, Z36

incl: pregnancy confirmed

excl: unwanted pregnancy W79; ectopic pregnancy W80; high risk pregnancy W84

W79 Unwanted pregnancy Z32.1, Z64.0

W80 Ectopic pregnancy O00

criteria: confirmation by ultrasonography, laparoscopy, culdoscopy or surgery

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

W81 Toxaemia of pregnancy O10 to O16

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

consider: other symptom/complaint in pregnancy W29
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W82 Abortion, spontaneous O02, O03, O05, O06

incl: abortion threatened/complete/incomplete/missed/habitual, miscarriage

excl: ante-partum bleeding W03; induced abortion W83; premature contractions
after the 28th week of pregnancy W92; fetal death/stillbirth after the 28th
week of pregnancy W93

W83 Abortion, induced O04, Z30.3

incl: termination of pregnancy, all complications

W84 Pregnancy high risk

O24.0 to O24.3, O24.9, O25, O30 to O36, O40, O43, O44, O99.0 to O99.7, Z35

incl: 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 fetus for age
excl: infections complicating pregnancy W71; ectopic pregnancy W80; toxaemia
of pregnancy W81; gestational diabetes W85

W85 Gestational diabetes O24.4

incl: diabetes manifested during pregnancy

excl: pre-existing diabetes T89, T90
criteria: fasting plasma glucose level over 5.5 mmol/L and/or plasma glucose level
greater than 8.0 mmol/L 2 h after a 75-g oral glucose tolerance test
consider: hyperglycaemia A91

W90 Uncomplicated labour/delivery, livebirth O80, Z37.0, Z37.9, Z38, Z39

W91 Uncomplicated labour/delivery, stillbirth Z37.1, Z37.9

W92 Complicated labour/delivery, livebirth

O42, O45, O60 to O71, O73, O75.0, O75.1, O75.4 to O75.9, O81 to O84, Z37.2,
Z37.5, Z37.9, Z38, Z39
incl: livebirth after complicated delivery: assisted extraction, breech delivery,
caesarian section, dystocia, induction of labour, injuries caused by child-
birth, placenta praevia in delivery, version
excl: post-partum haemorrhage W17; eclampsia W81

W93 Complicated labour/delivery, stillbirth

O42, O45, O60 to O71, O73, O75.0, O75.1, O75.4 to O75.9, O81 to O84,
Z37.1, Z37.3, Z37.4, Z37.6, Z37.7, Z37.9
incl: stillbirth after complicated delivery: assisted extraction, breech delivery,
caesarian section, dystocia, induction of labour, injuries caused by child-
birth, placenta praevia in delivery, version
excl: post-partum haemorrhage W17; eclampsia W81
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W94 Puerperal mastitis O91

incl: breast abscess

criteria: pain, inflammation of breast within 6 weeks of parturition or while lactating
consider: disorders of lactation W19

W95 Breast disorder in pregnancy/puerperium, other O92.0 to O92.4

incl: breast disorder in puerperium, cracked nipple

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

W96 Complications of puerperium, other O87, O90.4, O90.8, O90.9

excl: puerperal depression P76; puerperal psychosis P98; puerperal infection

W70; toxaemia of pregnancy W81; breast disorder in pregnancy W95

W99 Disorder of pregnancy/delivery, other

O07, O08, O22, O26, O28, O41.0, O41.8, O41.9, O47, O48,
O88, O90.5, O95 to O97
excl: pseudocyesis P75

X Female genital system (including breast)

Component 1—Symptoms and complaints

X01 Genital pain female N94.8

incl: pelvic pain, vulval pain

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

X02 Menstrual pain N94.4 to N94.6

incl: dysmenorrhoea

X03 Intermenstrual pain N94.0

incl: Mittelschmerz, ovulation pain

X04 Painful intercourse female N94.1, N94.2

incl: female dyspareunia, vaginismus NOS

excl: psychogenic sexual problems P07, P08

X05 Menstruation absent/scanty N91

incl: amenorrhoea, delayed/late menses, oligomenorrhoea

excl: question of pregnancy W01; fear of pregnancy W02
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X06 Menstruation excessive N92.0, N92.2, N92.4

incl: menorrhagia, pubertal bleeding

X07 Menstruation irregular/frequent N92.0, N92.1, N92.5, N92.6

incl: polymenorrhoea
excl: menorrhagia/pubertal bleeding X06

X08 Intermenstrual bleeding N92.3, N93.8, N93.9

incl: breakthrough bleeding, dysfunctional uterine bleeding, metrorrhagia, ovula-

tion bleeding, spotting
excl: post-menopausal bleeding X12; post-coital bleeding X13

X09 Premenstrual symptom/complaint N94.8, N94.9

excl: premenstrual tension syndrome X89

X10 Postponement of menstruation Z30.9

criteria: postponement of the expected regular menstruation by hormonal treatment

X11 Menopausal symptom/complaint N95.1 to N95.3, N95.8, N95.9

incl: atrophic vaginitis, menopause syndrome, symptom/complaint related to

menopause, senile vaginitis
excl: post-menopausal bleeding X12

X12 Post-menopausal bleeding N95.0

criteria: vaginal bleeding following either at least 6 months’ amenorrhoea or demon-
stration of menopause by appropriate laboratory test
consider: irregular menstruation X07

X13 Post-coital bleeding N93.0

incl: contact bleeding

X14 Vaginal discharge N89.8

incl: fluor vaginalis, leukorrhoea

excl: vaginal bleeding X06, X07, X08; atrophic vaginitis X11; gonorrhoea female
X71; urogenital candidiasis female X72; urogenital trichomoniasis female
X73; chlamydia genital female X92
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X15 Vaginal symptom/complaint, other N89.8, N89.9

incl: vaginal dryness

excl: female genital pain X01; organic vaginismus X04; atrophic vaginitis X11

X16 Vulval symptom/complaint L29.2, N90.9

incl: vulval pruritus, vulval dryness

excl: vulval pain X01; abscess vulva X99

X17 Pelvis symptom/complaint female N94.8, N94.9

excl: genital pain female X01

X18 Breast pain female N64.4

incl: mastodynia
excl: breast pain in pregnancy/lactation W19

X19 Breast lump/mass female N63

incl: lumpy breasts

X20 Nipple symptom/complaint female N64.0, N64.5

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

excl: nipple symptom/complaint in pregnancy/lactation W19

X21 Breast symptom/complaint female, other

N61, N62, N64.3, N64.5, N64.8, N64.9

incl: mastitis (non-lactating), mastopathy, galactorrhoea

excl: mastitis (lactating) W94

X22 Concern about breast appearance female R46.8

X23 Fear of sexually transmitted disease female Z71.1

excl: 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

X24 Fear of sexual dysfunction female Z71.1

excl: sexual dysfunction P07, P08

criteria: concern about/fear of sexual dysfunction in a patient without sexual
dysfunction
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X25 Fear of genital cancer female Z71.1

excl: if the patient has the disease, code the disease

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

X26 Fear of breast cancer female Z71.1

excl: if the patient has the disease, code the disease

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

X27 Fear genital/breast disease female, other Z71.1

excl: fear of female genital cancer X25; fear of female breast cancer X26; if the
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

X28 Limited function/disability (X) Z73.6, Z90.7

excl: 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)
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

X29 Genital symptom/complaint female, other N94.8, N94.9, R36

incl: urethral discharge in female

Component 7—Diagnosis/diseases
X70 Syphilis female A50 to A53, A65, N74.2

incl: syphilis any site

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

X71 Gonorrhoea female A54, N74.3

incl: gonorrhoea any site

criteria: purulent vaginal discharge in a patient after a contact with a proven case; or
Gram-negative intracellular diplococci demonstrated in discharge; or culture
of Neisseria gonorrhoea
consider: urethritis U72; urethral discharge female X29
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X72 Genital candidiasis female B37.3, B37.4

incl: monilial infection of vagina/cervix, thrush

criteria: inflamed urogenital mucosa or skin with characteristic white adherent
exudate; or demonstration of candida
consider: vaginal discharge X14; vaginitis X84

X73 Genital trichomoniasis female A59.0

criteria: characteristic foul-smelling discharge; or demonstration of trichomonads on

microscopy
consider: vaginal discharge X14; vaginitis X84

X74 Pelvic inflammatory disease N70, N71, N73, N74.8

incl: endometritis, oophoritis, salpingitis

excl: sexually transmitted diseases female X70–X73; chlamydia infection
female X92
criteria: lower abdominal pain with marked tenderness of uterus or adnexa by palpa-
tion, plus other evidence of inflammation
consider: pelvic congestion syndrome X99

X75 Malignant neoplasm cervix C53

excl: carcinoma-in-situ cervix X81; cervical intraepithelial neoplasia (CIN) grade 3

X81; abnormal cervix smear (CIN) grades 1 and 2 X86
criteria: characteristic histological appearance

X76 Malignant neoplasm breast female C50

incl: intraductal carcinoma

excl: carcinoma-in-situ X81
criteria: characteristic histological appearance
consider: breast lump X19

X77 Malignant neoplasm genital female, other C51, C52, C54 to C57
incl: malignancy of adnexae, ovaries, uterus, vagina, vulva
excl: carcinoma in-situ X81
criteria: characteristic histological appearance
consider: other/unspecified female genital neoplasm X81

X78 Fibromyoma uterus D25

incl: 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
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X79 Benign neoplasm breast female D24

incl: fibroadenoma
excl: cystic disease of breast X88
criteria: characteristic histological appearance
consider: lump in female breast X19

X80 Benign neoplasm female, genital D26 to D28

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

X81 Genital neoplasm female, other/unspecified

D05, D06, D07.0 to D07.3, D39, D48.6

incl: carcinoma-in-situ, biopsy-proven cervical intraepithelial neoplasia (CIN)

grade 3, female genital neoplasm not specified as benign or malignant/when
histology is not available
excl: endometrial polyp X99

X82 Injury genital female

S30.2, S31.4, S31.5, S37.4 to S37.6, S38.0, S38.2, S39.8, S39.9, T19.2, T19.3, T28.3, T28.8

incl: foreign body in vagina, female circumcision

excl: genital injury due to childbirth W92, W93

X83 Congenital anomaly genital female Q50 to Q52, Q56, Q83

incl: hermaphroditism, imperforate hymen

excl: other genetic syndrome A90

X84 Vaginitis/vulvitis NOS N76, N77

incl: vaginosis, gardnerella
excl: atrophic vaginitis X11; genital candidiasis female X72; genital trichomoniasis
female X73

X85 Cervical disease NOS N72, N84.1, N86, N88

incl: cervical erosion, cervical leukoplakia, cervicitis, mucous cervical polyp, old
laceration of cervix
excl: abnormality of cervix in pregnancy/childbirth/puerperium W76; abnormal
cervix smear X86

X86 Abnormal cervix smear N87, R87

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

excl: cervical intraepithelial neoplasia (CIN) grade 3 X81
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X87 Uterovaginal prolapse N81

incl: cystocoele, procidentia, rectocoele

excl: stress incontinence U04

X88 Fibrocystic disease breast N60, N64.8, N64.9

incl: chronic cystic disease of breast, cystic fibroadenosis of breast, dysplasia of

breast, solitary cyst of breast

X89 Premenstrual tension syndrome N94.3

criteria: cyclic occurrence in the menstrual cycle of two or more of the following:
oedema; breast tenderness/swelling; headache; irritability; mood changes
consider: premenstrual symptom X09

X90 Genital herpes female A60

incl: anogenital herpes simplex

criteria: small vesicles with characteristic appearance and location that evolve to
painful ulcers and scabs

X91 Condylomata acuminata female A63.0

incl: venereal warts, human papilloma virus infection

criteria: characteristic appearance of lesions, or characteristic histological appearance

X92 Chlamydia infection, genital female A56.0 to A56.4, A56.8, N74.4

criteria: proven chlamydial infection

X99 Genital disease female, other

A55, A57, A58, A63.8, N61, N64.1, N64.2, N64.8, N64.9, N75, N80, N82,
N83, N84.0, N84.2, N84.3, N84.8, N84.9, N85, N89.0 to N89.7, N90.0 to
N90.8, N94.8, N94.9, N96, N98, Z90.1, Z90.7
incl: Bartholin cyst/abscess, endometriosis, genital tract fistula female, pelvic
congestion syndrome, physiological ovarian cyst
excl: sexually transmitted disease NOS A78

Y Male genital system

Component 1—Symptoms and complaints

Y01 Pain in penis N48.8

excl: priapism/painful erection Y08

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Y02 Pain in testis/scrotum R10.2, N50.8

incl: pain perineum, pain pelvis

Y03 Urethral discharge male R36

Y04 Penis symptom/complaint, other N48.8, N48.9

incl: foreskin symptom/complaint

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

Y05 Scrotum/testis symptom/complaint, other L29.1, N50.8, N50.9

incl: lump in testis

excl: pain in testis/scrotum Y02

Y06 Prostate symptom/complaint N42.8, N42.9

incl: prostatism
excl: urinary frequency/urgency U02; urinary retention U08

Y07 Impotence NOS N48.4

incl: impotence of organic origin

excl: reduced sexual desire P07; psychogenic impotence/reduced sexual fulfil-
ment P08

Y08 Sexual function symptom/complaint male N48.3, N48.8

incl: painful erection, priapism

excl: reduced sexual desire P07; psychogenic impotence/reduced sexual fulfil-
ment P08; impotence of organic origin Y07

Y10 Infertility/subfertility male N46, Z31.0, Z31.4 to Z31.9

criteria: failure of conception after 2 years of trying

Y13 Sterilization male Z30.2

incl: family planning involving male sterilization

Y14 Family planning male, other Z30.0, Z30.8, Z30.9

incl: contraception NOS, family planning NOS

excl: genetic counselling A98

Y16 Breast symptom/complaint male N62, N63, N64.5

incl: gynaecomastia, lump breast

excl: disease of male breast Y99
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International Classification of Primary Care-2-Revised 139

Y24 Fear of sexual dysfunction male Z71.1

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

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

Y25 Fear of sexually transmitted disease male Z71.1

excl: 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

Y26 Fear of genital cancer male Z71.1

excl: in a patient with the disease, code the disease

criteria: concern about/fear of cancer in a patient without the disease/until the diag-
nosis is proven

Y27 Fear of genital disease male, other Z71.1

excl: fear of sexually transmitted disease Y25; fear of male 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

Y28 Limited function/disability (Y) Z73.6, Z90.7

excl: sexual dysfunction P07, P08; impotence NOS Y07

criteria: limitation of function/disability due to a problem of the male genital system
(including breast)
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

Y29 Genital symptom/complaint male, other N50.8, N50.9

Component 7—Diagnosis/diseases
Y70 Syphilis male A50 to A53, A65

incl: syphilis any site

criteria: demonstration of Treponema pallidum on microscopy; or positive serologi-
cal test for syphilis

Y71 Gonorrhoea male A54

incl: gonorrhoea any site (cont.)

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140 WONCA International Classification of Primary Care

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
consider: urethritis U72; urethral discharge Y03

Y72 Genital herpes male A60

incl: anogenital herpes

criteria: small vesicles with characteristic appearance and location that evolve to
painful ulcers and scabs

Y73 Prostatitis/seminal vesiculitis A59.0, N41, N49.0

criteria: tenderness of prostate/seminal vesicles to palpation, and indications of

inflammation in urine test

Y74 Orchitis/epididymitis A56.1, N45

excl: 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)
consider: symptom of testis Y05

Y75 Balanitis A63.8, B37.4, N48.1

incl: candidiasis glans penis

excl: scabies S72; male syphilis Y70; male gonorrhoea Y71; male genital
herpes Y72
criteria: signs of inflammation of the prepuce/glans penis

Y76 Condylomata acuminata male A63.0

incl: venereal warts, human papilloma virus infection

criteria: characteristic appearance of lesions, or characteristic histological appearance

Y77 Malignant neoplasm prostate C61

criteria: characteristic histological appearance

consider: benign/unspecified neoplasm male genital Y79

Y78 Malignant neoplasm male genital, other C50, C60, C62, C63

incl: carcinoma testis/seminoma, carcinoma breast

excl: carcinoma-in-situ Y79
criteria: characteristic histological appearance
consider: benign/unspecified neoplasm male genital Y79
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International Classification of Primary Care-2-Revised 141

Y79 Benign/unspecified neoplasm male genital

D05, D07.4 to D07.6, D24, D29, D40, D48.6

incl: benign genital neoplasm, genital neoplasm not specified as benign or

malignant/when histology is not available, benign neoplasm male breast,
carcinoma-in-situ
excl: prostatic hypertrophy Y85

Y80 Injury male genital

S30.2, S31.2, S31.3, S31.5, S38.0, S38.2, S39.8, S39.9, T28.3, T28.8

incl: circumcision

Y81 Phimosis/redundant prepuce N47

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

Y82 Hypospadias Q54

Y83 Undescended testicle Q53

incl: cryptorchidism
excl: retractile testis Y84
criteria: the testicle has never been observed in the scrotum, and the testicle cannot
be manipulated into the scrotum

Y84 Congenital genital anomaly male, other Q55, Q56, Q83

incl: hermaphroditism, retractile testis

Y85 Benign prostatic hypertrophy N40

incl: 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

Y86 Hydrocoele N43.0 to N43.3

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
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142 WONCA International Classification of Primary Care

Y99 Genital disease male, other

A55, A56.1, A56.3 to A56.8, A57, A58, A63.8, N42.0 to N42.2, N42.8, N42.9,
N43.4, N44, N48.0, N48.2, N48.5, N48.6, N48.8, N48.9, N49.1, N49.2, N49.8,
N49.9, N50.0, N50.1, N50.8, N50.9, N51, N64.8, N64.9, Z90.7
incl: other disease of male breast, epididymal cyst, spermatocele, torsion of the testis
excl: sexually transmitted disease NOS A78; gynaecomastia Y16; carcinoma male
breast Y78

Z Social problems

Component 1—Symptoms and complaints

Z01 Poverty/financial problem Z59.5 to Z59.9

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.

Z02 Food/water problem Z58.6, Z59.4

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.

Z03 Housing/neighbourhood problem Z59.0 to Z59.3, Z59.8, Z59.9

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.

Z04 Social cultural problem Z60.1 to Z60.9

incl: illegitimate pregnancy

excl: unwanted pregnancy W79
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.
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International Classification of Primary Care-2-Revised 143

Z05 Work problem Z56.1 to Z56.7, Z57

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.

Z06 Unemployment problem Z56.0

excl: retirement problem P25

Note: Problems with unemployment essentially require the patient’s expression of con-
cern 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.

Z07 Education problem Z55

incl: illiteracy
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 educa-
tion, as well as the individual’s perception.

Z08 Social welfare problem Z59.7

Note: Problems with social welfare essentially require the patient’s expression of con-
cern 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.

Z09 Legal problem Z65.0 to Z65.3

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.

Z10 Health care system problem Z64.4, Z75

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.
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144 WONCA International Classification of Primary Care

Labelling these problems requires acknowledgement of absolute differences in the

health care system as well as the individual’s perception.

Z11 Compliance/being ill problem Z75

incl: poor compliance

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.

Z12 Relationship problem with partner T74.0, T74.3, Z63.0

incl: emotional abuse

excl: physical abuse Z25
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.

Z13 Partner’s behaviour problem Z63.0

incl: infidelity, physical abuse

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.

Z14 Partner illness problem Z63.6

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.

Z15 Loss/death of partner problem Z63.4, Z63.5

incl: bereavement, divorce, separation

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.

Z16 Relationship problem with child T74.0, T74.3, Z61, Z62, Z63.8

incl: child abuse (emotional)

excl: physical abuse Z25
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.

Z18 Illness problem with child Z63.6

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.
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International Classification of Primary Care-2-Revised 145

Z19 Loss/death of child problem Z63.4

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.

Z20 Relationship problem, parent/family T74.0, Z63.1, Z63.8

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

excl: 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.

Z21 Behaviour problem, parent/family Z63.1, Z63.9

excl: 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.

Z22 Illness problem, parent/family Z63.6, Z63.7

excl: problem with partner being ill Z14

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.

Z23 Loss/death of parent/family member problem Z63.4

excl: loss of partner Z15; loss of child Z19

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.

Z24 Relationship problem, friend Z63.9

excl: 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.

Z25 Assault/harmful event problem T74.1, T74.2, T74.8, T74.9, Z65.4, Z65.5

incl: victim of physical abuse, rape, sexual attack

excl: partner emotional abuse Z12; partner physical abuse Z13; child emotional
abuse Z16; 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.
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146 WONCA International Classification of Primary Care

Z27 fear of a social problem Z71.1

incl: concern about/fear of having a social problem

excl: if the patient has a social problem, code the problem
criteria: fear of a social problem in a patient without the problem

Z28 Limited function/disability (Z) Z73.4, Z73.6

criteria: limitation of function/disability caused by social problems, including isolation/

living alone/loneliness
Note: The COOP/WONCA Charts are suitable for documenting the patient’s functional
status (see Chapter 8).

Z29 Social problem NOS

Z58.0 to Z58.5, Z58.8, Z58.9, Z63.2, Z63.3, Z63.7, Z63.8, Z63.9, Z64.1,
Z65.8, Z65.9, Z72.6, Z72.8, Z72.9, Z73.5, Z73.8, Z73.9, Z76.5
incl: environmental problems, malingering
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11 Conversion codes
from ICD-10

The relationship between ICPC and ICD-10 is complex. There are some concepts in
both that are not represented exactly in the other.18 However, for most rubrics in each
classification one or more corresponding rubrics in the other can be mapped. This has
been done in both directions in this book.
Because of these complexities, the conversion of a code from one classification to the
other and then re-conversion back again will not necessarily lead back to the same original
code, because in each direction there may be several codes to choose from. Exact choices
can be made only if the title of the condition is used with the help of a thesaurus. The
point of having the code conversions in this book is simply to indicate where the contents
of rubrics in each classification overlap.

ICPC-2 to ICD-10
In the tabular list of ICPC-2 rubrics (Chapter 10) each rubric includes all the ICD-10
rubrics to which it relates. Where it relates to all of the three-digit ICD-10 code, this is
given; where it relates to only part of the three-digit ICD-10 code, all the relevant four-
digit ICD-10 codes are given. However, this does not imply that the ICD-10 codes listed
relate only to the ICPC-2 rubric, because some ICD-10 rubrics relate to more than one
ICPC-2 rubric, as can be seen by perusing the list of conversion codes from ICD-10 to
ICPC-2 in this chapter.

ICD-10 to ICPC-2
In this chapter conversion codes are listed for all ICD-10 three-digit codes, and where
not all of a three-digit code maps to the same ICPC-2 code, the conversions for all the
four-digit ICD-10 codes are given. Not included are rubrics in Chapter XX of ICD-10,
External Causes of Morbidity and Mortality, as ICPC is in general not based on aetiology.

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

A00 D70 A06 D70 A17 A70 A23 A78
A01 D70 A07 D70 A18 A70 A24 A78
A02 D70 A08 D70 A19 A70 A25 A78
A03 D70 A09 D73 A20 A78 A26 A78
A04 D70 A15 A70 A21 A78 A27 A78
A05 D70 A16 A70 A22 A78 A28 A78
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148 WONCA International Classification of Primary Care

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

A30 A78 A55 Y99 A75 A78 B08.1 S95
A31 A78 A56.0 U72 A77 A78 B08.2 A76
A32.0 A78 A56.0 X92 A78 A78 B08.3 A76
A32.1 A78 A56.1 X92 A79 A78 B08.4 A76
A32.1 N71 A56.1 Y74 A80 N70 B08.5 R74
A32.7 A78 A56.1 Y99 A81 N73 B08.8 A76
A32.8 A78 A56.2 U72 A82 A77 B09 A76
A32.9 A78 A56.2 X92 A83 N71 B15 D72
A33 N72 A56.3 X92 A84 N71 B16 D72
A34 N72 A56.3 Y99 A85.0 N70 B17 D72
A35 N72 A56.4 X92 A85.1 N71 B18 D72
A36 R83 A56.4 Y99 A85.2 N71 B19 D72
A37 R71 A56.8 X92 A85.8 N71 B20 B90
A38 A78 A56.8 Y99 A86 N71 B21 B90
A39.0 N71 A57 X99 A87 N71 B22 B90
A39.1 A78 A57 Y99 A88.0 A76 B23 B90
A39.2 A78 A58 X99 A88.1 H82 B24 B90
A39.3 A78 A58 Y99 A88.8 N73 B25 A77
A39.4 A78 A59.0 U72 A89 N73 B26 D71
A39.5 K70 A59.0 X73 A90 A77 B27 A75
A39.8 A78 A59.0 Y73 A91 A77 B30 F70
A39.9 A78 A59.8 A78 A92 A77 B33.0 A77
A40 A78 A59.9 A78 A93 A77 B33.1 A77
A41 A78 A60 X90 A94 A77 B33.2 K70
A42 A78 A60 Y72 A95 A77 B33.3 A77
A43 A78 A63.0 X91 A96 A77 B33.8 A77
A44 A78 A63.0 Y76 A98 A77 B34 A77
A46 S76 A63.8 X99 A99 A77 B35 S74
A48.0 A78 A63.8 Y75 B00.0 S71 B36 S74
A48.1 R81 A63.8 Y99 B00.1 S71 B37.0 D83
A48.2 A78 A64 A78 B00.2 R74 B37.1 R83
A48.3 A78 A65 X70 B00.2 S71 B37.2 S75
A48.4 A78 A65 Y70 B00.3 N71 B37.3 X72
A48.8 A78 A66 S76 B00.4 N71 B37.4 U72
A49 A78 A67 S76 B00.5 F73 B37.4 X72
A50 X70 A68 A78 B00.7 A77 B37.4 Y75
A50 Y70 A69.0 D83 B00.8 S71 B37.5 N71
A51 X70 A69.1 D83 B00.9 S71 B37.6 K70
A51 Y70 A69.2 A78 B01 A72 B37.7 A78
A52 X70 A69.8 A78 B02 S70 B37.8 A78
A52 Y70 A69.9 A78 B03 A76 B37.9 A78
A53 X70 A70 A78 B04 A76 B38 A78
A53 Y70 A71 F86 B05 A71 B39 A78
A54 X71 A74.0 F70 B06 A74 B40 A78
A54 Y71 A74.8 A78 B07 S03 B41 A78
A55 X99 A74.9 A78 B08.0 A76 B42 A78
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Conversion codes from ICD-10 149

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

B43 A78 B88.0 S72 C25 D76 C61 Y77
B44 R83 B88.1 S73 C26 D77 C62 Y78
B45 A78 B88.2 S72 C30.0 R85 C63 Y78
B46 A78 B88.3 S73 C30.1 H75 C64 U75
B47 A78 B88.8 S73 C31 R85 C65 U75
B48 A78 B88.9 S73 C32 R85 C66 U77
B49 A78 B89 A78 C33 R84 C67 U76
B50 A73 B90 A70 C34 R84 C68 U77
B51 A73 B91 N70 C37 B74 C69 F74
B52 A73 B92 A78 C38.0 K72 C70 N74
B53 A73 B94.0 F86 C38.1 A79 C71 N74
B54 A73 B94.1 N71 C38.2 A79 C72 N74
B55 A78 B94.2 D97 C38.3 A79 C73 T71
B56 A78 B94.8 A78 C38.4 R85 C74 T73
B57 A78 B94.9 A78 C38.8 A79 C75 T73
B58.0 F73 B95 A78 C39 R85 C76 A79
B58.1 D97 B96 A78 C40 L71 C77 B74
B58.2 N71 B97 A77 C41 L71 C78 A79
B58.3 R83 B99 A78 C43 S77 C79 A79
B58.8 A78 C00 D77 C44 S77 C80 A79
B58.9 A78 C01 D77 C45.0 R85 C81 B72
B59 A78 C02 D77 C45.1 D77 C82 B72
B60 A78 C03 D77 C45.2 K72 C83 B72
B64 A78 C04 D77 C45.7 A79 C84 B72
B65 D96 C05 D77 C45.9 A79 C85 B72
B66 D96 C06 D77 C46.0 S77 C88 B74
B67 D96 C07 D77 C46.1 L71 C90 B74
B68 D96 C08 D77 C46.2 D77 C91 B73
B69 D96 C09 R85 C46.3 B74 C92 B73
B70 D96 C10 R85 C46.7 A79 C93 B73
B71 D96 C11 R85 C46.8 A79 C94 B73
B72 D96 C12 R85 C46.9 A79 C95 B73
B73 D96 C13 R85 C47 N74 C96 B74
B74 D96 C14.0 R85 C48 D77 C97 A79
B75 D96 C14.2 R85 C49 L71 D00 D78
B76 D96 C14.8 D77 C50 X76 D01 D78
B77 D96 C15 D77 C50 Y78 D02 R92
B78 D96 C16 D74 C51 X77 D03 S79
B79 D96 C17 D77 C52 X77 D04 S79
B80 D96 C18 D75 C53 X75 D05 X81
B81 D96 C19 D75 C54 X77 D05 Y79
B82 D96 C20 D75 C55 X77 D06 X81
B83 D96 C21 D75 C56 X77 D07.0 X81
B85 S73 C22 D77 C57 X77 D07.1 X81
B86 S72 C23 D77 C58 W72 D07.2 X81
B87 S73 C24 D77 C60 Y78 D07.3 X81
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150 WONCA International Classification of Primary Care

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

D07.4 Y79 D36.1 N75 D61.2 A86 E06.9 T99
D07.5 Y79 D36.7 A99 D61.3 B82 E07 T99
D07.6 Y79 D36.9 A99 D61.8 B82 E10 T89
D09.0 U79 D37 D78 D61.9 B82 E11 T90
D09.1 U79 D38.0 R92 D62 B82 E12 T90
D09.2 F74 D38.1 R92 D63 B82 E13 T90
D09.3 T73 D38.2 R92 D64.0 B79 E14 T90
D09.7 A79 D38.3 R92 D64.1 B82 E15 T87
D09.9 A79 D38.4 R92 D64.2 A85 E16.0 T87
D10 D78 D38.5 H75 D64.2 A86 E16.1 T87
D11 D78 D38.5 R92 D64.3 B82 E16.2 T87
D12 D78 D38.6 R92 D64.4 B79 E16.3 T87
D13 D78 D39 X81 D64.8 B82 E16.4 D86
D14.0 H75 D40 Y79 D64.9 B82 E16.8 T99
D14.0 R86 D41 U79 D65 B83 E16.9 T87
D14.1 R86 D42 N76 D66 B83 E20 T99
D14.2 R86 D43 N76 D67 B83 E21 T99
D14.3 R86 D44 T73 D68 B83 E22 T99
D14.4 R86 D45 B75 D69 B83 E23 T99
D15.0 B75 D46 B82 D70 B84 E24 T99
D15.1 K72 D47 B75 D71 B84 E25 T99
D15.2 K72 D48.0 L97 D72 B84 E26 T99
D15.7 A99 D48.1 H75 D73 B99 E27 T99
D15.9 A99 D48.1 L97 D74 B99 E28 T99
D16 L97 D48.2 N76 D75 B99 E29 T99
D17 S78 D48.3 D78 D76 B99 E30 T99
D18 S81 D48.4 D78 D77 B99 E31 T99
D19 R86 D48.5 H75 D80 B99 E32 T99
D20 D78 D48.5 S79 D81 B99 E34.0 T99
D21 L97 D48.6 X81 D82 B99 E34.1 T99
D22 S82 D48.6 Y79 D83 B99 E34.2 T99
D23 S79 D48.7 F74 D84 B99 E34.3 T10
D24 X79 D48.7 K72 D86 B99 E34.4 T99
D24 Y79 D48.9 A99 D89 B99 E34.5 T99
D25 X78 D50 B80 E00 T80 E34.8 T99
D26 X80 D51 B81 E01 T86 E34.9 T99
D27 X80 D52 B81 E02 T86 E35 T99
D28 X80 D53 B82 E03 T86 E40 T91
D29 Y79 D55 B82 E04 T81 E41 T91
D30 U78 D56 B78 E05 T85 E42 T91
D31 F74 D57 B78 E06.0 T70 E43 T91
D32 N75 D58 B78 E06.1 T99 E44 T91
D33 N75 D59 B82 E06.2 T99 E45 T91
D34 T72 D60 B82 E06.3 T99 E46 T91
D35 T73 D61.0 B79 E06.4 T99 E50 T91
D36.0 B75 D61.1 A85 E06.5 T99 E51.1 T91
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Conversion codes from ICD-10 151

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

E51.2 N99 F09 P71 F41.9 P74 F63.2 P80
E51.8 T91 F10.0 P16 F42 P79 F63.3 P29
E51.9 T91 F10.1 P15 F43.0 P02 F63.8 P80
E52 T91 F10.2 P15 F43.1 P82 F63.9 P80
E53 T91 F10.3 P15 F43.2 P02 F64 P09
E54 T91 F10.4 P15 F43.8 P02 F65 P09
E55 T91 F10.5 P15 F43.9 P02 F66 P09
E56 T91 F10.6 P15 F44 P75 F68 P80
E58 T91 F10.7 P15 F45.0 P75 F69 P80
E59 T91 F10.8 P15 F45.1 P75 F70 P85
E60 T91 F10.9 P15 F45.2 P75 F71 P85
E61 T91 F11 P19 F48.0 P78 F72 P85
E63 T91 F12 P19 F48.1 P99 F73 P85
E64 T91 F13 P18 F48.8 P99 F78 P85
E65 T99 F13 P19 F48.9 P99 F79 P85
E66 T82 F14 P19 F50.0 P86 F80 P24
E66 T83 F15 P19 F50.1 P86 F81 P24
E67 T99 F16 P19 F50.2 P86 F82 P24
E68 T99 F17 P17 F50.3 P86 F83 P24
E70 T99 F18 P19 F50.4 P86 F84 P99
E71 T99 F19 P18 F50.5 D10 F88 P99
E72 T99 F19 P19 F50.8 P29 F89 P99
E73 T99 F20 P72 F50.9 P29 F90 P81
E74 T99 F21 P72 F51 P06 F91 P22
E75 T99 F22 P72 F52.0 P07 F91 P23
E76 T99 F23 P98 F52.1 P08 F92 P22
E77 T99 F24 P72 F52.2 P08 F92 P23
E78 T93 F25 P72 F52.3 P08 F93 P22
E79 T99 F28 P72 F52.4 P08 F94 P22
E80 T99 F29 P98 F52.5 P08 F94 P23
E83 T99 F30 P73 F52.6 P08 F95 P10
E84 T99 F31 P73 F52.7 P08 F98.0 P12
E85 T99 F32 P76 F52.8 P08 F98.1 P13
E86 T11 F33 P76 F52.9 P08 F98.2 P11
E87 T99 F34.0 P73 F53.0 P76 F98.3 P11
E88 T99 F34.1 P76 F53.1 P98 F98.4 P10
E89 A87 F34.8 P76 F53.8 P99 F98.5 P10
E90 T99 F34.9 P76 F53.9 P99 F98.6 P10
F00 P70 F38 P76 F54 P99 F98.8 P22
F01 P70 F39 P76 F55 P18 F98.8 P23
F02 P70 F40 P79 F59 P99 F98.8 P29
F03 P70 F41.0 P74 F60 P80 F98.9 P22
F04 P71 F41.1 P74 F61 P80 F98.9 P23
F05 P71 F41.2 P76 F62 P80 F98.9 P29
F06 P71 F41.3 P74 F63.0 P80 F99 P99
F07 P71 F41.8 P74 F63.1 P80 G00 N71
12_Wonca-[Link] 06/04/2005 8:08 AM Page 152

152 WONCA International Classification of Primary Care

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

G01 N71 G44.4 A85 G93.6 N99 H10.2 F70
G02 N71 G44.8 N01 G93.7 N99 H10.3 F70
G03 N71 G45 K89 G93.8 N99 H10.4 F70
G04 N71 G46 K90 G93.9 N99 H10.5 F70
G05 N71 G47 P06 G94 N99 H10.8 F70
G06 N73 G50.0 N92 G95 N99 H10.9 F70
G07 N73 G50.1 N03 G96 N99 H11.0 F99
G08 N73 G50.8 N92 G97 A87 H11.1 F99
G09 N73 G50.9 N92 G98 N18 H11.2 F99
G10 N99 G51 N91 G98 N99 H11.3 F75
G11 N99 G52 N99 G99 N99 H11.4 F99
G12 N99 G53 N91 H00 F72 H11.8 F99
G13 N99 G54 N94 H01 F72 H11.9 F99
G20 N87 G55 N94 H02.0 F99 H13 F70
G21 N87 G56.0 N93 H02.1 F99 H15 F99
G22 N87 G56.1 N94 H02.2 F16 H16.0 F85
G23 N99 G56.2 N94 H02.3 F16 H16.1 F73
G24 N99 G56.3 N94 H02.4 F16 H16.1 F79
G25.0 N08 G56.4 N94 H02.5 F16 H16.2 F73
G25.1 N08 G56.8 N94 H02.6 F16 H16.3 F73
G25.2 N08 G56.9 N94 H02.7 F16 H16.4 F73
G25.3 N08 G57 N94 H02.8 F16 H16.8 F73
G25.4 N08 G58 N94 H02.8 F99 H16.9 F73
G25.5 N08 G59 N94 H02.9 F16 H17 F99
G25.6 N08 G60 N94 H02.9 F99 H18 F99
G25.8 N04 G61 N94 H03 F73 H19 F85
G25.8 N08 G62 N94 H04.0 F99 H20 F73
G25.9 N08 G63 N94 H04.1 F99 H21 F73
G26 N99 G64 N94 H04.2 F03 H22 F73
G30 P70 G70 N99 H04.3 F73 H25 F92
G31.0 N99 G71 N99 H04.4 F73 H26 F92
G31.1 N99 G72 N99 H04.5 F99 H27 F99
G31.2 P15 G73 N99 H04.6 F99 H28 F92
G31.8 N99 G80 N99 H04.8 F99 H30 F73
G31.9 N99 G81 N99 H04.9 F99 H31 F99
G32 N99 G82 N99 H05.0 F73 H32 F73
G35 N86 G83 N99 H05.1 F73 H33 F82
G36 N99 G90 N99 H05.2 F99 H34 F99
G37 N99 G91 N99 H05.3 F99 H35.0 F83
G40 N88 G92 N99 H05.4 F99 H35.1 F83
G41 N88 G93.0 N99 H05.5 F99 H35.2 F83
G43 N89 G93.1 N99 H05.8 F99 H35.3 F84
G44.0 N90 G93.2 N99 H05.9 F99 H35.4 F83
G44.1 N89 G93.3 A04 H06 F99 H35.5 F99
G44.2 N95 G93.4 N99 H10.0 F70 H35.6 F99
G44.3 N01 G93.5 N99 H10.1 F71 H35.7 F99
12_Wonca-[Link] 06/04/2005 8:08 AM Page 153

Conversion codes from ICD-10 153

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

H35.8 F99 H57.8 F02 H83.8 H99 I30 K70
H35.9 F99 H57.8 F13 H83.9 H99 I31 K84
H36 F83 H57.8 F15 H90 H86 I32 K70
H40 F93 H57.8 F75 H91.0 H86 I33 K70
H42 F93 H57.8 F99 H91.1 H84 I34 K83
H43 F99 H57.9 F29 H91.2 H86 I35 K83
H44.0 F99 H58 F99 H91.3 H86 I36 K83
H44.1 F99 H59 A87 H91.8 H86 I37 K83
H44.2 F99 H60 H70 H91.9 H86 I38 K70
H44.3 F99 H61.0 H99 H92.0 H01 I39 K70
H44.4 F99 H61.1 H99 H92.1 H04 I40 K70
H44.5 F99 H61.2 H81 H92.2 H05 I41 K70
H44.6 F79 H61.3 H99 H93.0 H99 I42.0 K84
H44.7 F79 H61.8 H99 H93.1 H03 I42.1 K84
H44.8 F99 H61.9 H99 H93.2 H02 I42.2 K84
H44.9 F99 H62 H70 H93.3 H99 I42.3 K84
H45 F99 H65 H72 H93.8 H13 I42.4 K73
H46 F99 H66.0 H71 H93.8 H99 I42.5 K84
H47 F99 H66.1 H74 H93.9 H29 I42.6 K84
H48 F99 H66.2 H74 H94 H99 I42.7 K84
H49 F95 H66.3 H74 H95 A87 I42.8 K84
H50 F95 H66.4 H71 I00 K71 I42.9 K84
H51 F95 H66.9 H71 I01 K71 I43 K84
H52 F91 H67 H71 I02 K71 I44 K84
H53.0 F99 H68 H73 I05 K71 I45 K84
H53.1 F04 H69 H73 I06 K71 I46 K84
H53.1 F05 H70.0 H71 I07 K71 I47 K79
H53.2 F05 H70.1 H74 I08 K71 I48 K78
H53.3 F05 H70.2 H74 I09 K71 I49 K80
H53.4 F99 H70.8 H74 I10 K86 I50 K77
H53.5 F99 H70.9 H74 I11 K87 I51 K84
H53.6 F99 H71 H74 I12 K87 I52 K84
H53.8 F05 H72 H77 I13 K87 I60 K90
H53.8 F99 H73.0 H71 I15 K87 I61 K90
H53.9 F05 H73.1 H74 I20 K74 I62 K90
H54.0 F94 H73.8 H99 I21 K75 I63 K90
H54.1 F94 H73.9 H99 I22 K75 I64 K90
H54.2 F94 H74 H99 I23 K75 I65 K91
H54.3 F94 H75 H74 I24.0 K74 I66 K91
H54.4 F28 H80 H83 I24.1 K75 I67.0 K91
H54.5 F28 H81 H82 I24.8 K74 I67.1 K91
H54.6 F28 H82 H82 I24.9 K74 I67.2 K91
H54.7 F05 H83.0 H82 I25 K76 I67.3 K91
H55 F14 H83.1 H99 I26 K93 I67.4 K87
H57.0 F99 H83.2 H99 I27 K82 I67.5 K91
H57.1 F01 H83.3 H85 I28 K82 I67.6 K91
12_Wonca-[Link] 06/04/2005 8:08 AM Page 154

154 WONCA International Classification of Primary Care

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

I67.7 K91 J01 R75 J41 R79 K03.1 D82
I67.8 K91 J02.0 R72 J42 R79 K03.2 D82
I67.9 K91 J02.8 R74 J43 R95 K03.3 D82
I68 K91 J02.9 R74 J44 R95 K03.4 D82
I69 K91 J03.0 R72 J45 R96 K03.5 D82
I70 K92 J03.8 R76 J46 R96 K03.6 D82
I71 K99 J03.9 R76 J47 R99 K03.7 D82
I72 K99 J04 R77 J60 R99 K03.8 D29
I73 K92 J05.0 R77 J61 R99 K03.8 D82
I74 K92 J05.1 R83 J62 R99 K03.9 D82
I77 K99 J06 R74 J63 R99 K04 D82
I78.0 K99 J10.0 R81 J64 R99 K05 D82
I78.1 K06 J10.1 R80 J65 R99 K06 D82
I78.8 K99 J10.8 R80 J66 R99 K07.0 D82
I78.9 K99 J11.0 R81 J67 R99 K07.1 D82
I79 K99 J11.1 R80 J68 R99 K07.2 D82
I80 K94 J11.8 R80 J69 R99 K07.3 D82
I81 K94 J12 R81 J70 R99 K07.4 D82
I82 K94 J13 R81 J80 R99 K07.5 D82
I83.0 S97 J14 R81 J81 R99 K07.6 D82
I83.1 K95 J15 R81 J82 R99 K07.6 L07
I83.2 S97 J16 R81 J84 R99 K07.8 D82
I83.9 K95 J17 R81 J85 R83 K07.9 D82
I84 K96 J18 R81 J86 R83 K08.0 D82
I85 K99 J20 R78 J90 R82 K08.1 D82
I86 K99 J21 R78 J91 R82 K08.2 D82
I87.0 K94 J22 R78 J92 R99 K08.3 D82
I87.1 K99 J30 R97 J93 R99 K08.8 D19
I87.2 K95 J31 R83 J94 R82 K08.8 D82
I87.8 K06 J32 R75 J95 A87 K08.9 D82
I87.8 K94 J33 R99 J96 R99 K09 D82
I87.9 K99 J34.0 R73 J98 R99 K10 D82
I88 B71 J34.1 R99 J99 R99 K11 D83
I89.0 K99 J34.2 R99 K00.0 D82 K12 D83
I89.1 B99 J34.3 R99 K00.1 D82 K13.0 D83
I89.8 B99 J34.8 R07 K00.2 D82 K13.1 D20
I89.9 B99 J34.8 R08 K00.3 D82 K13.2 D83
I95.0 K88 J34.8 R09 K00.4 D82 K13.3 D83
I95.1 K88 J34.8 R90 K00.5 D82 K13.4 D83
I95.2 A85 J34.8 R99 K00.6 D82 K13.5 D83
I95.8 K88 J35 R90 K00.7 D19 K13.6 D83
I95.9 K88 J36 R76 K00.8 D82 K13.7 D20
I97 A87 J37 R83 K00.9 D82 K13.7 D83
I98 K99 J38 R99 K01 D82 K14.0 D83
I99 K99 J39 R99 K02 D82 K14.1 D83
J00 R74 J40 R78 K03.0 D82 K14.2 D83
12_Wonca-[Link] 06/04/2005 8:08 AM Page 155

Conversion codes from ICD-10 155

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

K14.3 D83 K52.9 D99 K82 D98 L27.1 A85
K14.4 D83 K55 D99 K83 D98 L27.2 S88
K14.5 D20 K56.0 D99 K85 D99 L27.8 S88
K14.6 D20 K56.1 D99 K86 D99 L27.9 S88
K14.8 D20 K56.2 D99 K87.0 D98 L28 S99
K14.8 D83 K56.3 D99 K87.1 D99 L29.0 D05
K14.9 D20 K56.4 D12 K90 D99 L29.1 Y05
K14.9 D83 K56.5 D99 K91.0 A87 L29.2 X16
K20 D84 K56.6 D99 K91.1 D99 L29.3 D05
K21 D84 K56.7 D99 K91.2 D99 L29.8 S02
K22 D84 K57 D92 K91.3 A87 L29.9 S02
K23 D84 K58 D93 K91.4 A89 L30.0 S88
K25 D86 K59.0 D12 K91.5 D99 L30.1 S92
K26 D85 K59.1 D11 K91.8 D99 L30.2 S99
K27 D86 K59.2 D99 K91.9 D99 L30.3 S88
K28 D86 K59.3 D99 K92.0 D14 L30.4 S88
K29 D87 K59.4 D04 K92.1 D15 L30.5 S99
K30 D07 K59.8 D99 K92.2 D99 L30.8 S88
K31.0 D87 K59.9 D99 K92.8 D99 L30.9 S88
K31.1 D87 K60 D95 K92.9 D99 L40 S91
K31.2 D87 K61 D95 K93 D99 L41 S99
K31.3 D87 K62.0 D78 L00 S84 L42 S90
K31.4 D87 K62.1 D78 L01 S84 L43 S99
K31.5 D87 K62.2 D99 L02 S10 L44 S99
K31.6 D87 K62.3 D99 L03.0 S09 L45 S99
K31.7 D78 K62.4 D99 L03.1 S76 L50 S98
K31.8 D87 K62.5 D16 L03.2 S76 L51 S99
K31.9 D87 K62.6 D99 L03.3 S76 L52 S99
K35 D88 K62.7 D99 L03.8 S76 L53.0 S99
K36 D88 K62.8 D04 L03.9 S76 L53.1 S99
K37 D88 K62.8 D99 L04 B70 L53.2 S99
K38 D99 K62.9 D99 L05 S85 L53.3 S99
K40 D89 K63 D99 L08 S76 L53.8 S99
K41 D91 K65 D99 L10 S99 L53.9 S06
K42 D91 K66 D99 L11 S99 L53.9 S07
K43 D91 K67 D99 L12 S99 L54 S99
K44 D90 K70 D97 L13 S99 L55 S80
K45 D91 K71 D97 L14 S99 L56 S80
K46 D91 K72 D97 L20 S87 L57 S80
K50 D94 K73 D97 L21 S86 L58 S80
K51 D94 K74 D97 L22 S89 L59 S80
K52.0 D94 K75 D97 L23 S88 L60.0 S94
K52.1 D99 K76 D97 L24 S88 L60.1 S22
K52.2 D99 K77 D97 L25 S88 L60.2 S99
K52.8 D99 K80 D98 L26 S99 L60.3 S99
K52.9 D11 K81 D98 L27.0 A85 L60.4 S22
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156 WONCA International Classification of Primary Care

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

L60.5 S22 L93 S99 M25.1 L99 M43.0 L84
L60.8 S99 L94 S99 M25.2 L99 M43.1 L83
L60.9 S22 L95 S99 M25.3 L99 M43.1 L84
L62 S22 L97 S97 M25.4 L08 M43.2 L99
L63 S23 L98.0 S76 M25.4 L10 M43.3 L83
L64 S23 L98.1 S99 M25.4 L11 M43.4 L83
L65 S23 L98.2 S99 M25.4 L12 M43.5 L83
L66 S23 L98.3 S99 M25.4 L13 M43.5 L84
L67 S24 L98.4 S97 M25.4 L15 M43.6 L83
L68 S24 L98.5 S99 M25.4 L16 M43.8 L85
L70 S96 L98.6 S99 M25.4 L17 M43.9 L85
L71 S99 L98.8 S99 M25.4 L20 M45 L88
L72.0 S99 L98.9 S99 M25.5 L08 M46.0 L83
L72.1 S93 L99 S99 M25.5 L10 M46.0 L84
L72.2 S99 M00 L70 M25.5 L11 M46.1 L84
L72.8 S99 M01 L70 M25.5 L12 M46.2 L70
L72.9 S99 M02 L99 M25.5 L13 M46.3 L70
L73.0 S99 M03 L99 M25.5 L15 M46.4 L70
L73.1 S99 M05 L88 M25.5 L16 M46.5 L70
L73.2 S92 M06 L88 M25.5 L17 M46.8 L84
L73.8 S99 M07 L99 M25.5 L20 M46.9 L84
L73.9 S99 M08 L88 M25.6 L08 M47.0 L84
L74 S92 M09 L99 M25.6 L10 M47.1 L83
L75 S92 M10 T92 M25.6 L11 M47.1 L86
L80 S99 M11 T99 M25.6 L12 M47.2 L83
L81.0 S08 M12 L99 M25.6 L13 M47.2 L86
L81.1 S08 M13 L91 M25.6 L15 M47.8 L83
L81.2 S08 M14 L99 M25.6 L16 M47.8 L84
L81.3 S08 M15 L91 M25.6 L17 M47.9 L83
L81.4 S99 M16 L89 M25.6 L20 M47.9 L84
L81.5 S99 M17 L90 M25.7 L99 M48 L83
L81.6 S99 M18 L91 M25.8 L20 M48 L84
L81.7 S99 M19 L91 M25.8 L99 M49 L99
L81.8 S99 M19 L92 M25.9 L20 M50 L83
L81.9 S99 M20 L98 M25.9 L99 M51.0 L86
L82 S99 M21 L98 M30 K99 M51.1 L86
L83 S99 M22.0 L80 M31 K99 M51.2 L84
L84 S20 M22.1 L80 M32 L99 M51.2 L86
L85 S99 M22.2 L99 M33 L99 M51.3 L84
L86 S99 M22.3 L99 M34 L99 M51.3 L86
L87 S99 M22.4 L99 M35 L99 M51.4 L84
L88 S99 M22.8 L99 M36 L99 M51.4 L86
L89 S97 M22.9 L99 M40 L85 M51.8 L84
L90 S99 M23 L99 M41 L85 M51.8 L86
L91 S99 M24 L99 M42 L94 M51.9 L84
L92 S99 M25.0 L99 M43.0 L83 M51.9 L86
12_Wonca-[Link] 06/04/2005 8:08 AM Page 157

Conversion codes from ICD-10 157

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

M53.0 L83 M67.2 L99 M84 L99 N31 U99
M53.1 L83 M67.3 L87 M85 L99 N32 U99
M53.2 L84 M67.4 L87 M86 L70 N33 U99
M53.3 L03 M67.8 L99 M87 L99 N34 U72
M53.3 L84 M67.9 L99 M88 L99 N35 U99
M53.8 L83 M68 L99 M89 L99 N36 U99
M53.8 L84 M70 L87 M90 L99 N37 U99
M53.9 L83 M71.0 L70 M91 L94 N39.0 U71
M53.9 L84 M71.1 L70 M92 L94 N39.1 U98
M54.0 L01 M71.2 L87 M93 L94 N39.2 U90
M54.0 L02 M71.3 L87 M94 L99 N39.3 U04
M54.0 L03 M71.4 L87 M95 L99 N39.4 U04
M54.1 L99 M71.5 L87 M96 A87 N39.8 U99
M54.2 L01 M71.8 L87 M99 L99 N39.9 U99
M54.3 L86 M71.9 L87 N00 U88 N40 Y85
M54.4 L86 M72 L87 N01 U88 N41 Y73
M54.5 L03 M73 L99 N02 U06 N42.0 Y99
M54.6 L02 M75 L92 N03 U88 N42.1 Y99
M54.8 L02 M76 L87 N04 U88 N42.2 Y99
M54.9 L02 M77.0 L87 N05 U88 N42.8 Y06
M60.0 L70 M77.1 L93 N06 U99 N42.8 Y99
M60.1 L18 M77.2 L87 N07 U88 N42.9 Y06
M60.2 L18 M77.3 L87 N08 U88 N42.9 Y99
M60.8 L18 M77.4 L17 N10 U70 N43.0 Y86
M60.9 L18 M77.5 L17 N11 U70 N43.1 Y86
M61 L99 M77.8 L87 N12 U70 N43.2 Y86
M62.0 L99 M77.9 L87 N13 U99 N43.3 Y86
M62.1 L99 M79.0 L18 N14 U88 N43.4 Y99
M62.2 L99 M79.1 L18 N15.0 U88 N44 Y99
M62.3 L99 M79.2 N29 N15.1 U70 N45 Y74
M62.4 L99 M79.2 N94 N15.8 U88 N46 Y10
M62.5 L19 M79.2 N99 N15.9 U70 N47 Y81
M62.6 L19 M79.3 L18 N16 U88 N48.0 Y99
M62.8 L99 M79.4 L99 N17 U99 N48.1 Y75
M62.9 L99 M79.5 L81 N18 U99 N48.2 Y99
M63 L99 M79.6 L09 N19 U99 N48.3 Y08
M65.0 L70 M79.6 L12 N20 U95 N48.4 Y07
M65.1 L70 M79.6 L14 N21 U95 N48.5 Y99
M65.2 L87 M79.6 L17 N22 U95 N48.6 Y99
M65.3 L87 M79.6 L18 N23 U14 N48.8 Y01
M65.4 L87 M79.8 L99 N25 U99 N48.8 Y04
M65.8 L87 M79.9 L19 N26 U99 N48.8 Y08
M65.9 L87 M80 L95 N27 U99 N48.8 Y99
M66 L99 M81 L95 N28 U99 N48.9 Y04
M67.0 L99 M82 L95 N29 U99 N48.9 Y99
M67.1 L99 M83 T99 N30 U71 N49.0 Y73
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158 WONCA International Classification of Primary Care

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

N49.1 Y99 N74.8 X74 N92.5 X07 O16 W81
N49.2 Y99 N75 X99 N92.6 X07 O20 W03
N49.8 Y99 N76 X84 N93.0 X13 O21 W05
N49.9 Y99 N77 X84 N93.8 X08 O22 W99
N50.0 Y99 N80 X99 N93.9 X08 O23 W71
N50.1 Y99 N81 X87 N94.0 X03 O24.0 W84
N50.8 Y02 N82 X99 N94.1 X04 O24.1 W84
N50.8 Y05 N83 X99 N94.2 X04 O24.2 W84
N50.8 Y29 N84.0 X99 N94.3 X89 O24.3 W84
N50.8 Y99 N84.1 X85 N94.4 X02 O24.4 W85
N50.9 Y05 N84.2 X99 N94.5 X02 O24.9 W84
N50.9 Y29 N84.3 X99 N94.6 X02 O25 W84
N50.9 Y99 N84.8 X99 N94.8 X01 O26 W29
N51 Y99 N84.9 X99 N94.8 X09 O26 W99
N60 X88 N85 X99 N94.8 X17 O28 W99
N61 X21 N86 X85 N94.8 X29 O29 A87
N61 X99 N87 X86 N94.8 X99 O30 W84
N62 X21 N88 X85 N94.9 X09 O31 W84
N62 Y16 N89.0 X99 N94.9 X17 O32 W84
N63 X19 N89.1 X99 N94.9 X29 O33 W84
N63 Y16 N89.2 X99 N94.9 X99 O34 W84
N64.0 X20 N89.3 X99 N95.0 X12 O35 W84
N64.1 X99 N89.4 X99 N95.1 X11 O36 W84
N64.2 X99 N89.5 X99 N95.2 X11 O40 W84
N64.3 X21 N89.6 X99 N95.3 X11 O41.0 W99
N64.4 X18 N89.7 X99 N95.8 X11 O41.1 W71
N64.5 X20 N89.8 X14 N95.9 X11 O41.8 W99
N64.5 X21 N89.8 X15 N96 X99 O41.9 W99
N64.5 Y16 N89.9 X15 N97 W15 O42 W92
N64.8 X21 N90.0 X99 N98 X99 O42 W93
N64.8 X88 N90.1 X99 N99 A87 O43 W84
N64.8 X99 N90.2 X99 O00 W80 O44 W84
N64.8 Y99 N90.3 X99 O01 W73 O45 W92
N64.9 X21 N90.4 X99 O02 W82 O45 W93
N64.9 X88 N90.5 X99 O03 W82 O46 W03
N64.9 X99 N90.6 X99 O04 W83 O47 W99
N64.9 Y99 N90.7 X99 O05 W82 O48 W99
N70 X74 N90.8 X99 O06 W82 O60 W92
N71 X74 N90.9 X16 O07 W99 O60 W93
N72 X85 N91 X05 O08 W99 O61 W92
N73 X74 N92.0 X06 O10 W81 O61 W93
N74.0 A70 N92.0 X07 O11 W81 O62 W92
N74.1 A70 N92.1 X07 O12 W81 O62 W93
N74.2 X70 N92.2 X06 O13 W81 O63 W92
N74.3 X71 N92.3 X08 O14 W81 O63 W93
N74.4 X92 N92.4 X06 O15 W81 O64 W92
12_Wonca-[Link] 06/04/2005 8:08 AM Page 159

Conversion codes from ICD-10 159

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

O64 W93 O85 W70 P05 A94 P83 A94
O65 W92 O86.0 A87 P07 A93 P90 A94
O65 W93 O86.1 W70 P08 A94 P91 A94
O66 W92 O86.2 W71 P10 A94 P92 A94
O66 W93 O86.3 W70 P11 A94 P93 A94
O67 W92 O86.4 W71 P12 A94 P94 A94
O67 W93 O86.8 W71 P13 A94 P95 A95
O68 W92 O87 W96 P14 A94 P96 A94
O68 W93 O88 W99 P15 A94 Q00 N85
O69 W92 O89 A87 P20 A94 Q01 N85
O69 W93 O90.0 A87 P21 A94 Q02 N85
O70 W92 O90.1 A87 P22 A94 Q03 N85
O70 W93 O90.2 A87 P23 A94 Q04 N85
O71 W92 O90.3 K84 P24 A94 Q05 N85
O71 W93 O90.4 W96 P25 A94 Q06 N85
O72 W17 O90.5 W99 P26 A94 Q07 N85
O73 W92 O90.8 W96 P27 A94 Q10.0 F81
O73 W93 O90.9 W18 P28 A94 Q10.1 F81
O74 A87 O90.9 W96 P29 A94 Q10.2 F81
O75.0 W92 O91 W94 P35 A94 Q10.3 F81
O75.0 W93 O92.0 W95 P36 A94 Q10.4 F81
O75.1 W92 O92.1 W95 P37 A94 Q10.5 F80
O75.1 W93 O92.2 W95 P38 A94 Q10.6 F81
O75.2 W71 O92.3 W95 P39 A94 Q10.7 F81
O75.3 W71 O92.4 W95 P50 A94 Q11 F81
O75.4 W92 O92.5 W19 P51 A94 Q12 F81
O75.4 W93 O92.6 W19 P52 A94 Q13 F81
O75.5 W92 O92.7 W19 P53 A94 Q14 F81
O75.5 W93 O95 W99 P54 A94 Q15 F81
O75.6 W92 O96 W99 P55 A94 Q16 H80
O75.6 W93 O97 W99 P56 A94 Q17 H80
O75.7 W92 O98 W71 P57 A94 Q18 D81
O75.7 W93 O99.0 W84 P58 A94 Q20 K73
O75.8 W92 O99.1 W84 P59 A94 Q21 K73
O75.8 W93 O99.2 W84 P60 A94 Q22 K73
O75.9 W92 O99.3 W84 P61 A94 Q23 K73
O75.9 W93 O99.4 W84 P70 A94 Q24 K73
O80 W90 O99.5 W84 P71 A94 Q25 K73
O81 W92 O99.6 W84 P72 A94 Q26 K73
O81 W93 O99.7 W84 P74 A94 Q27 K73
O82 W92 O99.8 W76 P75 A94 Q28 K73
O82 W93 P00 A94 P76 A94 Q30 R89
O83 W92 P01 A94 P77 A94 Q31 R89
O83 W93 P02 A94 P78 A94 Q32 R89
O84 W92 P03 A94 P80 A94 Q33 R89
O84 W93 P04 A94 P81 A94 Q34 R89
12_Wonca-[Link] 06/04/2005 8:08 AM Page 160

160 WONCA International Classification of Primary Care

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

Q35 D81 Q86 A90 R07.2 K02 R20.3 N06
Q36 D81 Q87 A90 R07.3 L04 R20.8 N06
Q37 D81 Q89.0 B79 R07.4 A11 R20.8 S01
Q38 D81 Q89.1 T80 R09.0 R29 R21 S06
Q39 D81 Q89.2 T78 R09.1 R82 R21 S07
Q40 D81 Q89.2 T80 R09.2 R29 R22.0 S04
Q41 D81 Q89.3 A90 R09.3 R25 R22.1 S04
Q42 D81 Q89.4 A90 R09.8 K03 R22.2 S04
Q43 D81 Q89.7 A90 R09.8 K29 R22.3 S04
Q44 D81 Q89.8 B79 R09.8 K81 R22.4 S04
Q45 D81 Q89.9 A90 R09.8 R21 R22.7 S05
Q50 X83 Q90 A90 R09.8 R29 R22.9 S04
Q51 X83 Q91 A90 R10.0 D01 R23.0 S08
Q52 X83 Q92 A90 R10.1 D02 R23.1 S08
Q53 Y83 Q93 A90 R10.1 D06 R23.2 S08
Q54 Y82 Q95 A90 R10.2 D04 R23.3 S29
Q55 Y84 Q96 A90 R10.2 D06 R23.4 S21
Q56 X83 Q97 A90 R10.2 Y02 R23.8 S04
Q56 Y84 Q98 A90 R10.3 D04 R23.8 S05
Q60 U85 Q99 A90 R10.3 D06 R23.8 S08
Q61 U85 R00.0 K04 R10.4 D01 R23.8 S29
Q62 U85 R00.1 K04 R11 D09 R25.0 N08
Q63 U85 R00.2 K04 R11 D10 R25.1 N08
Q64 U85 R00.8 K05 R11 D29 R25.2 L07
Q65 L82 R01 K81 R12 D03 R25.2 L09
Q66 L82 R02 K92 R13 D21 R25.2 L12
Q67 L82 R03.0 K85 R14 D08 R25.2 L14
Q68 L82 R03.1 K29 R15 D17 R25.2 L17
Q69 L82 R04.0 R06 R16.0 D23 R25.2 L18
Q70 L82 R04.1 R29 R16.1 B87 R25.3 N08
Q71 L82 R04.2 R24 R16.2 B87 R25.8 N08
Q72 L82 R04.8 R29 R16.2 D23 R26.0 N29
Q73 L82 R04.9 R29 R17 D13 R26.1 N29
Q74 L82 R05 R05 R18 D29 R26.2 N29
Q75 L82 R06.0 R02 R19.0 D24 R26.8 A29
Q76 L82 R06.1 R04 R19.0 D25 R26.8 L29
Q77 L82 R06.2 R03 R19.1 D29 R26.8 N29
Q78 L82 R06.3 R04 R19.2 D29 R27 N29
Q79 L82 R06.4 R98 R19.3 D29 R29.0 N08
Q80 S83 R06.5 R04 R19.4 D18 R29.0 N29
Q81 S83 R06.6 R29 R19.5 D18 R29.1 N29
Q82 S83 R06.7 R07 R19.6 D20 R29.2 N29
Q83 X83 R06.8 R04 R19.8 D29 R29.3 L29
Q83 Y84 R07.0 R21 R20.0 N06 R29.4 L13
Q84 S83 R07.1 R01 R20.1 N06 R29.8 L04
Q85 A90 R07.2 K01 R20.2 N05 R29.8 L05
12_Wonca-[Link] 06/04/2005 8:08 AM Page 161

Conversion codes from ICD-10 161

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

R29.8 L07 R46.8 W21 R75 B90 S00.7 S19
R29.8 L09 R46.8 X22 R76 A91 S00.8 S12
R29.8 L12 R47 N19 R77 A91 S00.8 S15
R29.8 L14 R48 P24 R78 A91 S00.8 S16
R29.8 L17 R49 R23 R79 A91 S00.8 S17
R29.8 L29 R50 A03 R80 U98 S00.8 S19
R29.8 N29 R51 N01 R81 U98 S00.9 S12
R30 U01 R51 N03 R82 U98 S00.9 S15
R31 U06 R52 A01 R83 A91 S00.9 S16
R32 U04 R53 A04 R84 A91 S00.9 S17
R33 U08 R53 A05 R85 A91 S00.9 S19
R34 U05 R54 P05 R86 A91 S01.0 S18
R35 U02 R55 A06 R87 A91 S01.1 F79
R36 X29 R56 N07 R87 X86 S01.2 R88
R36 Y03 R57 K99 R89 A91 S01.2 S18
R39.0 U13 R58 A10 R90 A91 S01.3 H79
R39.1 U05 R59 B02 R91 A91 S01.4 S18
R39.2 U99 R60 K07 R92 A91 S01.5 D80
R39.8 U07 R61 A09 R93 A91 S01.7 S18
R39.8 U13 R62.0 P22 R94 A91 S01.8 S18
R39.8 U29 R62.8 T10 R95 A95 S01.9 S18
R40 A07 R62.9 T10 R95 A96 S02.0 N80
R41 P20 R63.0 T03 R96 A96 S02.1 N80
R42 N17 R63.1 T01 R98 A96 S02.2 L76
R43 N16 R63.2 T02 R99 A96 S02.3 L76
R44 P29 R63.3 T04 S00.0 S12 S02.4 L76
R45.0 P01 R63.3 T05 S00.0 S15 S02.5 D80
R45.1 P04 R63.4 T08 S00.0 S16 S02.6 L76
R45.2 P03 R63.5 T07 S00.0 S17 S02.7 L76
R45.3 P03 R63.8 T29 S00.0 S19 S02.8 L76
R45.4 P04 R64 T08 S00.1 F75 S02.9 L76
R45.5 P04 R68.0 A29 S00.2 F79 S02.9 N80
R45.6 P04 R68.1 A16 S00.2 S12 S03.0 L80
R45.7 P29 R68.2 D20 S00.2 S15 S03.1 R88
R45.8 P29 R68.3 S22 S00.3 R88 S03.2 D80
R46.0 P29 R68.8 A02 S00.3 S12 S03.3 L80
R46.1 P29 R68.8 A08 S00.3 S15 S03.4 L79
R46.2 P29 R68.8 A29 S00.4 H78 S03.5 L79
R46.3 P29 R68.8 B04 S00.4 S12 S04 N81
R46.4 P29 R68.8 B29 S00.4 S15 S05.0 F79
R46.5 P29 R69 A99 S00.5 D80 S05.1 F75
R46.6 P29 R70 B99 S00.5 S12 S05.2 F79
R46.7 P29 R71 B99 S00.5 S15 S05.3 F79
R46.8 A18 R72 B84 S00.7 S12 S05.4 F79
R46.8 H15 R73 A91 S00.7 S15 S05.5 F79
R46.8 P29 R74 A91 S00.7 S17 S05.6 F79
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162 WONCA International Classification of Primary Care

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

S05.7 F79 S10.8 S12 S20.7 S12 S31.4 X82
S05.8 F79 S10.8 S15 S20.7 S15 S31.5 X82
S05.9 F79 S10.8 S16 S20.7 S17 S31.5 Y80
S06.0 N79 S10.8 S17 S20.7 S19 S31.7 A81
S06.1 N80 S10.8 S19 S20.8 S12 S31.8 S18
S06.2 N80 S10.9 S12 S20.8 S15 S32 L76
S06.3 N80 S10.9 S15 S20.8 S17 S33.0 L80
S06.4 N80 S10.9 S16 S20.8 S19 S33.1 L80
S06.5 N80 S10.9 S17 S21 A80 S33.2 L80
S06.6 N80 S10.9 S19 S21 S18 S33.3 L80
S06.7 N80 S11 A80 S22 L76 S33.4 L81
S06.8 N80 S11 S18 S23.0 L80 S33.5 L84
S06.9 N80 S12 L76 S23.1 L80 S33.6 L79
S07.0 H79 S13.0 L80 S23.2 L80 S33.7 L84
S07.0 N80 S13.1 L80 S23.3 L79 S34 N81
S07.1 N80 S13.2 L80 S23.4 L79 S35 A80
S07.8 N80 S13.3 L80 S23.5 L79 S36.0 B76
S07.9 N80 S13.4 L79 S24 N81 S36.1 D80
S08.0 N80 S13.5 L79 S25 A80 S36.2 D80
S08.1 H79 S13.6 L79 S26 A80 S36.3 D80
S08.8 N80 S14 N81 S27 A80 S36.4 D80
S08.9 N80 S15 A80 S27 R88 S36.5 D80
S09.0 N80 S16 L81 S28 A81 S36.6 D80
S09.1 L81 S17.0 R88 S29 A81 S36.7 A81
S09.2 H79 S17.8 A81 S30.0 L81 S36.8 D80
S09.7 N80 S17.9 A81 S30.0 S16 S36.9 D80
S09.8 H79 S18 A81 S30.1 L81 S37.0 U80
S09.8 N80 S19.7 A81 S30.1 S16 S37.1 U80
S09.9 D80 S19.8 A81 S30.2 X82 S37.2 U80
S09.9 F79 S19.8 R88 S30.2 Y80 S37.3 U80
S09.9 H79 S19.9 A81 S30.7 S12 S37.4 X82
S09.9 L81 S20.0 S16 S30.7 S15 S37.5 X82
S09.9 N80 S20.1 S12 S30.7 S17 S37.6 X82
S09.9 N81 S20.1 S15 S30.7 S19 S37.7 A81
S09.9 R88 S20.1 S17 S30.8 S12 S37.8 A81
S10.0 D80 S20.1 S19 S30.8 S15 S37.9 A80
S10.0 R88 S20.2 L81 S30.8 S17 S38.0 X82
S10.0 S16 S20.2 S16 S30.8 S19 S38.0 Y80
S10.1 S12 S20.3 S12 S30.9 S12 S38.1 A80
S10.1 S15 S20.3 S15 S30.9 S15 S38.2 X82
S10.1 S17 S20.3 S17 S30.9 S17 S38.2 Y80
S10.1 S19 S20.3 S19 S30.9 S19 S38.3 A80
S10.7 S12 S20.4 S12 S31.0 S18 S39.0 A80
S10.7 S15 S20.4 S15 S31.1 S18 S39.0 A81
S10.7 S17 S20.4 S17 S31.2 Y80 S39.0 L81
S10.7 S19 S20.4 S19 S31.3 Y80 S39.6 A81
12_Wonca-[Link] 06/04/2005 8:08 AM Page 163

Conversion codes from ICD-10 163

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

S39.7 A81 S50.8 S12 S67 L81 S82.6 L73
S39.8 A80 S50.8 S15 S68 L81 S82.7 L73
S39.8 A81 S50.8 S17 S69 L81 S82.8 L73
S39.8 L81 S50.8 S19 S70.0 L81 S82.9 L73
S39.8 X82 S50.9 S19 S70.0 S16 S83.0 L80
S39.8 Y80 S51 S18 S70.1 L81 S83.1 L80
S39.9 A80 S52 L72 S70.1 S16 S83.2 L96
S39.9 A81 S53.0 L80 S70.7 S12 S83.3 L96
S39.9 L81 S53.1 L80 S70.7 S15 S83.4 L78
S39.9 X82 S53.2 L79 S70.7 S17 S83.5 L96
S39.9 Y80 S53.3 L79 S70.7 S19 S83.6 L78
S40.0 L81 S53.4 L79 S70.8 S12 S83.7 L96
S40.0 S16 S54 N81 S70.8 S15 S84 N81
S40.7 S12 S55 A80 S70.8 S17 S85 A80
S40.7 S15 S56 L81 S70.8 S19 S86 L81
S40.7 S17 S57 L81 S70.9 S19 S87 L81
S40.7 S19 S58 L81 S71 S18 S88 L81
S40.8 S12 S59 L81 S72 L75 S89 L81
S40.8 S15 S60.0 L81 S73.0 L80 S90.0 L81
S40.8 S17 S60.0 S16 S73.1 L79 S90.0 S16
S40.8 S19 S60.1 L81 S74 N81 S90.1 L81
S40.9 S19 S60.1 S16 S75 A80 S90.1 S16
S41 S18 S60.2 L81 S76 L81 S90.2 L81
S42 L76 S60.2 S16 S77 L81 S90.2 S16
S43.0 L80 S60.7 S12 S78 L81 S90.3 L81
S43.1 L80 S60.7 S15 S79 L81 S90.3 S16
S43.2 L80 S60.7 S17 S80.0 L81 S90.7 S12
S43.3 L80 S60.7 S19 S80.0 S16 S90.7 S15
S43.4 L79 S60.8 S12 S80.1 L81 S90.7 S17
S43.5 L79 S60.8 S15 S80.1 S16 S90.7 S19
S43.6 L79 S60.8 S17 S80.7 S12 S90.8 S12
S43.7 L79 S60.8 S19 S80.7 S15 S90.8 S15
S44 N81 S60.9 S19 S80.7 S17 S90.8 S17
S45 A80 S61 S18 S80.7 S19 S90.8 S19
S46 L81 S62 L74 S80.8 S12 S90.9 S19
S47 L81 S63.0 L80 S80.8 S15 S91 S18
S48 L81 S63.1 L80 S80.8 S17 S92 L74
S49 L81 S63.2 L80 S80.8 S19 S93.0 L80
S50.0 L81 S63.3 L79 S80.9 S19 S93.1 L80
S50.0 S16 S63.4 L79 S81 S18 S93.2 L79
S50.1 L81 S63.5 L79 S82.0 L76 S93.3 L80
S50.1 S16 S63.6 L79 S82.1 L73 S93.4 L77
S50.7 S12 S63.7 L79 S82.2 L73 S93.5 L79
S50.7 S15 S64 N81 S82.3 L73 S93.6 L79
S50.7 S17 S65 A80 S82.4 L73 S94 N81
S50.7 S19 S66 L81 S82.5 L73 S95 A80
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164 WONCA International Classification of Primary Care

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

S96 L81 T11.5 L81 T19.1 U80 T48 A84
S97 L81 T11.6 L81 T19.2 X82 T49 A84
S98 L81 T11.8 L81 T19.3 X82 T50 A84
S99 L81 T11.9 L81 T19.8 U99 T51 A86
T00 A81 T12 L76 T19.9 U99 T52 A86
T01 A81 T13.0 L81 T20 S14 T53 A86
T02 A81 T13.0 S12 T21 S14 T54 A86
T03 A81 T13.0 S15 T22 S14 T55 A86
T04 A81 T13.0 S16 T23 S14 T56 A86
T05 A81 T13.0 S17 T24 S14 T57 A86
T06.0 N81 T13.0 S19 T25 S14 T58 A86
T06.1 N81 T13.1 S18 T26 F79 T59 A86
T06.2 N81 T13.2 L79 T27 R88 T60 A86
T06.3 K99 T13.2 L80 T28.0 D80 T61 A86
T06.4 L81 T13.3 N81 T28.1 D80 T62 A86
T06.5 A81 T13.4 A80 T28.2 D80 T63 A86
T06.8 A81 T13.5 L81 T28.3 U80 T64 A86
T07 A81 T13.6 L81 T28.3 X82 T65 A86
T08 L76 T13.8 L81 T28.3 Y80 T66 A88
T09.0 L81 T13.9 L81 T28.4 A80 T67 A88
T09.0 S12 T14.0 S12 T28.5 D80 T68 A88
T09.0 S15 T14.0 S15 T28.6 D80 T69 A88
T09.0 S16 T14.0 S16 T28.7 D80 T70.0 H79
T09.0 S17 T14.0 S17 T28.8 U80 T70.1 R88
T09.0 S19 T14.0 S19 T28.8 X82 T70.2 A88
T09.1 S18 T14.1 S13 T28.8 Y80 T70.3 A88
T09.2 L79 T14.1 S15 T28.9 A80 T70.4 A88
T09.2 L80 T14.1 S18 T29 A81 T70.8 A88
T09.3 N81 T14.1 S19 T30 S14 T70.9 A88
T09.4 N81 T14.2 L76 T31 S14 T71 A88
T09.5 L81 T14.3 L79 T32 S14 T73 A88
T09.6 L81 T14.3 L80 T33 A88 T74.0 Z12
T09.8 L81 T14.4 N81 T34 A88 T74.0 Z16
T09.9 L81 T14.5 A80 T35 A88 T74.0 Z20
T10 L76 T14.6 L81 T36 A84 T74.1 Z25
T11.0 L81 T14.7 A80 T37 A84 T74.2 Z25
T11.0 S12 T14.7 L81 T38 A84 T74.3 Z12
T11.0 S15 T14.8 A80 T39 A84 T74.3 Z16
T11.0 S16 T14.9 A80 T40 A84 T74.8 Z25
T11.0 S17 T14.9 B77 T41 A84 T74.9 Z25
T11.0 S19 T14.9 W75 T42 A84 T75 A88
T11.1 S18 T15 F76 T43 A84 T78.0 A92
T11.2 L79 T16 H76 T44 A84 T78.1 A92
T11.2 L80 T17 R87 T45 A84 T78.2 A92
T11.3 N81 T18 D79 T46 A84 T78.3 A92
T11.4 A80 T19.0 U80 T47 A84 T78.4 A92
12_Wonca-[Link] 06/04/2005 8:08 AM Page 165

Conversion codes from ICD-10 165

ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

T78.8 A88 Z10 A98 Z34 W78 Z56.0 Z06
T78.9 A88 Z11 A98 Z35 W84 Z56.1 Z05
T79.0 A82 Z12 A98 Z36 W78 Z56.2 Z05
T79.1 A82 Z13 A98 Z37.0 W90 Z56.3 Z05
T79.2 A82 Z20 A23 Z37.1 W91 Z56.4 Z05
T79.3 S11 Z21 B90 Z37.1 W93 Z56.5 Z05
T79.4 A82 Z22 A99 Z37.2 W92 Z56.6 Z05
T79.5 A82 Z23 A98 Z37.3 W93 Z56.7 Z05
T79.6 L99 Z24 A98 Z37.4 W93 Z57 Z05
T79.7 A82 Z25 A98 Z37.5 W92 Z58.0 Z29
T79.8 A82 Z26 A98 Z37.6 W93 Z58.1 Z29
T79.9 A82 Z27 A98 Z37.7 W93 Z58.2 Z29
T80 A87 Z28 A23 Z37.9 W90 Z58.3 Z29
T81 A87 Z29 A98 Z37.9 W91 Z58.4 Z29
T82 A89 Z30.0 W14 Z37.9 W92 Z58.5 Z29
T83 A89 Z30.0 Y14 Z37.9 W93 Z58.6 Z02
T84 A89 Z30.1 W12 Z38 W90 Z58.8 Z29
T85 A89 Z30.2 W13 Z38 W92 Z58.9 Z29
T86 A87 Z30.2 Y13 Z39 W90 Z59.0 Z03
T87 A87 Z30.3 W10 Z39 W92 Z59.1 Z03
T88.0 A87 Z30.3 W83 Z40 A98 Z59.2 Z03
T88.1 A87 Z30.4 W11 Z41 A99 Z59.3 Z03
T88.2 A87 Z30.5 W12 Z42 A99 Z59.4 Z02
T88.3 A87 Z30.8 W14 Z43 A89 Z59.5 Z01
T88.4 A87 Z30.8 Y14 Z44 A89 Z59.6 Z01
T88.5 A87 Z30.9 W14 Z45 A89 Z59.7 Z01
T88.6 A85 Z30.9 X10 Z46.0 F17 Z59.7 Z08
T88.7 A85 Z30.9 Y14 Z46.0 F18 Z59.8 Z01
T88.8 A87 Z31.0 W15 Z46.1 A89 Z59.8 Z03
T88.9 A87 Z31.0 Y10 Z46.2 A89 Z59.9 Z01
T90 A82 Z31.1 W15 Z46.3 A89 Z59.9 Z03
T91 A82 Z31.2 W15 Z46.4 A89 Z60.0 P25
T92 A82 Z31.3 W15 Z46.5 A89 Z60.1 Z04
T93 A82 Z31.4 W15 Z46.6 A89 Z60.2 Z04
T94 A82 Z31.4 Y10 Z46.7 A89 Z60.3 Z04
T95 A82 Z31.5 A98 Z46.8 A89 Z60.4 Z04
T96 A82 Z31.6 W15 Z46.9 A89 Z60.5 Z04
T97 A82 Z31.6 Y10 Z47 A99 Z60.8 Z04
T98 A82 Z31.8 W15 Z48 A99 Z60.9 Z04
Z00 A97 Z31.8 Y10 Z49 A99 Z61 Z16
Z01 A98 Z31.9 W15 Z50 A99 Z62 Z16
Z02 A97 Z31.9 Y10 Z51 A99 Z63.0 Z12
Z03 A99 Z32.0 W01 Z52 A99 Z63.0 Z13
Z04 A99 Z32.1 W78 Z53 A99 Z63.1 Z20
Z08 A99 Z32.1 W79 Z54 A99 Z63.1 Z21
Z09 A99 Z33 W78 Z55 Z07 Z63.2 Z29
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ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2 ICD-10 ICPC-2

Z63.3 Z29 Z71.1 N26 Z73.6 A28 Z86.3 A23
Z63.4 Z15 Z71.1 N27 Z73.6 B28 Z86.4 A23
Z63.4 Z19 Z71.1 P27 Z73.6 D28 Z86.5 A23
Z63.4 Z23 Z71.1 R26 Z73.6 F28 Z86.6 A23
Z63.5 Z15 Z71.1 R27 Z73.6 H28 Z86.7 K22
Z63.6 Z14 Z71.1 S26 Z73.6 K28 Z87 A23
Z63.6 Z18 Z71.1 S27 Z73.6 L28 Z88 A23
Z63.6 Z22 Z71.1 T26 Z73.6 N28 Z89 L99
Z63.7 Z22 Z71.1 T27 Z73.6 P28 Z90.0 A99
Z63.7 Z29 Z71.1 U26 Z73.6 R28 Z90.1 X99
Z63.8 Z16 Z71.1 U27 Z73.6 S28 Z90.2 R99
Z63.8 Z20 Z71.1 W02 Z73.6 T28 Z90.3 D99
Z63.8 Z29 Z71.1 W27 Z73.6 U28 Z90.4 D99
Z63.9 Z21 Z71.1 X23 Z73.6 W28 Z90.5 U99
Z63.9 Z24 Z71.1 X24 Z73.6 X28 Z90.6 U99
Z63.9 Z29 Z71.1 X25 Z73.6 Y28 Z90.7 X28
Z64.0 W79 Z71.1 X26 Z73.6 Z28 Z90.7 X99
Z64.1 Z29 Z71.1 X27 Z73.8 Z29 Z90.7 Y28
Z64.2 P29 Z71.1 Y24 Z73.9 Z29 Z90.7 Y99
Z64.3 P29 Z71.1 Y25 Z74 A28 Z90.8 A99
Z64.4 Z10 Z71.1 Y26 Z75 Z10 Z91.0 A23
Z65.0 Z09 Z71.1 Y27 Z75 Z11 Z91.1 A23
Z65.1 Z09 Z71.1 Z27 Z76.0 A99 Z91.2 A23
Z65.2 Z09 Z71.2 A99 Z76.1 A99 Z91.3 A23
Z65.3 Z09 Z71.3 A99 Z76.2 A99 Z91.4 A23
Z65.4 Z25 Z71.4 A99 Z76.3 A99 Z91.5 A23
Z65.5 Z25 Z71.5 A99 Z76.4 A99 Z91.5 P77
Z65.8 Z29 Z71.6 A99 Z76.5 Z29 Z91.6 A23
Z65.9 Z29 Z71.7 A99 Z76.8 A99 Z91.8 A23
Z70 A98 Z71.8 A20 Z76.9 A99 Z92 A23
Z71.0 A99 Z71.8 A99 Z80 A21 Z93 A89
Z71.1 A13 Z71.9 A99 Z81 A23 Z94 A89
Z71.1 A25 Z72.0 A23 Z82.0 A23 Z95 A89
Z71.1 A26 Z72.1 A23 Z82.1 A23 Z96 A89
Z71.1 A27 Z72.2 A23 Z82.2 A23 Z97 A89
Z71.1 B25 Z72.3 A23 Z82.3 K22 Z98.0 D99
Z71.1 B26 Z72.4 A23 Z82.4 K22 Z98.1 L99
Z71.1 B27 Z72.5 A23 Z82.5 A23 Z98.2 N99
Z71.1 D26 Z72.6 Z29 Z82.6 A23 Z98.8 A99
Z71.1 D27 Z72.8 Z29 Z82.7 A23 Z99.0 A28
Z71.1 F27 Z72.9 Z29 Z82.8 A23 Z99.1 R28
Z71.1 H27 Z73.0 P29 Z83 A23 Z99.2 U28
Z71.1 K24 Z73.1 P29 Z84 A23 Z99.3 A28
Z71.1 K25 Z73.2 A23 Z85 A21 Z99.8 A28
Z71.1 K27 Z73.3 P29 Z86.0 A23 Z99.9 A28
Z71.1 L26 Z73.4 Z28 Z86.1 A23
Z71.1 L27 Z73.5 Z29 Z86.2 A23
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12 Alphabetical index

This index is not meant to be comprehensive, nor to be a nomenclature (see Chapter 1).
It is a list only of the titles of rubrics (in upper case) and of inclusion terms in the rubrics
(in lower case). These comprise the synonyms and terms most commonly used in general/
family practice. Users requiring a more extensive index or nomenclature will need to
develop their own or use ones already available in countries such as Australia, Canada,
The Netherlands, and some Scandinavian countries. In order to maintain consistency,
this should be done in cooperation with the WONCA Classification Committee.
Abbreviations are not included in this index, except the following:
complt = complaint
/ = or
sympt = symptom
NOS = not otherwise specified in this classification
abdominal adhesion D99 ABUSE, ALCOHOL, CHRONIC P15
abnormal blinking F14 abuse, child, emotional Z16
abnormal breathing R04 abuse, child, physical Z25
abnormal chromosome A90 ABUSE, DRUG P19
abnormal imaging test A91 ABUSE, MEDICATION P18
ABNORMAL PAP SMEAR X86 abuse, partner, emotional Z12
abnormal platelets B83 abuse, physical Z25
abnormal red cells B99 ABUSE, TOBACCO P17
abnormal taste N16 accessory auricle H80
abnormal test result A91 achalasia D84
ABNORMAL WHITE CELLS B84 ache, stomach D02
abortion, complete W82 aches, multiple A01
abortion, habitual W82 acidity D03
abortion, incomplete W82 ACNE S96
ABORTION, INDUCED W83 acoustic neuroma N75
abortion, missed W82 acromegaly T99
ABORTION, SPONTANEOUS W82 addiction to drug P19
abortion, threatened W82 adenovims disease A77
ABRASION S17 adjustment disorder, acute P02
abscess, breast, puerperal W94 adjustment disorder, persistent P82
abscess, ischiorectal D95 adverse effect cold A88
ABSCESS, NOSE R73 ADVERSE EFFECT
ABSCESS, PERIANAL D95 MEDICATION A85
abscess, perinephric U70 adverse effect pressure A88
abscess, skin S10 adverse effect treatment A87
ABUSE, ALCOHOL, ACUTE P16 ADVERSE EFFECT, PHYSICAL A88
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168 WONCA International Classification of Primary Care

AFFECTIVE PSYCHOSIS NOS P73 analgesic nephropathy U88

agitation P04 anaphylactic shock A92
agranulocytosis B84 anaphylaxis, medication A85
AIDS B90 aneurysm, aortic K99
AIDS, FEAR OF B25 aneurysm, cerebral K91
albuminuria U90 aneurysm, heart K76
ALCOHOL ABUSE, ACUTE P16 aneurysm, other K99
ALCOHOL ABUSE, CHRONIC P15 angina pectoris K74
alcohol brain syndrome PI5 angiomatous birthmark S81
alcohol hepatitis D97 angioneurotic oedema A92
alcohol psychosis P15 ANGRY FEELING P04
alcoholic gastritis D87 ANKLE SYMPT/COMPLT L16
alcoholism P15 ankylosing spondylitis L88
allergic dermatitis S88 anorexia T03
allergic gastroenteropathy D99 ANOREXIA NERVOSA P86
allergic oedema A92 anosmia, disturbance of smell/taste N16
ALLERGIC RHINITIS R97 ANTEPARTUM BLEEDING W03
allergy to medication A85 anuria U05
ALLERGY/ALLERGIC anxiety NOS P01
REACTION A92 anxiety and depression P76
alopecia S23 ANXIETY DISORDER/STATE P74
Alzheimer’s disease P70 anxiety neurosis P74
amblyopia F99 anxious feeling P01
amenorrhoea X05 aortic valve disease K83
amnesia P20 aphasia N19
amputation, old A82 aphonia R23
amputation, traumatic, recent L81 apnoea R04
amyloidosis T99 apnoea, sleep P06
anaemia, aplastic B82 apoplexy K90
anaemia, blood loss B80 APPENDICITIS D88
ANAEMIA, FOLATE APPETITE, EXCESSIVE T02
DEFICIENCY B81 arcus senilis F99
anaemia, haemolytic, acquired B82 ARM SYMPT/COMPLT L09
ANAEMIA, HEREDITARY B82 ARRHYTHMIA, CARDIAC K80
ANAEMIA, IRON DEFICIENCY B80 arterial embolism K92
anaemia, macrocytic B81 arterial stenosis K92
anaemia, megaloblastic B81 arteriosclerosis K92
ANAEMIA, OTHER/ arteritis K99
UNSPECIFIED B82 arthralgia L20
anaemia, pernicious B81 arthritis NOS L91
anaemia, of pregnancy W84 arthritis, osteo: see osteoarthrosis
anaemia, protein deficiency B82 arthritis, psoriatic S91
ANAEMIA, VIT B12 DEFICIENCY B81 arthritis, pyogenic L70
anaesthesia N06 ARTHRITIS, RHEUMATOID L88
anaesthetic shock A87 arthrodesis L99
anal spasm D04 arthropathy, crystal T99
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Alphabetical index 169

arthrosis, osteo: see osteoarthrosis BEHAVIOUR PROBLEM,

ascites D29 PARENT Z21
ASSAULT Z25 BEHAVIOUR PROBLEM,
ASTHMA R96 PARTNER Z13
astigmatism F91 behaviour strange P29
ataxia N29 BELCHING D08
atheroma K92 BELL’S PALSY N91
ATHEROSCLEROSIS K92 benign paroxysmal vertigo H82
atherosclerotic heart disease K76 BENIGN PROSTATIC
ATRIAL FIBRILLATION K78 HYPERTROPHY Y85
ATRIAL FLUTTER K78 BENIGN: see NEOPLASM,
atrial septal defect K73 BENIGN
atrophy, muscle L19 bereavement: see LOSS
attention deficit disorder P81 beri-beri T91
autism P99 bigeminy K80
autoimmune disease, blood B99 biliary anomaly D81
avulsion, nail S19 biliary colic D98
AXILLA SYMPT/COMPLT L05 bipolar disorder P73
back pain NOS L02 birthmark S83
BACK PAIN SYNDROME, birthmark, angiomatous S81
WITH RADIATION L86 BITE, ANIMAL/HUMAN S13
BACK PAIN SYNDROME, BITE, INSECT S12
WITHOUT RADIATION L84 black eye F75
back pain, lumbar L03 blackhead S96
BACK SYMPT/COMPLT L02 blackout A06
backache NOS L02 bladder diverticulum U99
backache, low L03 bladder neck obstruction U99
backache, thoracic L02 BLADDER SYMPT/COMPLT U13
bacterial endocarditis K70 BLEEDING NOS A10
bacteriuria, asymptomatic U71 BLEEDING, ANTEPARTUM W03
bad breath D20 bleeding, breakthrough X08
BALANITIS Y75 bleeding, duodenal ulcer D85
BALDNESS S23 BLEEDING, EAR H05
Bartholin’s cyst/abscess X99 BLEEDING,
basal cell carcinoma S77 INTERMENSTRUAL X08
basilar insufficiency K89 BLEEDING, POST-COITAL X13
bat ear H80 BLEEDING,
bedsore S97 POST-MENOPAUSAL X12
BEDWETTING P12 BLEEDING, POST-PARTUM W17
BEHAVING IRRITABLE/ANGRY P04 BLEEDING, RECTAL D16
behaviour disorder, adult P80 bleeding, skin S29
BEHAVIOUR PROBLEM, BLEPHARITIS F72
ADOLESCENT P23 BLINDNESS F94
BEHAVIOUR PROBLEM, CHILD P22 blindness, one eye F28
BEHAVIOUR PROBLEM, blindness, temporary F05
FAMILY Z21 BLISTER S17
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bloating D08 bunion L98

blocked ear H13 BURN S14
BLOCKED LACRIMAL DUCT, burn, chemical S14
INFANT F80 burning eye F13
blocked lacrimal duct, not infant F99 burning feet N05
blocked nose R07 burning sensation skin S01
blocked sinuses R09 burning urination U01
BLOOD DISEASE, OTHER B99 BURSITIS L87
blood in/from ear H05 bursitis of shoulder L92
blood in stool D16 cachexia T08
blood in urine U06 caesarian section W92/W93
BLOOD PRESSURE, ELEVATED K85 calcified tendon L87
BLOOD SYMPT/COMPLT B04 calculus, urinary U95
bloodshot eye F02 CALLOSITIES S20
blotches, generalized S07 campylobacter enteritis D70
blotch, localized S06 cancer phobia P79
BOIL S10 cancer: see NEOPLASM,
BOIL, NOSE R73 MALIGNANT
bow leg L82 CANDIDIASIS,
BOWEL MOVEMENTS FEMALE GENITAL X72
CHANGED D18 candidiasis, oral D83
BOWEL TRAINING PROBLEM P13 candidiasis, penis Y75
Bowen’s disease S79 candidiasis, perianal S75
bradycardia K80 CANDIDIASIS, SKIN S75
brain syndrome, chronic P98 carbon monoxide toxicity A86
breakthrough bleeding X08 CARBUNCLE S10
BREAST DISORDER, carcinoma-in-situ, breast X81
OTHER, IN PREGNANCY/ carcinoma-in-situ, cervix X81
PUERPERIUM W95 carcinoma-in-situ: see neoplasm,
BREAST SYMPT/COMPLT, unspecified/uncertain carcino-
FEMALE X21 matosis, unknown primary A79
BREAST SYMPT/COMPLT, cardiac arrest K84
MALE Y16 cardiac asthma K77
breath holding R04 cardiac bruit K81
BREATHING PROBLEM R04 cardiomegaly K84
bronchiectasis R99 cardiomyopathy K84
BRONCHIOLITIS, ACUTE R78 CARDIOVASCULAR
bronchitis NOS R78 DISEASE, OTHER K99
BRONCHITIS, ACUTE R78 CARDIOVASCULAR RISK
BRONCHITIS, CHRONIC R79 FACTOR K22
bronchitis, wheezy R96 CARDIOVASCULAR
bronchopneumonia R81 SYMPT/COMPLT K29
brucellosis A78 caries D82
BRUISE S16 carotid bruit K81
BULIMIA P86 CARPAL TUNNEL
bundle branch block K84 SYNDROME N93
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carrier of disease A99 CHOLELITHIASIS D98

CATARACT F92 cholera D70
cellulite S29 cholesteatoma H74
cellulitis S76 chorea K71
cerebral abscess N73 choriocarcinoma W72
cerebral contusion N80 chromosome abnormality A90
cerebral embolism K90 chronic airways limitation R95
cerebral haemorrhage K90 chronic fatigue syndrome A04
cerebral haemorrhage, chronic obstructive airway disease R95
traumatic N80 circumcision, female X82
cerebral infarction K90 circumcision, male Y80
cerebral injury N80 cirrhosis D97
cerebral palsy N99 claudication, intermittent K92
cerebral thrombosis K90 cleft lip and palate D81
cerebrovascular accident K90 clubbing of nail S22
CEREBROVASCULAR clubfoot (talipes) L82
DISEASE K91 clumsiness A29
cervical disc lesion L83 COAGULATION DEFECT B83
CERVICAL EROSION X85 coccydynia L03
cervical intraepithelial coeliac disease D99
neoplasia, grade 3 X81/X86 cold in head R74
cervical intraepithelial cold sore S71
neoplasia, grades 1 and 2 X85/X86 colic, abdominal D01
cervical spine sympt/complt L01 colic, infant D01
cervical spine syndrome L83 collapse A06
CERVICAL DISEASE NOS X85 collapse, lung R99
cervicitis X85 collapsed vertebra NOS L84
cervicobrachial syndrome L83 Colic’s fracture L72
cestodes D96 colostomy A89
CHALAZION F72 colour blindness F99
cheilosis D83 COMA A07
chemical dermatitis S88 comedones S96
chest infection R78 compensation neurosis P80
CHEST SYMPT/COMPLT L04 complement defect B99
chest tightness R29 COMPLIANCE PROBLEM Z11
CHICKENPOX A72 COMPLICATED DELIVERY,
chilblains A88 LIVEBIRTH W92
child abuse, emotional Z16 COMPLICATED DELIVERY,
child abuse, physical Z25 STILLBIRTH W93
CHILLS A02 COMPLICATION OF
CHLAMYDIA INFECTION, PUERPERIUM W96
GENITAL, FEMALE X92 complication of rubella A74
chlamydial urethritis U72 COMPLICATION OF
choking feeling D21 TREATMENT A87
cholangitis D98 COMPULSIVE DISORDER P79
CHOLECYSTITIS D98 concern about aging P05
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172 WONCA International Classification of Primary Care

CONCERN ABOUT CONGENITAL ANOMALY,

APPEARANCE A18 RESPIRATORY R89
CONCERN ABOUT CONGENITAL ANOMALY, SKIN S83
APPEARANCE, BREAST X22 CONGENITAL ANOMALY,
CONCERN ABOUT URINARY TRACT U85
APPEARANCE, EAR H15 congenital deafness H86
concern about body image A18 congenital deformity, foot L82
CONCERN ABOUT congenital dislocation, hip L82
BODY IMAGE RELATED congenital metabolic disorder T80
TO PREGNANCY W21 congenital rubella A74
concern about: see also FEAR CONGESTION, NASAL R07
OF CONCERN ABOUT congestion, sinuses R09
TREATMENT A13 congestive heart failure K77
CONCUSSION N79 CONJUNCTIVITIS, ALLERGIC F71
conduction disorders, heart K84 CONJUNCTIVITIS,
CONDYLOMATA INFECTIOUS F70
ACUMINATA, FEMALE X91 CONSTIPATION D12
CONDYLOMATA contact bleeding cervix XI3
ACUMINATA, MALE Y76 CONTACT LENS SYMPT/
CONGENITAL ANOMALY NOS A90 COMPLT F18
CONGENITAL ANOMALY, contact of infectious disease A23
BLOOD B79 CONTRACEPTION NOS W14
CONGENITAL ANOMALY, CONTRACEPTION,
CARDIOVASCULAR K73 INTRAUTERINE W12
CONGENITAL ANOMALY, contraception, male Y14
COMPLICATING PREGNANCY W76 CONTRACEPTION, ORAL W11
CONGENITAL ANOMALY, CONTRACEPTION,
DIGESTIVE D81 POST-COITAL W10
CONGENITAL ANOMALY, EAR H80 contractures L99
CONGENITAL ANOMALY, CONTUSION S16
ENDOCRINE/METABOLIC T80 CONTUSION, EYE F75
CONGENITAL ANOMALY, EYE F81 contusion, kidney U80
CONGENITAL ANOMALY, conversion disorder P75
FEMALE GENITAL X83 CONVULSION N07
CONGENITAL ANOMALY, cor pulmonale K82
LYMPH B79 CORN S20
CONGENITAL ANOMALY, corneal abrasion F79
MALE GENITAL Y84 corneal opacity F99
CONGENITAL ANOMALY, CORNEAL ULCER F85
MULTIPLE A90 coronary artery disease K76
CONGENITAL ANOMALY, coryza R74
MUSCULOSKELETAL L82 costochondritis L99
CONGENITAL ANOMALY, COUGH R05
NEUROLOGICAL N85 coughing blood R24
congenital anomaly, nose R89 cowpox A77
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Alphabetical index 173

Coxsackie disease A77 DEGENERATION, MACULAR F84

cracked lip D20 DEHYDRATION T11
cracked nipple in puerperium W95 delay in speech P22
crackling in ear H29 delayed menses, suggestive
cradle cap S86 of pregnancy W01
CRAMP, ABDOMINAL D01 delayed milestones P22
cramp, leg L14 delayed puberty T99
creeping eruption D96 delinquency, adolescent P23
cretinism T80 delirium P71
Crohn’s disease D94 delirium tremens P15
cross-eye F95 delivery, assisted, livebirth W92
croup R77 delivery, assisted, stillbirth W93
cruciate ligament damage L96 delivery, breech, livebirth W92
crying infant A16 delivery, breech, stillbirth W93
cryptorchidism Y83 DELIVERY, COMPLICATED,
culture shock P02 LIVEBIRTH W92
Cushing’s syndrome T99 DELIVERY, COMPLICATED,
cyanosis S08 STILLBIRTH W93
CYST, PILONIDAL S85 DELIVERY, UNCOMPLICATED,
CYST, SEBACEOUS S93 LIVEBIRTH W90
CYSTIC DISEASE, BREAST X88 DELIVERY, UNCOMPLICATED,
cystic fibroadenosis X88 STILLBIRTH W91
cystic fibrosis T99 delusions P29
CYSTITIS U71 DEMENTIA P70
cystocoele X87 dendritic ulcer F85
dacrocystitis F73 dengue fever A77
DAMAGE KNEE, dental abscess D82
ACUTE INTERNAL L96 denture problem D19
dandruff S86 DEPRESSIVE DISORDER P76
dark urine U07 dermatitis NOS S88
DEAFNESS H86 dermatitis artefacta S99
deafness one ear H28 DERMATITIS, ALLERGIC S88
DEATH A96 DERMATITIS, ATOPIC
DEATH OF CHILD Z19 ECZEMA S87
DEATH OF FAMILY MEMBER Z23 dermatitis, chemical S88
DEATH OF PARENT Z23 DERMATITIS, CONTACT S88
DEATH OF PARTNER Z15 dermatitis, eyelid F72
decubitus ulcer S97 DERMATITIS, SEBORRHOEIC S86
deep vein thrombosis K94 dermatomycosis S74
DEFORMITY OF LIMB, dermatomyositis L99
ACQUIRED L98 DERMATOPHYTOSIS S74
DEFORMITY OF SPINE, dermoid cyst S79
ACQUIRED L85 DETACHED RETINA F82
deformity, post-traumatic A82 deviated nasal septum R99
degeneration, facet joint L84 diabetes NOS T90
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174 WONCA International Classification of Primary Care

diabetes insipidus T99 DISCHARGE, VAGINAL X14

diabetes, affecting pregnancy W84 discoid lupus erythematosus S99
DIABETES, GESTATIONAL W85 discomfort, abdominal D01
DIABETES, INSULIN discomfort, epigastric D02
DEPENDENT T89 disease NOS A99
DIABETES, NON-INSULIN DISEASE ABSENT A97
DEPENDENT T90 disease, adenovirus A77
diabetes, type 1 T89 DISEASE, BLOOD, OTHER B99
diabetes, type 2 T90 DISEASE, CARDIOVASCULAR,
diabetic neuropathy N94 OTHER K99
diabetic retinopathy F83 disease carrier A99
diaphragmatic hernia D90 disease, coeliac D99
DIARRHOEA D11 DISEASE, DIGESTIVE
diarrhoea, presumed infective D73 SYSTEM, OTHER D99
dietary deficiency T91 DISEASE, DIVERTICULAR D92
DIGESTIVE SYMPT/COMPLT D29 DISEASE, EAR, OTHER H99
diphtheria R83 DISEASE, ENDOCRINE,
diplopia F05 OTHER T99
DISABILITY, BLOOD/ DISEASE, EYE, OTHER F99
LYMPH/SPLEEN B28 DISEASE, FEMALE
DISABILITY, CIRCULATORY K28 GENITAL, OTHER X99
DISABILITY, DIGESTIVE D28 DISEASE, GENERAL, OTHER A99
DISABILITY, EAR H28 DISEASE, HEART VALVE K83
DISABILITY, ENDOCRINE T28 disease, heart, atherosclerotic K76
DISABILITY, EYE F28 DISEASE, HEART, OTHER K84
DISABILITY, FEMALE DISEASE, HODGKIN’S B72
GENITAL X28 DISEASE, INFECTIOUS,
DISABILITY, GENERAL A28 OTHER A78
DISABILITY, MALE GENITAL Y28 DISEASE, LIVER D97
DISABILITY, METABOLIC T28 DISEASE, LYMPH, OTHER B99
DISABILITY, DISEASE, MALE GENITAL,
MUSCULOSKELETAL L28 OTHER Y99
DISABILITY, disease, male breast Y99
NEUROLOGICAL N28 DISEASE, MASTOID H99
DISABILITY, NUTRITIONAL T28 DISEASE, MOUTH/
DISABILITY, PREGNANCY W28 TONGUE/LIP D83
DISABILITY, DISEASE, MUSCULO-
PSYCHOLOGICAL P28 SKELETAL, OTHER L99
DISABILITY, RESPIRATORY R28 DISEASE, NEUROLOGICAL,
DISABILITY, SKIN S28 OTHER N99
DISABILITY, URINARY U28 DISEASE, OESOPHAGUS D84
disc degeneration/prolapse L86 DISEASE, PELVIC
DISCHARGE, EAR H04 INFLAMMATORY X74
DISCHARGE, EYE F03 disease, pericardium K84
discharge, nipple X20 DISEASE, RESPIRATORY,
DISCHARGE, URETHRAL Y03 OTHER R99
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Alphabetical index 175

DISEASE, SKIN, OTHER S99 dysfunction, adrenal T99

DISEASE, SPLEEN, OTHER B99 dysfunctional uterine bleeding X08
DISEASE, SWEAT GLAND S92 dyshidrosis S92
disease, unspecified nature or site A99 dyslexia P24
DISEASE, URINARY, OTHER U99 dysmenorrhoea X02
DISEASE, VIRAL, OTHER A77 dyspareunia, non-organic P08
DISLOCATION L80 dyspareunia, organic X04
DISORDER, SPEECH N19 DYSPEPSIA D07
DISORDER, STOMACH dysphagia D21
FUNCTION D87 dysphasia N19
disorientation P20 dysplasia, breast X88
disproportion W84 dysplasia, cervical X85/X86
disseminated sclerosis N86 DYSPNOEA R02
distress, respiratory R04 dystocia W92/W93
disturbance of concentration P20 dystonia N08
DISTURBANCE SMELL/TASTE N16 DYSURIA U01
DISTURBANCE, SLEEP P06 EAR INJURY H79
diverticulitis, intestine D92 EAR SYMPT/COMPLT,
diverticulosis, intestine D92 OTHER H29
diverticulum, bladder U99 EAR WAX, EXCESSIVE H81
diverticulum, oesophagus D84 EAR, BUZZING H03
divorce Z15 EAR, PLUGGED FEELING H13
Down’s syndrome A90 EAR, RINGING H03
dribbling D20 EARACHE H01
dribbling urine U05 eating disorder NOS P29
drop attack K89 EATING PROBLEM
dropsy K07 IN CHILD P11
drowning A88 ecchymosis S16
drowsy A29 echo in ear H03
DRUG ABUSE P19 eclampsia W81
drunk P16 ectopic beat K80
dry eye F13 ECTOPIC PREGNANCY W80
dry mouth D20 ectropion F99
dry scalp S24 eczema NOS S88
dry skin S21 ECZEMA, ATOPIC S87
dry throat R21 eczema, external auditory
dry vagina X15 meatus H70
dry vulva X16 EDUCATION PROBLEM Z07
dumping syndrome D99 EFFECT OF PROSTHETIC
duodenitis D87 DEVICE A89
duplex kidney/ureter U85 effusion of joint L20
Dupuytren’s contracture L87 ELBOW SYMPT/COMPLT L10
dwarfism T80 electrolyte disorder A91
dysarthria N19 emesis D10
dysentery NOS D73 emotional abuse, partner Z12
dysentery, specified organism D70 emphysema R95
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empty nest syndrome P25 EYE MOVEMENTS

empyema R83 ABNORMAL F14
ENCEPHALITIS N71 EYE SENSATIONS ABNORMAL F13
ENCOPRESIS P13 eye strain F05
endarteritis K92 EYE SYMPT/COMPLT, OTHER F29
endocarditis, acute/subacute K70 EYE, RED F02
endocarditis, chronic K83 EYELID SYMPT/COMPLT F16
ENDOCRINE DISEASE NOS T99 faecal impaction D12
ENDOCRINE SYMPT/ faecal incontinence D17
COMPLT, OTHER T29 FAECES, CHANGE D18
endometrial polyp X99 failure to thrive T10
endometriosis X99 FAINTING A06
endometritis X74 Fallet’s tetralogy K73
ENTERITIS, CHRONIC D94 falls A29
entropion F99 false teeth problem D19
ENURESIS P12 family history of
enuresis, organic U04 cardiovascular disease K22
environmental problem Z29 family history of disease NOS A23
eosinophilia B84 family history of malignancy A21
epicondylitis, lateral L93 family planning NOS W14
epididymal cyst Y99 family planning, IUD W12
EPIDIDYMITIS Y74 family planning, male Y14
epiglottitis R83 family planning sympt/complt W29
EPILEPSY N88 family planning, oral W11
episcleritis F99 FAMILY PLANNING, OTHER Y14
EPISTAXIS R06 FAMILY RELATIONSHIP
eructation D08 PROBLEM Z20
erysipelas S76 fasciitis L87
erythema multiforme S99 fatigue A04
erythema nodosum S99 fatty liver D97
erythema, generalized S07 FEAR OF AIDS B25
erythema, localized S06 fear of attempting suicide P27
ESR raised B99 fear of blindness F27
essential hypertension K86 FEAR OF BREAST
eustachian block H73 CANCER, FEMALE X26
EUSTACHIAN SALPINGITIS H73 FEAR OF CANCER NOS A26
EUTHANASIA, REQUEST/ FEAR OF CANCER OF
DISCUSSION A20 BLOOD/LYMPH SYSTEM B26
exhaustion A04 FEAR OF CANCER OF
extrasystoles K80 BREAST FEMALE X26
EYE APPEARANCE FEAR OF CANCER OF
ABNORMAL F15 DIGESTIVE SYSTEM D26
eye, circle under S08 FEAR OF CANCER OF
eye colour change F15 ENDOCRINE SYSTEM T26
EYE INFECTION/ FEAR OF CANCER OF
INFLAMMATION, OTHER F73 GENITAL SYSTEM, FEMALE X25
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FEAR OF CANCER OF FEAR OF MENTAL DISORDER P27

GENITAL SYSTEM, MALE Y26 FEAR OF METABOLIC
FEAR OF CANCER DISEASE T27
OF MUSCULOSKELETAL FEAR OF PREGNANCY W02
SYSTEM L26 FEAR OF SEXUAL
FEAR OF CANCER OF DYSFUNCTION, FEMALE X24
NEUROLOGICAL SYSTEM N26 FEAR OF SEXUAL
FEAR OF CANCER OF DYSFUNCTION, MALE Y24
RESPIRATORY SYSTEM R26 FEAR OF SEXUALLY
FEAR OF CANCER OF SKIN S26 TRANSMITTED DISEASE,
FEAR OF CANCER OF FEMALE X23
URINARY SYSTEM U26 FEAR OF SEXUALLY
FEAR OF COMPLICATIONS TRANSMITTED DISEASE,
OF PREGNANCY W27 MALE Y25
fear of congenital anomaly of baby W27 FEAR OF SOCIAL PROBLEM Z27
fear of deafness H27 fear of suicide attempt P27
FEAR OF DEATH/DYING A25 FEAR OF TREATMENT A13
fear of diabetes T27 febrile convulsion N07
FEAR OF DISEASE NOS A27 feeding behaviour problem, child P11
FEAR OF DISEASE OF FEEDING PROBLEM, ADULT T05
BLOOD/LYMPH SYSTEM B27 FEEDING PROBLEM, CHILD T04
FEAR OF DISEASE OF FEEDING PROBLEM, INFANT T04
CARDIOVASCULAR SYSTEM K27 FEELING ANXIOUS P01
FEAR OF DISEASE OF FEELING DEPRESSED P03
DIGESTIVE SYSTEM D27 feeling faint N17
FEAR OF DISEASE OF EAR H27 feeling frightened P01
FEAR OF DISEASE OF FEELING ILL A05
ENDOCRINE SYSTEM T27 feeling inadequate P03
FEAR OF DISEASE OF EYE F27 FEELING IRRITABLE/ANGRY P04
FEAR OF DISEASE OF FEELING NERVOUS P01
GENITAL SYSTEM, FEMALE X27 FEELING TENSE P01
FEAR OF DISEASE OF FEELING/BEHAVING OLD P05
GENITAL SYSTEM, MALE Y27 female circumcision X82
FEAR OF DISEASE OF HEART K24 FEVER A03
FEAR OF DISEASE fever blister S71
OF MUSCULOSKELETAL fever with rash A76
SYSTEM L27 fever, dengue A77
FEAR OF DISEASE OF fever, glandular A75
NEUROLOGICAL SYSTEM N27 FEVER, RHEUMATIC K71
FEAR OF DISEASE OF fever, Ross River A77
RESPIRATORY SYSTEM R27 fever, scarlet A78
FEAR OF DISEASE OF SKIN S27 fever, typhoid D70
FEAR OF DISEASE OF FIBRILLATION, ATRIAL K78
URINARY SYSTEM U27 fibroadenoma X79
fear of heart attack K24 FIBROCYSTIC DISEASE
FEAR OF HYPERTENSION K25 BREAST X88
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fibroid uterus X78 FOREIGN BODY, LARYNX R87

fibromyalgia L18 foreign body, mouth D79
fibromyoma of cervix X78 FOREIGN BODY, NOSE R87
FIBROMYOMA UTERUS X78 foreign body, oesophagus D79
fibrosarcoma L71 foreign body, rectum D79
fibrositis L18 FOREIGN BODY, SKIN S15
fifth disease A76 foreign body, urinary tract U80
FINANCIAL PROBLEM Z01 foreign body, vagina X82
FINGER SYMPT/COMPLT L12 foreskin sympt/complt Y04
fissure of nipple X20 FRACTURE NOS L76
FISSURE, ANAL D95 fracture due to osteoporosis L95
fistula, anal D95 fracture, carpal bone L74
fistula, arteriovenous K99 FRACTURE, FEMUR L75
FISTULA, PILONIDAL S85 FRACTURE, FIBULA L73
fit (seizure) N07 FRACTURE, HAND/FOOT BONE L74
FLANK SYMPT/COMPLT L05 fracture, malunion or non-union L99
flash burn F79 fracture, metatarsal bone L74
flatfoot L98 fracture, neck of femur L75
FLATULENCE D08 fracture, phalange L74
flea infestation S73 FRACTURE, RADIUS L72
flexural dermatitis S87 fracture, tarsal bone L74
floating spots in vision F04 FRACTURE, TIBIA L73
fluid on lung R29 FRACTURE, ULNA L72
fluid retention K07 freckles S08
fluor vaginalis X14 frigidity P07
flushing S08 frozen shoulder L92
FLUTTER, ATRIAL K78 fullness, epigastric D02
focal seizure N88 fungal respiratory infection R83
foetus small for age W84 fungal skin infection S74
folliculitis S10 furuncle S10
food allergy A92 furuncle, external auditory meatus H70
FOOD AND WATER PROBLEM Z02 gait abnormality N29
food craving T29 galactorrhoea, lactating W19
food intolerance D99 galactorrhoea, non-lactating X21
food poisoning D73 gallstone D98
FOOT AND TOE SYMPT/ ganglion L87
COMPLT L17 gangrene K92
foreign body swallowed D79 gardnerella vaginitis X84
foreign body under nail S15 gas pain D08
FOREIGN BODY, BRONCHUS R87 gaseous distension D08
foreign body, deep L81 gastric erosion, acute D86
FOREIGN BODY, DIGESTIVE gastric flu D73
SYSTEM D79 gastric ulcer D86
FOREIGN BODY, EAR H76 gastritis (incl alcoholic) D87
FOREIGN BODY, EYE F76 GASTROENTERITIS,
FOREIGN BODY, INHALED R87 PRESUMED INFECTION D73
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GASTROINTESTINAL Guillain–Barre syndrome N94

INFECTION, SPECIFIED gynaecomastia Y16
ORGANISM D70 HAEMANGIOMA S81
GASTROINTESTINAL haemarthrosis L81
DISEASE, OTHER D99 HAEMATEMESIS D14
gastrojejunal ulcer D86 haematological abnormality NOS B99
gastrostomy A89 haematoma S16
GENERAL SYMPT/COMPLT, haematoma, extradural N80
OTHER A29 HAEMATURIA U06
generalized seizure N88 HAEMOLYTIC ANAEMIA B78
genetic counselling, female W14 haemophilia B83
genetic counselling, male Y14 HAEMOPTYSIS R24
GENITAL HERPES, FEMALE X90 HAEMORRHAGE NOS A10
GENITAL HERPES, MALE Y72 haemorrhage in pregnancy W03
GENITAL SYMPT/COMPLT, HAEMORRHAGE, EYE F75
FEMALE, OTHER X29 haemorrhage, post-partum W17
GENITAL SYMPT/COMPLT, haemorrhage, post-operative A87
MALE, OTHER Y29 HAEMORRHOID K96
genital tract fistula X99 HAIR LOSS S23
GENITAL TRICHOMONIASIS X73 HAIR SYMPT/COMPLT,
genu recurvatum L82 OTHERS S24
genu valgum/varum L98 halitosis D20
giardia enteritis D70 hallucination P29
giddiness N17 hallux valgus/varus L98
Gilberts syndrome T99 HAND SYMPT/COMPLT LI2
gingivitis D82 hand, foot, mouth disease A77
glandular fever A75 HARMFUL EVENT Z25
GLASSES SYMPT/COMPLT F17 hay fever R97
GLAUCOMA F93 head cold R74
GLOMERULONEPHRITIS U88 HEAD INJURY N80
glomerulonephritis, acute U88 HEADACHE N01
glossitis D83 HEADACHE, CLUSTER N90
glue ear H72 HEADACHE, TENSION N95
glycosuria U98 HEALTH CARE PROBLEM Z10
GOITRE T81 HEALTH MAINTENANCE A98
GONORRHOEA, FEMALE X71 HEARING COMPLAINT H02
GONORRHOEA, MALE Y71 heart block K84
GOUT T92 heart disease NOS K84
grand mal N88 heart disease, arteriosclerotic K76
granuloma S99 HEART FAILURE K77
granuloma annulare S99 heart murmur K81
Graves disease T85 HEART PRESSURE K02
graze S17 heart trouble K29
grief P02 heart valve prosthesis problem A89
growing pains in child L29 HEART, AWARENESS OF K04
GROWTH DELAY T10 HEARTBURN D03
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heat rash S92 hyperaldosteronism T99

heat stroke A88 hyperemesis D10
Heberden’s nodes L91 hyperemesis of pregnancy W05
hepatitis NOS D97 hyperglycaemia A91
hepatitis, chronic active D72 hyperhidrosis A09
HEPATITIS, VIRAL D72 hyperinsulism T87
HEPATOMEGALY D23 hyperkeratosis NOS S99
hermaphroditism X83 hyperkeratosis, solar S80
hermaphroditism Y84 HYPERKINETIC DISORDER P81
HERNIA, ABDOMINAL OTHER D91 hyperlipidaemia T93
hernia, femoral D91 hypermetropia F91
HERNIA, HIATUS D90 hyperplasia of prostate Y85
hernia, incisional D91 hypersplenism B99
HERNIA, INGUINAL D89 HYPERTENSION,
hernia, umbilical D91 COMPLICATED K87
hernia, ventral D91 hypertension, essential K86
HERPES GENITAL, FEMALE X90 hypertension, labile K85
HERPES GENITAL, MALE Y72 hypertension of pregnancy W81
HERPES SIMPLEX S71 hypertension, pulmonary K82
herpes simplex, eye, without hypertension, transient K85
corneal ulcer F73 HYPERTENSION,
HERPES ZOSTER S70 UNCOMPLICATED K86
herpes zoster, ophthalmic F73 hypertensive encephalopathy K87
herpes, anogenital, female X90 hypertensive heart failure K87
herpes, anogenital, male Y72 hypertensive nephrosclerosis K87
hiccough R29 hypertensive renal disease K87
HIP SYMPT/COMPLT L13 hypertensive retinopathy F83
Hirschprung’s disease D81 HYPERTHYROIDISM T85
hirsutism S24 hypertrophy, kidney U99
HIV INFECTION B90 HYPERTROPHY, TONSILS/
hives S98 ADENOIDS R90
hoarseness R23 HYPERVENTILATION
HODGKIN’S DISEASE B72 SYNDROME R98
homesick P02 hyphaema F75
hordeolum F72 hypochondriacal disorder P75
HOUSING PROBLEM Z03 HYPOGLYCAEMIA T87
human papilloma virus infection X91 hypomania P73
hydatid disease D96 HYPOSPADIAS Y82
hydatidiform mole W73 HYPOTENSION, POSTURAL K88
hydradenitis S92 HYPOTHYROIDISM T86
hydramnios W84 hysteria P75
hydrocephalus N85 ichthyosis S83
HYDROCOELE Y86 icterus D13
hydronephrosis U99 idiopathic hypertension K86
hygiene poor P29 ileus D99
hyperactivity P81 illegitimate pregnancy Z04
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illiteracy Z07 INFECTIOUS DISEASE, OTHER A78

ILLNESS PROBLEM Z11 INFECTIOUS
ILLNESS PROBLEM, CHILD Z18 MONONUCLEOSIS A75
ILLNESS PROBLEM, FAMILY Z22 infective tenosynovitis L70
ILLNESS PROBLEM, PARENT Z22 INFERTILITY, FEMALE W15
ILLNESS PROBLEM, INFERTILITY, MALE Y10
PARTNER Z14 INFESTATION, SKIN S73
immunization reaction A87 infidelity Z13
immunodeficiency disorder B99 inflamed eye F02
imperforate hymen X83 inflamed throat R21
IMPETIGO S84 INFLAMMATION OF EYE F73
IMPOTENCE, ORGANIC Y07 INFLUENZA R80
impotence, psychogenic P08 influenzal pneumonia R81
INCONTINENCE BOWEL D17 ingrowing eyelash F99
INCONTINENCE URINE U04 INJURY NOS A80
INDIGESTION D07 injury, knee, acute internal L96
induction of labour W92/W93 injury, abdominal organ D80
infantile eczema S87 INJURY BLOOD/LYMPH/
INFECTED FINGER/TOE S09 SPLEEN, OTHER B77
infected post-traumatic injury, childbirth W92/W93
wound/bite S11 INJURY, COMPLICATING
infection, chest R78 PREGNANCY W75
INFECTION, CIRCULA- INJURY, DIGESTIVE
TORY SYSTEM K70 SYSTEM D80
INFECTION, INJURY, EAR, DEEP H79
COMPLICATING injury, ear, external H78
PREGNANCY W71 INJURY, EYE F79
infection, complication of INJURY, GENITAL,
treatment A87 FEMALE X82
INFECTION, ENDOCRINE T70 INJURY, GENITAL, MALE Y80
INFECTION, EYE NOS F73 INJURY, HEAD N80
infection, eyelid F72 INJURY, MULTIPLE A81
infection, lower urinary U71 INJURY, MUSCULO-
INFECTION, SKELETAL, NOS L81
MUSCULOSKELETAL L70 INJURY, NERVOUS SYSTEM,
INFECTION, OTHER N81
NEUROLOGICAL, OTHER N73 injury, pinna H78
infection, nose, localized R73 INJURY, RESPIRATORY R88
infection, post-operative A87 INJURY, SKIN, OTHER S19
INFECTION, RESPIRATORY, injury, teeth D80
OTHER R83 injury, tongue D80
infection, skin fungus S74 INJURY, URINARY TRACT U80
INFECTION, SKIN, OTHER S76 insect toxicity A86
INFECTION, SKIN, insomnia P06
POST-TRAUMATIC S11 insulin coma T87
infectious disease, contact of A23 intermittent claudication K92
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internal derangement of knee L99 kyphoscoliosis L85

internal injury A81 kyphosis L85
intertrigo S88 labile hypertension K85
intestinal obstruction D99 labour W90/W91
intestinal parasite D96 labour, complicated W92/W93
intolerance of food D99 labyrinthitis H82
intraocular pressure raised F93 LACERATION/CUT S18
intussuception D99 laceration, cervix, old X85
INVESTIGATION ABNORMAL A91 LACRIMAL DUCT
iridocyclitis F73 BLOCKED, INFANT F80
iritis F73 lacrimation F03
iron deficient, no anaemia T91 LACTATION SYMPT/
IRON DEFICIENCY ANAEMIA B80 COMPLT W19
IRREGULAR HEARTBEAT K05 lactose intolerance T99
irritable bladder U13 large tonsils R21
IRRITABLE BOWEL LARYNGITIS, ACUTE R77
SYNDROME D93 laryngotracheobronchitis R78
IRRITABLE INFANT A16 lassitude A04
ischaemia, limb K92 late onset diabetes T90
ISCHAEMIA,TRANSIENT lazy eye F14
CEREBRAL K89 lead poisoning A86
ISCHAEMIC HEART DISEASE, LEARNING PROBLEM,
WITH ANGINA K74 SPECIFIC P24
ISCHAEMIC HEART DISEASE, left bundle branch block K84
WITHOUT ANGINA K76 left ventricular failure K77
ITCH S02 leg cramp L14
itch, ear H29 LEG SYMPT/COMPLT L14
itch, eye F13 LEGAL PROBLEM Z09
ITCH, PERIANAL D02 Legg–Calve–Perthes disease L94
JAUNDICE D13 Legionnaire’s disease R81
JAW SYMPT/COMPLT L07 lesion of skin S29
jealousy, child P22 lethargy A04
jerking N08 LEUKAEMIA B73
jetlag A88 leukocytosis B84
joint replacement problem A89 leukoplakia, cervical X85
JOINT SYMPT/COMPLT NOS L20 leukorrhoea X14
juvenile arthritis L88 lice infestation S73
juvenile onset diabetes T89 lichen planus S99
keloid S99 lightheaded N17
keratitis F73 lightning strike A88
keratoacanthoma S99 limping N29
KERATOSIS, SOLAR S80 LIP SYMPT/COMPLT D20
KIDNEY SYMPT/COMPLT U14 LIPID DISORDER T93
knee damage, chronic internal L99 LIPOMA S78
knee meniscus damage, acute L96 liver failure D97
KNEE SYMPT/COMPLT L15 living alone Z28
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loin pain L05 LYMPHOMA B72

lonely P03 MACULAR DEGENERATION F84
long sighted F91 malabsorption syndrome D99
lordosis L85 malaise A05
LOSS OF APPETITE T03 MALARIA A73
loss of balance N17 malformations skull/face L82
loss of libido P07 MALIGNANCY NOS A79
loss of voice R23 malignant hypertension K87
LOSS/DEATH OF CHILD Z19 malignant: see NEOPLASM,
LOSS/DEATH OF FAMILY MALIGNANT
MEMBER Z23 malingering Z29
LOSS/DEATH OF PARENT Z23 malnutrition T91
LOSS/DEATH OF PARTNER Z15 mallet finger L98
LOW BACK SYMPT/COMPLT L03 Mallory–Weiss syndrome D84
low blood pressure K29 malocclusion D82
low self-esteem P28 malpresentation W84
lumbago L03 malunion of fracture L99
lumbalgia L03 mania P73
lump NOS A08 manic depression P73
lump, abdomen D24 marasmus T91
lump, testis Y05 Marfan’s syndrome A90
lump, throat R21 marginal peptic ulcer D86
LUMP, BREAST, FEMALE X19 marital problem Z12
lump, breast, male Y16 mass: see lump mastitis (lactating) W94
LUMP/SWELLING, mastitis (non-lactating) X21
GENERALIZED S05 mastodynia X18
LUMP/SWELLING, mastoiditis H74
LOCALIZED S04 mastopathy X21
LUMPS/SWELLINGS, MEASLES A71
multiple sites S05 meatitis U72
lung abscess R83 Meckel’s diverticulum D81
lung congestion R29 median bar of prostate Y85
lyme disease A78 mediastinal disease R99
LYMPH DISEASE, OTHER B99 MEDICATION ABUSE P18
LYMPH GLAND(S) meibomian cyst F72
ENLARGED/PAINFUL B02 MELAENA D15
LYMPH/SPLEEN SYMPT/ melanoma, malignant S77
COMPLT, OTHER B29 MEMORY DISTURBANCE P20
LYMPHADENITIS, ACUTE B70 Meniere’s disease H82
LYMPHADENITIS, CHRONIC meningioma N75
NON-SPECIFIC B71 meningism N29
lymphadenopathy B02 MENINGITIS N71
LYMPH ANGIOMA S81 meningococcal infection A78
lymphangitis, acute S76 MENOPAUSAL SYMPT/
lymphocytosis B84 COMPLT X11
lymphoedema K99 menorrhagia X06
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MENSTRUATION ABSENT/ MURMUR, ARTERIAL/HEART K81

SCANTY X05 muscle stiffness L19
MENSTRUATION EXCESSIVE X06 muscle strain L19
MENSTRUATION MUSCLE SYMPT/COMPLT L19
POSTPONEMENT X10 MUSCULOSKELETAL
MENSTRUATION, SYMPT/COMPLT, OTHER L29
IRREGULAR/FREQUENT X07 myalgia L18
mental illness NOS P99 myasthenia gravis N99
MENTAL RETARDATION P85 mycoplasma A78
mesenteric lymphadenitis B71 myeloproliferative disease B74
mesenteric vascular disease D99 MYOCARDIAL INFARCTION,
mesothelioma R85 ACUTE K75
METABOLIC DISEASE, myocardial infarction, old K76
OTHER T99 myocardial ischaemia K76
METABOLIC SYMPT/ myocarditis K70
COMPLT, OTHER T29 myoclonus N08
metastatic malignancy NOS A79 myoma uterus X78
metatarsalgia L17 myopia F91
metrorrhagia X08 myositis L99
mid-life crisis P25 MYRINGITIS, ACUTE H71
MIGRAINE N89 MYXOEDEMA T86
miliaria S92 NAEVUS S82
miscarriage W82 NAIL SYMPT/COMPLT S22
mite infestation S73 NAIL, INGROWING S94
mitral stenosis K71 napkin rash S89
mitral valve disease K83 nasal congestion R07
mittelschmerz X03 nasal polyp R99
MOLE S82 nasopharyngitis, acute R74
MOLLUSCUM nasopharyngitis, chronic R83
CONTAGIOSUM S95 NAUSEA D09
MONILIASIS: nausea of pregnancy W05
see CANDIDIASIS NECK SYMPT/COMPLT L01
morning after pill W10 NECK SYNDROME L83
morning sickness, pregnancy W05 needle stick injury S19
motion sickness A88 NEIGHBOURHOOD
motor neurone disease N99 PROBLEM Z03
MOUTH SYMPT/COMPLT D20 NEOPLASM,
MOVEMENTS ABNORMAL N08 CARDIOVASCULAR K72
mucocoele lip, mouth D83 NEOPLASM, EAR H75
mucous colitis D93 NEOPLASM, ENDOCRINE,
mucous polyp, cervical X85 OTHER T73
multiple myeloma B74 NEOPLASM, EYE/ADNEXA F74
multiple pregnancy W84 NEOPLASM, GENITAL
MULTIPLE SCLEROSIS N86 OTHER/UNCERTAIN X81
MUMPS D71 NEOPLASM, UNCERTAIN
Munchhausen’s syndrome P80 NATURE, NERVOUS SYSTEM N76
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NEOPLASM, UNCERTAIN NEOPLASM MALIGNANT,

NATURE, RESPIRATORY R92 DIGESTIVE, OTHER D77
NEOPLASM, URINARY NEOPLASM MALIGNANT,
TRACT NOS U79 GENITAL, FEMALE X77
NEOPLASM BENIGN, BREAST X79 NEOPLASM MALIGNANT,
neoplasm benign, breast, male Y79 GENITAL, MALE Y78
NEOPLASM BENIGN, NEOPLASM MALIGNANT,
GENITAL, FEMALE X80 KIDNEY U75
NEOPLASM BENIGN, neoplasm malignant, liver D77
NERVOUS SYSTEM N75 NEOPLASM MALIGNANT,
NEOPLASM BENIGN, LUNG R84
RELATED TO PREGNANCY W73 NEOPLASM MALIGNANT,
NEOPLASM BENIGN, MUSCULOSKELETAL L71
RESPIRATORY R86 NEOPLASM MALIGNANT,
NEOPLASM BENIGN, NERVOUS SYSTEM N74
THYROID T72 NEOPLASM MALIGNANT,
NEOPLASM BENIGN, PANCREAS D76
URINARY TRACT U78 NEOPLASM MALIGNANT,
NEOPLASM BENIGN/ PROSTATE Y77
UNCERTAIN, BLOOD/ NEOPLASM MALIGNANT,
LYMPH/SPLEEN B75 RELATED TO PREGNANCY W72
NEOPLASM BENIGN/ NEOPLASM MALIGNANT,
UNCERTAIN, DIGESTIVE D78 RESPIRATORY, OTHER R85
NEOPLASM BENIGN/ NEOPLASM MALIGNANT,
UNCERTAIN, MALE GENITAL Y79 SKIN S77
NEOPLASM NEOPLASM MALIGNANT,
BENIGN/UNCERTAIN, STOMACH D74
MUSCULOSKELETAL L97 ovulation bleeding X08
NEOPLASM BENIGN/ ovulation pain X03
UNCERTAIN, RELATED Paget’s disease of bone L99
TO PREGNANCY W73 pain NOS A29
NEOPLASM BENIGN/ PAIN, ABDOMINAL,
UNCERTAIN, SKIN S79 GENERAL D01
NEOPLASM MALIGNANT, PAIN, ABDOMINAL,
BLADDER U76 LOCALIZED D06
NEOPLASM MALIGNANT, PAIN, BACK NOS L02
BLOOD, OTHER B74 PAIN, BREAST, FEMALE X18
NEOPLASM MALIGNANT, PAIN, CARDIOVASCULAR
BREAST, FEMALE X76 NOS K03
neoplasm malignant, breast, male Y78 PAIN, CHEST NOS A11
NEOPLASM MALIGNANT, pain, chest, musculoskeletal L04
BRONCHUS R84 pain, colon D06
NEOPLASM MALIGNANT, PAIN, EAR H01
CERVIX X75 PAIN, EPIGASTRIC D02
NEOPLASM MALIGNANT, PAIN, EYE F01
COLON/RECTUM D75 PAIN, FACE N03
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PAIN, GENERAL A01 PARTNER RELATIONSHIP

PAIN, GENITAL, FEMALE X01 PROBLEM Z12
pain, head N01 passing wind D08
PAIN, HEART K01 past history of malignancy A21
PAIN, INTERMENSTRUAL X03 patella disorder L99
pain, joint L20 patent ductus arteriosa K73
PAIN, LYMPH GLAND(S) B02 pathological fracture NOS L99
PAIN, MENSTRUAL X02 PEDICULOSIS S73
PAIN, MUSCLE L18 peeling skin S21
pain, nose R08 pelvic congestion syndrome X99
PAIN, PENIS Y01 PELVIC INFLAMMATORY
PAIN, RECTAL/ANAL D04 DISEASE X74
PAIN, RESPIRATORY SYSTEM R01 pelvic instability W28
pain, sinuses R09 pelvic pain, female X01
PAIN, SKIN TENDERNESS S01 pelvic pain, male Y02
PAIN, TESTIS/SCROTUM Y02 PELVIS SYMPT/COMPLT,
PAINFUL INTERCOURSE X04 FEMALE X17
painful lesion or rash S01 PENIS SYMPT/COMPLT Y04
painful respiration R01 peptic ulcer D86
PAINFUL URINATION U01 perforated duodenal ulcer D85
pallor S08 PERFORATION, EAR DRUM H77
PALPITATIONS OF HEART K04 perianal haematoma K96
pancreatic diseases D99 perianal pruritis D05
panic disorder P74 pericarditis K70
panniculitis L18 PERINATAL MORBIDITY A94
PAP SMEAR ABNORMAL X86 PERINATAL MORTALITY A95
papilloedema F99 perineal pain, male Y02
papilloma, bladder U78 perinephric abscess U70
papule S04 peripheral neuropathy N94
papules S05 PERIPHERAL VASCULAR
para-influenza R80 DISEASE K92
paraesthesia N06 peritonitis D99
PARALYSIS N18 peritonsillar abscess R76
paralysis agitans N87 PERSONALITY DISORDER P80
PARALYSIS, FACIAL N91 perspiration problem A09
paranoia P72 pertussis R71
parapertussis R71 pes planus L98
paraphimosis Y81 petechiae S29
parathyroid dysfunction T99 petit mal N88
paresis N18 phantom limb N94
Parkinson’s disease N87 pharyngitis, acute R74
PARKINSONISM N87 pharyngitis, chronic R83
paronychia S09 PHASE OF LIFE PROBLEM,
parotitis D83 ADULT P25
partner abuse, emotional Z12 PHIMOSIS Y81
partner abuse, physical Z25 PHLEBITIS K94
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phlebothrombosis K94 polyp, endometrial X99

PHOBIA P79 polyp of rectum D78
photophobia F05 polyp of urinary tract U78
photosensitivity S80 polyphagia T02
physical abuse, partner Z25 polyuria U02
physiological delay T10 pompholyx S92
pigmentation skin S08 poor compliance Z11
piles K96 popping ear H29
pilonidal abscess S85 porphyria T99
pimple S96 portal hypertension D97
pituitary dysfunction T99 portal thrombosis K94
PITYRIASIS ROSEA S90 portwine stain S81
pityriasis versicolor S74 post-concussion effect N79
placenta praevia, in pregnancy W84 post-herpetic neuralgia S70
placenta praevia, in delivery W92/W93 post-nasal drip R08
plant sting S88 post-natal depression P76
plant toxicity A86 post-partum haemorrhage W17
PLEURISY/PLEURAL POST-PARTUM SYMPT/
EFFUSION R82 COMPLT W18
pleuritic pain R01 post-polio syndrome N70
pleurodynia R01 post-traumatic headache N01
pneumoconiosis R99 post-traumatic stress, acute P02
PNEUMONIA R81 POST-TRAUMATIC STRESS
pneumonia, aspiration R99 DISORDER P82
pneumonitis, allergic R99 post-viral fatigue A04
pneumonitis, chemical R99 postural vertigo H82
pneumonitis, infective R81 Pott’s fracture L73
pneumonitis, mould R99 POVERTY Z01
pneumothorax R99 pyoderma S76
poisoning by pyogenic arthritis L70
animal/insect/plant A86 pyrexia A03
POISONING BY pyuria U98
MEDICATION A84 Q fever A78
POLIOMYELITIS N70 query pregnant W01
pollution of environment Z29 quinsy R76
polyarteritis nodosa K99 radiation complication A87
polycystic kidney, congenital U85 radiation skin damage S80
polycythaemia rubra vera B75 radicular syndrome of upper limb L83
polycythaemia, secondary B99 raised cholesterol/triglyceride T93
polydipsia T01 rape Z25
polymenorrhoea X07 RASH, DIAPER S89
polymorphous light eruption S80 RASH, GENERALIZED S07
polymyalgia rheumatica L99 RASH, LOCALIZED S06
polyp of colon D78 Raynaud’s syndrome K92
polyp of duodenum D78 reaction to immunization A87
polyp of ear H99 reaction to transfusion A87
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reactive airways disease R96 RHEUMATIC HEART DISEASE K71

reactive depression P76 rheumatism L18
reactive psychosis P98 rhinitis, acute R74
reading difficulty F05 rhinitis, allergic R97
rectocoele X87 rhinitis, chronic R83
RED EYE F02 rhinitis, vasomotor R97
red nose R08 rhinophyma S99
red throat R21 rhinorrhea R07
redness, skin, localized S06 rickettsial disease A78
redness, skin, multiple sites S07 right bundle branch block K84
reduced lung function R28 right ventricular failure K77
REDUNDANT PREPUCE Y81 rigor A02
reflux D84 ringworm S74
REFRACTIVE ERROR F91 RISK FACTOR NOS A23
regional enteritis D94 RISK FACTOR,
Reiter’s disease L99 CARDIOVASCULAR
RELATIONSHIP PROBLEM, DISEASE K22
CHILD Z16 RISK FACTOR, MALIGNANCY A21
RELATIONSHIP PROBLEM, road traffic accident A80
FRIEND Z24 rodent ulcer S77
RELATIONSHIP PROBLEM, rosacea S99
PARENT/FAMILY Z20 roseola infantum A76
RELATIONSHIP PROBLEM, Ross River fever A77
PARTNER Z12 rotator cuff syndrome L92
renal artery bruit K81 RUBELLA A74
renal calculus U95 running nose R07
renal colic U14 rupture of ear drum H79
renal failure U99 rupture tendon, spontaneous L99
renal glycosuria T99 salivary calculus D83
renal transplant U28 salmonella enteritis D70
residual haemorrhoidal skin tag K96 salpingitis X74
respiratory distress R04 sarcoidosis B99
respiratory failure R99 SCABIES AND OTHER
respiratory infection, acute lower R78 ACARIASES S72
respiratory infection, acute upper R74 SCALD S14
RESPIRATORY SYMPT/ scaling skin S21
COMPLT, OTHER R29 SCALP SYMPT/COMPLT S24
restless infant A16 scar S99
RESTLESS LEGS N04 scarlet fever A78
restlessness P04 Scheuermann’s disease L94
retching D10 SCHIZOPHRENIA P72
RETINOPATHY F83 sciatica L86
retirement problem P25 scleritis F99
retractile testis Y84 scleroderma L99
retraction of nipple X20 scoliosis L85
RHEUMATIC FEVER K71 scotoma F05
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SCRATCH S17 skin allergy S88

SCROTUM SYMPT/COMPLT Y05 SKIN COLOUR CHANGE S08
scurvy T91 skin irritation S02
SEBORRHOEIC DERMATITIS S86 skin laceration S18
seborrhoeic wart S99 skin lesion S29
secondary megacolon D99 SKIN SYMPT/COMPLT, OTHER S29
SEIZURE N07 SKIN TEXTURE SYMPT/
seizure, epileptic N88 COMPLT S21
self-esteem low P28 sleep apnoea P06
SEMINAL VESICULITIS Y73 sleep problem P06
seminoma Y78 sleepwalking P06
senescence P05 slipped femoral epiphysis L94
senile dementia P70 slow urinary stream U28
senile keratosis S80 slow virus infection N73
senile vaginitis X11 slurred speech N19
senile wart S99 SMELL DISTURBANCE N16
SENILITY P05 smoking problem PI7
SENSATION DISTURBANCE N06 snake venom toxicity A86
separation of partners Z15 SNEEZING R07
sexual attack Z25 snoring R04
SEXUAL DESIRE REDUCED P07 snowblindness F79
SEXUAL FULFILMENT SOCIAL HANDICAP Z28
REDUCED P08 social isolation Z28
SEXUAL FUNCTION SYMPT/ SOCIAL PROBLEM NOS Z29
COMPLT, MALE Y08 SOCIAL WELFARE PROBLEM Z08
SEXUAL PREFERENCE SOCIAL/CULTURAL
CONCERN P09 PROBLEM Z04
sexually transmitted disease NOS A78 SOLAR KERATOSIS S80
shaking N08 SOMATIZATION DISORDER P75
shigella enteritis D70 somnolence P06
shingles S70 sore mouth D20
shiver A02 sore throat R21
shock, anaesthetic A87 sore(s) on skin S29
shock, cardiovascular K99 soreness, skin S01
shock, psychic P02 spasm, muscle N08
short sight F91 spastic colon D93
SHORTNESS OF BREATH R02 SPECIFIC LEARNING
SHOULDER SYMPT/COMPLT L08 PROBLEM P24
SHOULDER SYNDROME L92 speech delay P22
sick sinus syndrome K80 SPEECH DISORDER N19
sickle-cell anaemia B78 spermatocoele Y99
sickle-cell trait B78 spherocytosis B78
side effect medication A85 spider naevus K06
SINUS SYMPT/COMPLT R09 spina bifida N85
SINUSITIS ACUTE/CHRONIC R75 spinal cord injury N81
Sjogren’s syndrome L99 SPLEEN DISEASE, OTHER B99
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SPLEEN, RUPTURED B76 STYE F72

SPLENOMEGALY B87 subarachnoid haemorrhage K90
spondylolisthesis L84 subconjunctival haemorrhage F75
spondylosis L84 subdural haematoma N80
spondylosis, cervical L83 SUBLUXATION L80
spotting, vaginal X08 SUICIDE/SUICIDE ATTEMPT P77
SPRAIN/STRAIN, ANKLE L77 SUNBURN S80
sprain/strain, back L84 suppression of lactation W19
SPRAIN/STRAIN, JOINT, surgical emphysema R88
OTHER L79 suspiciousness P29
SPRAIN/STRAIN, KNEE L78 sweat rash S92
sprain/strain, neck L83 SWELLING NOS A08
sprue D99 swelling of joint L20
spur, bone L87 SWELLING, GENERALIZED S05
SPUTUM/PHLEGM SWELLING, LOCALIZED S04
ABNORMAL R25 swimmer’s ear H70
squamous cell carcinoma S77 SWOLLEN ANKLE K07
squint F95 swollen eye F15
STAMMERING P10 swollen feet/legs K07
status epilepticus N88 swollen lip D20
sterility W15 SYMPT/COMPLT:
STERILIZATION, FEMALE W13 see appropriate body system
STERILIZATION, MALE Y13 SYNCOPE A06
stiffness, joint L20 syndrome: see appropriate title
stiffness, muscle L19 synovial cyst L87
stillbirth W91/W93 SYNOVITIS L87
STING, INSECT S12 synovitis of shoulder L92
sting, plant S88 SYPHILIS, FEMALE X70
stomach dilatation, acute D87 SYPHILIS, MALE Y70
stomatitis D83 systemic lupus erythematosis L99
STRABISMUS F95 tachycardia NOS K04
strain: see sprain/strain TACHYCARDIA,
STREP THROAT R72 PAROXYSMAL K79
stress incontinence U04 tachypnoea R04
STRESS DISORDER, tarsal cyst F72
CHRONIC P82 TASTE DISTURBANCE N16
STRESS REACTION, teeth grinding D29
ACUTE P02 TEETH/GUM DISEASE D82
stretch marks S99 TEETH/GUM SYMPT/COMPLT D19
striae atrophicae S99 teething D19
stridor R04 temper tantrum, child P22
STROKE K90 temporomandibular joint disorder D82
stroke sequelae K91 temporomandibular joint
stupor A07 sympt/complt L07
STUTTERING P10 tendinitis, shoulder L92
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tendon rupture, spontaneous L99 TOXIC EFFECT, NON-

TENDONITIS L87 MEDICINAL SUBSTANCE A86
TENNIS ELBOW L93 toxic gastroenteropathy D99
tenosynovitis L87 toxic goitre T85
TENSE FEELING P01 toxoplasmosis A78
termination of pregnancy W83 TRACHEITIS, ACUTE R77
testicular dysfunction T99 tracheobronchitis R78
TESTIS SYMPT/COMPLT Y05 TRACHOMA F86
TETANUS N72 transfusion reaction A87
tetany N08 TRANSIENT CEREBRAL
thalassaemia B78 ISCHAEMIA K89
THIGH SYMPT/COMPLT L14 transient global amnesia K89
THIRST, EXCESSIVE T01 transient ischaemic attack K89
THROAT SYMPT/COMPLT R21 TRAUMA NOS A80
thrombocytopenia B83 TRAUMA, ACOUSTIC H85
THROMBOPHLEBITIS K94 TRAUMA, MULTIPLE A81
thrombosed external TRAUMA, SECONDARY
haemorrhoid K96 EFFECT A82
thrombosis, vein K94 traumatic amputation L81
thrush NOS A78 traumatic arthropathy L91
thrush, female genital X72 tremor N08
thrush, mouth D83 trichiniasis D96
thrush, skin, nail S75 bicuspid valve disease K83
THYROGLOSSAL DUCT/CYST T78 trigger finger L87
thyroid nodule T81 TUBERCULOSIS A70
thyroiditis T99 twitching eye F14
THYROTOXICOSIS T85 tympanitis, acute H71
TIC P10 typhoid fever D70
tic douloureux N92 ulcer, aphthous D83
tick infestation S73 ULCER, CORNEAL F85
tinea S74 ULCER, DUODENAL D85
TINGLING FINGERS/TOES N05 ulcer, oesophageal D84
TINNITUS EAR H03 ULCER, PEPTIC D86
TIREDNESS A04 ULCER, SKIN, CHRONIC S97
TOBACCO ABUSE P17 ULCERATIVE COLITIS D94
TONGUE SYMPT/COMPLT D20 umbilicus problem S29
tongue, coated D20 underweight T29
tongue-tie D81 UNDESCENDED TESTICLE Y83
tonsillar pain R21 UNEMPLOYMENT PROBLEM Z06
TONSILLITIS ACUTE R76 unhappy P03
tonsillitis, chronic R90 unstable angina K74
toothache D19 UPPER RESPIRATORY
torsion of testis Y99 INFECTION R74
torticollis L83 uraemia U99
TOXAEMIA OF PREGNANCY W81 ureteric reflux U99
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urethral caruncle U99 venous stasis K95

urethral discharge, female X29 ventricular fibrillation K80
urethral discharge, male Y03 ventricular flutter K80
urethral stricture U99 ventricular septal defect K73
urethral syndrome U72 verrucae S03
URETHRITIS U72 version W92/W93
URI R74 VERTIGINOUS
URINARY CALCULUS U95 SYNDROME H82
URINARY FREQUENCY/ VERTIGO/DIZZINESS N17
URGENCY U02 vestibular neuronitis H82
urinary infection NOS U71 Vincent’s angina D83
URINARY SYMPT/COMPLT, VIRAL DISEASE,
OTHER U29 OTHER/NOS A77
URINATION PROBLEM, VIRAL EXANTHEMS A76
OTHER U05 viral keratitis F85
URINE TEST ABNORMAL U98 vision, blurred F05
urine, bad odour of U07 VISUAL DISTURBANCE F05
URINE, COMPLAINT U07 VISUAL FLOATER/SPOT F04
urine, dark U07 visual loss F05
urine, dribbling U05 VITAMIN DEFICIENCY T91
URINE, RETENTION U08 vitiligo S99
urolithiasis U95 VOICE SYMPT/COMPLT R23
URTICARIA S98 VOMITING DIG
UTEROVAGINAL VOMITING BLOOD D14
PROLAPSE X87 vomiting, presumed infective D73
VAGINAL DISCHARGE X14 vulval pain X01
VAGINAL SYMPT/COMPLT X15 VULVAL SYMPT/COMPLT X16
vaginismus NOS X04 WART S03
vaginismus, psychogenic P08 wart, seborrhoeic/senile S99
vaginitis, atrophic X11 wasting of muscle L19
VAGINITIS/VULVITIS X84 water depletion T11
vaginosis X84 waterbrash D03
varices, oesophageal K99 watery eye F03
varicose eczema K95 weak eye F05
varicose ulcer S97 weak heart K29
VARICOSE VEIN, LEG K95 weak joint L20
varicose veins, other than leg K99 weak muscle L19
vascular headache N89 WEAKNESS, GENERAL A04
vasculitis K99 WEAKNESS, localized N18
vasectomy Y13 weal S98
vasospasm K92 weaning W19
vasovagal attack A06 WEIGHT GAIN T07
venereal wart, female X91 WEIGHT LOSS T08
venereal wart, male Y76 wen S93
venous insufficiency K95 WHEEZING R03
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whiplash, neck L83 worried P03

WHITE CELLS ABNORMAL B84 wound infection/disruption,
WHOOPING COUGH R71 post-operative A87
withdrawal, drug P19 wound infection, post-traumatic S11
woozy N17 wrinkle S21
WORK PROBLEM Z05 WRIST SYMPT/COMPLT L11
WORMS/OTHER PARASITES D96 xanthoma T93
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