ME International

The Nordic Adaptation of Classification of Occupationally
Related Disorders (Diseases and Symptoms) to ICD-10

(ICD-10: International Statistical Classification of Diseases and Related Health Problems)

Editors:
Finn Levy, Department of Occupational Medicine, Center for Preventive
Medicine (1K), Ullevaal University Hospital, Oslo
Axel Wannag, Directorate of Labour Inspection, Oslo

2000

The Nordic Adaptation of Classification of Occupationally Related Disorders (Diseases
and Symptoms) to ICD-10
DIVS: 2000:839
ISBN: 92-893-0559-2
3

Contents

Preface ............................................................................................................ 5

1. Introduction ............................................................................................... 7
1.1 Complete coding of an occupational disorder ..................................... 7
1.2 Construction of "the Nordic list of occupational disorders" ............... 8

2. List of ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries ............................................................... 11

Appendix I Neurotoxic conditions ............................................................. 43
Appendix II Vibration related disorders ...................................................... 46
Appendix III Asbestos related conditions ..................................................... 47
Appendix IV Conditions with aetiology to environmental factors

mechanisms not yet understood .............................................. 49
Appendix V Strength of association between the disease/symptom and

the occupational exposure ....................................................... 51

4

Preface

This report is a summary of a Nordic co-operative project called "The Nordic Adaptation of
Classification of Occupationally Related Disorders (diseases and symptoms) to ICD-10",
financed by the Nordic Council of Ministers (Nordisk Ministerråd) and completed 1996 to
2000.

The aim of the project was to provide a "Nordic list of occupational disorders" with advice on
how to code them in accordance with the WHO International Statistical Classification of
Diseases and Related Health Problems (ICD) version 10. Coding of occupational disorders is
not always self-evident within ICD-10. This holds especially true for central nervous system
disorders caused by occupational exposure and for some groups of not well-specified
conditions, which in the Nordic countries are claimed, but not yet proven, to be caused by
occupational exposures. By giving advise on how to "modify and adapt" these conditions to
the ICD-10 system, we hope if the advises are accepted to facilitate later comparisons of
Nordic data on occupational disorders.

We also had a hope to be able to mark out disorders from occupational and environmental
exposures, to bring attention to the potential for their prevention, within the ICD-10. This can
only be done indirectly by adding the codes for occupational (Y96) or environmental (Y97)
exposure to the codes for disorders. This can be done within the ICD-10, but we have
discovered that this possibility can be hampered by the design of local hospitals' ICD-10
registration systems, which may not allow the possibility to add other codes to the codes for
disorders.

In addition the ICD-10 codes for exposure (chapter T) are insufficient for coding for
exposures in the Nordic occupational- and environmental clinics. Thus a satisfactory coding
system for exposures must be created outside the frames of ICD-10.

The work was co-ordinated by Axel Wannag MD, Directorate of Labour Inspection, Oslo,
Norway. The work was carried out by a group of Nordic occupational physicians: Jens Peter
Bonde MD, Department of Occupational Medicine, Aarhus University Hospital, Aarhus,
Denmark; Antti Karjalainen MD, Finnish Institute of Occupational Health, Helsinki, Finland;
Finn Levy MD, Department of Occupational Medicine, Ullevaal University Hospital, Oslo,
Norway; Kjell Torén MD, Department of Occupational and Environmental Medicine,
Sahlgrenska University Hospital, Gothenburg, Sweden.

In addition the project received main contributions to the work from:
Ole Svane MD, Directorate of Labour Inspection, Copenhagen, Denmark; Leif Aringer MD,
National Board of Occupational Safety and Health, Stockholm; Olav Axelsson MD,
Department of Occupational Medicine, Folkhälsovetenskaplig Centrum, Linköping; Bengt O.
Persson MD, National Board of Occupational Safety and Health, Stockholm; Bodil Persson
MD, Department of Occupational Medicine, Folkhälsovetenskaplig Centrum, Linköping;
Björn Smedby MD, WHO Collaborating Centre for the Classification of Diseases in the
Nordic Countries, Uppsala, Sweden; Sverre Langård MD, Department of Occupational
Medicine, National Hospital of Norway, Oslo; Jan Haanes Marton MD, Department of
Occupational and Environmental Medicine, University Hospital of Tromsø, Tromsø, Norway.

6

The project members have also held informal discussions with other colleagues who gave us ideas and criticism. The project members thank all who contributed to the work.

Finn Levy and Axel Wannag did the main and final edition of the report.

Oslo, December 2000

Axel Wannag and Finn Levy

7

1. Introduction

Exposure from work can course diseases or symptoms. Some of these diseases are legally defined as occupational diseases, others are not. Which diseases are defined as occupational varies between countries, also to some extent between the Nordic countries. Occupational diseases are not a clear entity.

Thus to encompass the legally defined occupational diseases and the other diseases, symptoms and complaints from occupational exposure, we have chosen the expression "occupational disorder". In our opinion, this matches what ICD-10 encompasses in the expression "diseases and related health problems".

In all countries only a fraction of the preventable disorders of occupation is recognised as such. The vast majority of these disorders is still "hidden" in the general registration of national disorders. Neither are the registration systems (including ICD-10) well designed to accommodate the information that a disorder is a result of occupational exposure. Thus the sheer magnitude of preventable occupational disorders goes unrecognised, and there are little to no incentives from the national statistics to promote national prevention of occupational disorders.

Nordic occupational physicians and institutions of occupational health have for many years tried to improve the situation, with various successes. With the introduction of ICD-10 in the Nordic registration systems we saw a new possibility to mark out occupational disorders in the national statistics. However, ICD-10 can by no means accommodate all the information which is necessary for a complete coding of an occupational disorder in sufficient details. Neither can ICD-10, aimed at coding existing disorders, directly accommodate some groups of not well specified conditions, which in the Nordic countries are claimed, but not yet proven, to be caused by occupational exposures.

ICD-10, as a convention, set frames and limitations on the possibilities of finding the "ideal" code to an actual disorder. Thus all coding will, on some occasions, force adaptation and modification since the code you "ideally" should have had for the disorder at hand is not in the coding system. What is important is that the different Nordic physicians in their classification "adapt and modify" an occupational disorder to the same ICD-10 code in order to make the Nordic statistics comparable.

Thus the aim of this undertaking was to provide a "Nordic list of occupational disorders" with advice on how to code them in the ICD-10 system.

1.1 Complete coding of an occupational disorder
In our opinion a complete coding of an occupational disorder, consists of the following information:
1. A code for the disease/symptom according to the ICD-10 coding and selection rules.
2. A code connecting the disease/symptom to occupational/environmental exposure (from ICD-10 = Y96 occupational and Y97 environmental).
3. A code for the strength of association between the disease/symptom and the occupational exposure. (Our advice, modified from the scale used at the Department of Occupational Medicine. Folkhälsovetenskaplig Centrum, Linköping, Sweden, is given in appendix V).
8

(Strength of association could also be accommodated within ICD-10, but this would need amendments in ICD-10. So fare this has not been possible to achieve.)
4. A code for the occupational exposure. There are many "Exposure Code Systems". We probably need one of these existing systems amended to achieve a system which may be generally accepted.
5. A code for the occupation of the patient. International Standard Classification of Occupations (ISCO-88) is not suitable. Some nations have more detailed systems.
6. A code for the trade of the patient. Nomenclature Generale des Activites Economiques dans les Communautes Europeennes (NACE rev. 1) is often not detailed enough, and groups under the same code trades with different occupational exposures.

In our opinion ICD-10 can, at the moment, only provide codes for the first two of these points. National constraints on the use of ICD-10 may further complicate the occupational health statistics. The official Danish version of ICD-10 does not include the Y codes and thus occupational disorders can only be traced in the Danish health statistics to a very limited extend even if the present guidelines are implemented. Thus the complete coding of occupational disorders must still rest within the local coding systems of the occupational clinics, institutions and services.

However, in our opinion there would be a great improvement if the national coding systems for disorders would incorporate both 1) the code for the disease/symptom and 2) the code for the association to occupational (Y96) or environmental (Y97) exposures. This will depend on the technical construction of the national data systems. Unfortunately some systems, for the moment, seem to allow for only one ICD-10 code (6-digit) for each disorder. This makes it impossible, within ICD-10, to connect/link a disorder to an occupational/environmental exposure. This requires two connected 6-digit codes (at least).

Therefore we have been limited to focus on finding correct (and acceptably correct) disease/symptom codes for the occupational and environmental disorders and connect these with the ICD-10 codes for occupational (Y96) and for environmental (Y97) exposures.

1.2 Construction of the "Nordic list of occupational disorders"
As was pointed out to us by professor Björn Smedby of WHO Collaborating Centre for the Classification of Diseases in the Nordic Countries, there is a danger in using short lists of disorders. One can actually distort the picture of the complete panorama of disorders if one instead of using the complete ICD-10 list of "all" disorders to find the correct code, use the shortened version to pick a code which seems "acceptably good enough". This risk must be traded against the fact that a shortened list in many respects is handier in practical use.

Therefore we advise a hierarchical three-step level of lists:

· ICD-10 with its definitions of the disorders. (Thus one needs basic knowledge on how to use the ICD-10. Use of the complete ICD-10 classification list may be necessary for some rarer disorders of occupation, for example within occupational dermatology)
· The "Nordic list of occupational disorders"
· Lists which the different clinics, institutions and services can themselves abbreviate from the "Nordic list of occupational disorders" (which is easily done from the data file of the "Nordic list of occupational disorders")

We wanted the "Nordic list of occupational disorders" to cover the disorders most commonly encountered in the practice of Nordic occupational medicine. We therefore assembled seven
9

of the most used lists of occupational disorders from the Nordic occupational clinics and institutions, matched them with each other, exempted the rarer disorders, and included the remaining in the "Nordic list of occupational disorders".

Then the "Nordic list of occupational disorders" was matched with ICD-10 to identify the appropriate ICD-10 codes.
· Most disorders naturally had one and only one corresponding ICD-10 code.
· However, for a few occupational disorders ICD-10 offered more than one alternative code. This occurred within the disorders caused by neurotoxines (mostly solvents) and vibration. Therefore our advice for coding these disorders is given both in the "Nordic list of occupational disorders" and as appendices (I and II).
· We also found it sensible to give our advice for coding of the different asbestos related disorders in the list and in an appendix III.
· It was complicated to find a solution to the coding of "the not well specified conditions dominated by complaints attributed to occupational exposures", but not yet proven to be so. After various discussions and considerations, our advice appears in appendix IV.

We also found difficulties in discriminating between acute and chronic disorders, a separation which is important in occupational medicine. Our advice for acute disorders is that:
1) If one symptom is dominating in an acute disorder and the final diagnosis is not clear, this symptom should be coded with an R code, followed by Y96 or Y97.
2) If no symptom is dominating, then the acute disorder should be coded with a T-code for toxic effects (T51-65), followed by Y96 or Y97. (Beware that T51-65 is not quite logically presented. One has to look trough these codes to find the most appropriate).
10

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

A15 - A19 Tuberculosis
A15.-
Respiratory tuberculosis, bacteriologically and histologically confirmed
A15.0
Tuberculosis of lung, confirmed by sputum microscopy with or
without culture
A15.9
Respiratory tuberculosis unspecified, confirmed bacteriologically and
histologically
A16.-
Respiratory tuberculosis, not confirmed bacteriologically or histologically
A16.0
Tuberculosis of lung, bacteriologically and histologically negative
A16.9
Respiratory tuberculosis unspecified, without mention of
bacteriological or histological confirmation

Respiratory tuberculosis NOS. Tuberculosis NOS
A20 -A28 Certain zoonotic bacterial diseases
A26.-
Erysipeloid
A26.0
Cutaneous erysipeloid

Erythema migrans
A98.-
Other viral haemorrhagic fevers, not elsewhere classified
A98.5
Haemorrhagic fever with renal syndrome nephropathiaepidemica

Haemorrhagic fever: epidemic, Korean, Russian, Hantaan virus disease,
Nephropathia epidemica
B15 -B19 Viral hepatitis
B15 - B19 Viral hepatitis

Excludes: cytomegaloviral hepatitis (B25.1), herpesviral [herpes simplex]
hepatitis (B00.8), sequelae of viral hepatitis (B94.2)
B15.9
Hepatitis A without hepatic coma

Hepatitis A (acute)(viral) NOS
B16.9
Acute hepatitis B without delta-agent and without hepatic coma

Hepatitis B (acute)(viral) NOS
B17.8
Other specified acute viral hepatitis

Hepatitis non-A non-B (acute) (viral) NEC
B18.9
Chronic viral hepatitis, unspecified
B19.9
Unspecified viral hepatitis without hepatic coma

Viral hepatitis NOS
B20 -B24 Human immunodeficiency virus [HIV] disease
B24
Unspecified human immunodeficiency virus [HIV] disease

Acquired immunodeficiency syndrome [AIDS] NOS. AIDS-related
complex [ARC] NOS
B35.-
Dermatophytosis
Includes: favus infections due to species of Epidermophyton,
Microsporum and Trichophyton tinea, any type except those in B36
B35.9 Dermatophytosis,
unspecified
Ringworm NOS
B86.x
Scabies

Sarcoptic
itch
C00 -D48 Neoplasms

Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
11

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

C45.-
Mesothelioma

Includes: morphology code M905 with behaviour code /3
C45.0
Mesothelioma of pleura

Excludes: other malignant neoplasms of pleura (C38.4)
C45.1
Mesothelioma of peritoneum

Mesentery. Mesocolon. Omentum. Peritoneum (parietal)(pelvic)

Excludes: other malignant neoplasms of peritoneum (C48.-)
C45.2
Mesothelioma of pericardium

Excludes: other malignant neoplasms of pericardium (C38.0)
C45.9 Mesothelioma,
unspecified
C67.-
Malignant neoplasm of bladder
C67.9 Bladder,
unspecified
C81 -C96 Malignant neoplasms of lymphoid, haematopoietic and related tissue
C81
Hodgkin's disease

Includes: morphology codes M965-M966 with behaviour code /3
C81.9
Hodgkin's disease, unspecified
C85.-
Other and unspecified types of non-Hodgkin's lymphoma

Includes: morphology codes M9590-M9592, M9594, M971 with
behaviour, code /3
C85.9
Non-Hodgkin's lymphoma, unspecified type

Lymphoma NOS. Malignant lymphoma NOS, Non-Hodgkin's
lymphoma NOS
C91.-
Lymphoid leukaemia
Includes: morphology codes M982, M9940-M9941 with behaviour

code /3
C91.9
Lymphoid leukaemia, unspecified
C92.-
Myeloid leukaemia

Includes: leukaemia: granulocytic, myelogenous morphology codes
M986-M988, M9930 with behaviour code /3
C92.9
Myeloid leukaemia, unspecified
D61.-
Other aplastic anaemias
Excludes:

agranulocytosis (D70)
D61.2
Aplastic anaemia due to other external agents

Use additional external cause code (Chapter XX), if desired, to identify
cause
D61.9
Aplastic anaemia, unspecified

Hypoplastic anaemia NOS. Medullary hypoplasia. Panmyelophthisis
F00 -F99 Mental and behavioural disorders
F06.-
Other mental disorders due to brain damage and dysfunction and to physical
disease

(Look in ICD-10. There is a long text concerning inclusion and exclusion criteria)
F06.7
Mild cognitive disorder
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
13

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

F48.-
Other neurotic disorders

(Look in ICD-10. There is a long text concerning inclusion and exclusion criteria)
F48.0 Neurasthenia

Considerable cultural variations occur in the presentation of this disorder, and two main
types occur, with substantial overlap. In one type, the main feature is a complaint of
increased fatigue after mental effort, often associated with some decrease in occupational
performance or coping efficiency in daily tasks. The mental fatiguability is typically
described as an unpleasant intrusion of distracting associations or recollections, difficulty
in concentrating, and generally inefficient thinking. In the other type, the emphasis is on
feelings of bodily or physical weakness and exhaustion after only minimal effort,
accompanied by a feeling of muscular aches and pains and inability to relax. In both types
a variety of other unpleasant physical feelings is common, such as dizziness, tension
headaches, and feelings of general instability. Worry about decreasing mental and bodily
well-being, irritability, anhedonia, and varying minor degrees of both depression and
anxiety are all common. Sleep is often disturbed in its initial and middle phases but
hypersomnia may also be prominent.

Fatigue syndrome

Use additional code, if desired, to identify previous physical illness.

Excludes: asthenia NOS (R53), burn-out (Z73.0), malaise and fatigue (R53),
postviral fatigue syndrome (G93.3), psychasthenia (F48.8)
F48.8
Other specified neurotic disorders

Briquet's disorder. Dhat syndrome. Occupational neurosis, including
writer's cramp. Psychasthenia. Psychasthenic neurosis. Psychogenic
syncope
F48.9
Neurotic disorder, unspecified

Neurosis
NOS
G00 -G99 Diseases of the nervous system
G12.-
Spinal muscular atrophy and related syndromes
G12.2
Motor neuron disease

Familial motor neuron disease. Lateral sclerosis: amyotrophic, primary.

Progressive: bulbar palsy, spinal muscular atrophy
G21.-
Secondary parkinsonism
G21.2
Secondary parkinsonism due to other external agents

Use additional external cause code (Chapter XX), if desired, to identify
external agent.
G47.-
Sleep disorders

Excludes: nightmares (F51.5), nonorganic sleep disorders (F51.-),
sleepterrors (F51.4), sleepwalking (F51.3)]
G47.1
Disorders of excessive somnolence [hypersomnias]
G47.3 Sleep
apnoea

Sleep apnoea: central, obstructive

Excludes: pickwickian syndrome (E66.2)
G47.4
Narcolepsy and cataplexy
G47.9
Sleep disorder, unspecified
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
15

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

G56.-
Mononeuropathies of upper limb

Excludes: current traumatic nerve disorder - see nerve injury by body
region
G56.0
Carpal tunnel syndrome
G56.8
Other mononeuropathies of upper limb

Interdigital neuroma of upper limb
G56.9
Mononeuropathy of upper limb, unspecified
G57.-
Mononeuropathies of lower limb

Excludes: current traumatic nerve disorder - see nerve injury by body
region
G57.4
Lesion of medial popliteal nerve
G57.9
Mononeuropathy of lower limb, unspecified
G58.-
Other mononeuropathies
G58.8
Other specified mononeuropathies
G62.-
Other polyneuropathies
G62.2
Polyneuropathy due to other toxic agents

Use additional external cause code (Chapter XX), if desired, to identify
toxic agent. (alcohol is excluded G62.1)
G62.9 Polyneuropathy,
unspecified

Neuropathy NOS
G72.-
Other myopathies

Excludes: arthrogryposis multiplex congenita (Q74.3),
dermatopolymyositis (M33.-), ischaemic infarction of muscle (M62.2),
myositis (M60.-), polymyositis (M33.2)
G72.2
Myopathy due to other toxic agents

Use additional external cause code (Chapter XX), if desired, to identify
toxic agent.
G72.9 Myopathy,
unspecified
G92
Toxic encephalopathy

Use additional external cause code (Chapter XX), if desired, to identify
toxic agent.

G93.-
Other disorders of brain
G93.3
Postviral fatigue syndrome
Benign myalgic encephalomyelitis

G93.4 Encephalopathy,
unspecified
Excludes: encephalopathy: alcoholic (G31.2), toxic (G92)

H00 -H59 Diseases of the eye and adnexa
H04.-
Disorders of lacrimal system

Excludes: congenital malformations of lacrimal system (Q10.4-Q10.6)
H04.1
Other disorders of lacrimal gland

Dacryops. Dry eye syndrome (Sjögrens sicca syndrom). Lacrimal: cyst, gland
atrophy
H04.2 Epiphora
H04.8
Other disorders of lacrimal system
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
16

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

H10.-
Conjunctivitis

Excludes: keratoconjunctivitis (H16.2)
H10.1
Acute atopic (allergic) conjunctivitis
H10.2
Other acute conjunctivitis
H10.4 Chronic
conjunctivitis
H10.9 Conjunctivitis,
unspecified
H16.-
Keratitis
H16.1
Other superficial keratitis without conjunctivitis

Keratitis: areolar, filamentary, nummular, stellate, striate, superficial
punctate. Photokeratitis. Snow blindness
H16.2 Keratoconjunctivitis

Keratoconjunctivitis: NOS, exposure, neurotrophic, phlyctenular.

Ophthalmia nodosa. Superficial keratitis with conjunctivitis
H16.8
Other keratitis

(keratitis from UV exposure, welding, to be coded here )
H16.9 Keratitis,
unspecified
H26.-
Other cataract

Excludes: congenital cataract (Q12.0)
H26.1 Traumatic
cataract

Use additional external cause code (Chapter XX), if desired, to identify
cause.
H26.8
Other specified cataract (caused by radiation to be coded here)
H53.-
Visual disturbances
H53.1
Subjective visual disturbances

Asthenopia, Day blindness, Hemeralopia, Metamorphopsia,

Photophobia, Scintillating scotoma, Sudden visual loss, Visual halos
Excludes: visual hallucinations (R44.1)
H53.9
Visual disturbance, unspecified
H60 -H95 Diseases of the ear and mastoid process
H81.-
Disorders of vestibular function

Excludes: vertigo: NOS (R42), epidemic (A88.1)
H81.0 Ménière's
disease

Labyrinthine hydrops, Ménière's syndrome or vertigo
H81.9
Disorder of vestibular function, unspecified

Vertiginous syndrome NOS (see also R42)
H83.-
Other diseases of inner ear
H83.3
Noise effects on inner ear

Acoustic trauma, Noise-induced hearing loss
H93.-
Other disorders of ear, not elsewhere classified
H93.1 Tinnitus
I00 -I99
Diseases of the circulatory system
I20.-
Angina pectoris
I20.9
Angina pectoris, unspecified

Angina: NOS, cardiac, Anginal syndrome, Ischaemic chest pain

Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
17

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

I21
Acute myocardial infarction
I21.9
Acute myocardial infarction, unspecified.

Myocardial infarction (acute) NOS
I73.-
Other peripheral vascular diseases

Excludes: chilblains (T69.1), frostbite (T33-T35), immersion hand or foot
(T69.0), spasm of cerebral artery (G45.9)
I73.0
Raynaud's syndrome

Raynaud's: disease, gangrene, phenomenon (secondary)
J00 - J99 Diseases of the respiratory system
J30.-
Vasomotor rhinitis
J30.3
Other allergic rhinitis

Perennial allergic rhinitis
J30.4
Allergic rhinitis, unspecified
J31.-
Chronic rhinitis, nasopharyngitis and pharyngitis
J31.0 Chronic
rhinitis

Ozena, Rhinitis (chronic): NOS, atrophic, granulomatous, hypertrophic,
obstructive, purulent, ulcerative
Excludes: rhinitis: allergic (J30.1-J30.4), vasomotor (J30.0)
J34.-
Other disorders of nose and nasal sinuses

Excludes: varicose ulcer of nasal septum (I86.8)
J34.8
Other specified disorders of nose and nasal sinuses

Perforation of nasal septum NOS, Rhinolith
J37.-
Chronic laryngitis and laryngotracheitis

Use additional code (B95-B97), if desired, to identify infectious agent.
J37.0 Chronic
laryngitis

Laryngitis: catarrhal, hypertrophica, sicca

Excludes: laryngitis: NOS (J04.0), acute (J04.0), obstructive (acute) (J05.0)
J37.1 Chronic
laryngotracheitis

Laryngitis, chronic, with tracheitis (chronic)

Tracheitis, chronic, with laryngitis
Excludes: laryngotracheitis: NOS (J04.2), acute (J04.2). tracheitis: NOS
(J04.1), acute (J04.1), chronic (J42)
J38.-
Diseases of vocal cords and larynx, not elsewhere classified

Excludes: congenital laryngeal stridor (Q31.4), laryngitis: obstructive
(acute) (J05.0), ulcerative (J04.0), postprocedural subglottic stenosis
(J95.5), stridor (R06.1)
J38.2
Nodules of vocal cords

Chorditis (fibrinous)(nodosa)(tuberosa), Singer's nodes,

Teacher's
nodes

Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
18

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

J39.-
Other diseases of upper respiratory tract

Excludes: acute respiratory infection NOS (J22), upper (J06.9), upper
respiratory inflammation due to chemicals, gases, fumes or vapour
(J68.2)
J39.3
Upper respiratory tract hypersensitivity reaction, site unspecified
J39.8
Other specified diseases of upper respiratory tract
J39.9
Disease of upper respiratory tract, unspecified
J40 -J47
Chronic lower respiratory diseases
J42
Unspecified chronic bronchitis

Chronic: bronchitis NOS, tracheitis, tracheobronchitis

Excludes: chronic: asthmatic bronchitis (J44.-), bronchitis: simple and
mucopurulent (J41.-), with airways obstruction (J44.-), emphysematous
bronchitis (J44.-), obstructive pulmonary disease NOS (J44.9)
J43.-
Emphysema

Excludes: emphysema: compensatory (J98.3), due to inhalation of
chemicals, gases, fumes or vapours (J68.4), interstitial (J98.2), mediastinal
(J98.2), surgical (subcutaneous) (T81.8), traumatic subcutaneous (T79.7),
with chronic (obstructive) bronchitis (J44.-), emphysematous
(obstructive) bronchitis (J44.-)
J43.8 Other
emphysema

(induced by dust)
J44.-
Other chronic obstructive pulmonary disease

Includes: chronic: bronchitis: asthmatic (obstructive), emphysematous
with: airways obstruction, emphysema. obstructive: asthma, bronchitis
tracheobronchitis

Excludes: asthma (J45.-), asthmatic bronchitis NOS (J45.9), bronchiectasis
(J47), chronic: bronchitis: NOS (J42), simple and mucopurulent (J41.-),
tracheitis (J42), tracheobronchitis (J42), emphysema (J43.-), lung diseases
due to external agents (J60-J70)
J44.8
Other specified chronic obstructive pulmonary disease

Chronic bronchitis: asthmatic (obstructive) NOS, emphysematous NOS,
obstructive NOS

(induced by dust)

Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
19

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

J66.-
Airway disease due to specific organic dust
Excludes: bagassosis (J67.1), farmer's lung (J67.0), hypersensitivity
pneumonitis due to organic dust (J67.-), reactive airways dysfunction
syndrome (J68.3)
J66.0 Byssinosis

Airway disease due to cotton dust
J66.8
Airway disease due to other specific organic dusts

(organic dust toxic syndrome, ODTS)(not yet used in Norway)

J67.-
Hypersensitivity pneumonitis due to organic dust

Includes: allergic alveolitis and pneumonitis due to inhaled organic dust
and particles of fungal, actinomycetic or other origin

Excludes: pneumonitis due to inhalation of chemicals, gases, fumes or
vapours (J68.0)
J67.0 Farmer's
lung

Harvester's lung, Haymaker's lung, Mouldy hay disease
J67.1 Bagassosis

Bagasse: disease, pneumonitis
J67.2
Bird fancier's lung

Budgerigar fancier's disease or lung, Pigeon fancier's disease or lung
J67.3 Suberosis

Corkhandler's disease or lung, Corkworker's disease or lung
J67.4 Maltworker's
lung

Alveolitis due to Aspergillus clavatus
J67.5 Mushroom-worker's
lung
J67.6 Maple-bark-stripper's
lung

Alveolitis due to Cryptostroma corticale, Cryptostromosis
J67.7
Air-conditioner and humidifier lung

Allergic alveolitis due to fungi, thermophilic actinomycetes and other
organisms growing in ventilation [air-conditioning] systems
J67.8
Hypersensitivity pneumonitis due to other organic dusts

Cheese-washer's lung, Coffee-worker's lung, Fishmeal-worker's lung
Furrier's lung, Sequoiosis
J67.9
Hypersensitivity pneumonitis due to unspecified organic dust

Allergic alveolitis (extrinsic) NOS, Hypersensitivity pneumonitis NOS
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
21

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

J68.-
Respiratory conditions due to inhalation of chemicals, gases, fumes and
vapours

Use additional external cause code (Chapter XX), if desired, to identify
cause.
J68.0
Bronchitis and pneumonitis due to chemicals, gases, fumes and
vapours

Chemical bronchitis (acute)
J68.1
Acute pulmonary oedema due to chemicals, gases, fumes and
vapours

Chemical pulmonary oedema (acute)
J68.2
Upper respiratory inflammation due to chemicals, gases, fumes and
vapours, not elsewhere classified
J68.3
Other acute and subacute respiratory conditions due to chemicals,
gases, fumes and vapours

Reactive airways dysfunction syndrome
J68.4
Chronic respiratory conditions due to chemicals, gases, fumes and
vapours

Emphysema (diffuse)(chronic)-, Obliterative bronchiolitis (chronic)
(subacute)-, Pulmonary fibrosis (chronic) due to inhalation of chemicals,
gases, fumes and vapours
J68.8
Other respiratory conditions due to chemicals, gases, fumes and
vapours
J68.9
Unspecified respiratory condition due to chemicals, gases, fumes and
vapours
J70.-
Respiratory conditions due to other external agents

Use additional external cause code (Chapter XX), if desired, to identify
cause.
J70.1
Chronic and other pulmonary manifestations due to radiation

Fibrosis of lung following radiation
J70.8
Respiratory conditions due to other specified external agents
J70.9
Respiratory conditions due to unspecified external agent
J84.-
Other interstitial pulmonary diseases

Excludes: drug-induced interstitial lung disorders (J70.2-J70.4), interstitial
emphysema (J98.2), lung diseases due to external agents (J60-J70)
J90
Pleural effusion, not elsewhere classified

Pleurisy with effusion

Excludes: chylous (pleural) effusion (J94.0), pleurisy NOS (R09.1)
tuberculous (A15-A16)

(Asbestos related pleural effusion)
J91*
Pleural effusion in conditions classified elsewhere
J92.-
Pleural plaque

Includes: pleural thickening
J92.0
Pleural plaque with presence of asbestos
J92.9
Pleural plaque without asbestos

Pleural plaque NOS
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
22

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

L25.-
Unspecified contact dermatitis

Includes: unspecified contact eczema

Excludes: allergy NOS (T78.4), dermatitis (of): NOS (L30.9), allergic
contact (L23.-), due to substances taken internally (L27.-), eyelid (H01.1),
irritant contact (L24.-), perioral (L71.0), eczema of external ear (H60.5),
radiation-related disorders of the skin and subcutaneous tissue (L55-L59)
L25.0
Unspecified contact dermatitis due to cosmetics
L25.1
Unspecified contact dermatitis due to drugs in contact with skin

Use additional external cause code (Chapter XX), if desired, to identify
drug.

Excludes: allergic reaction NOS due to drugs (T88.7), dermatitis due to
ingested drugs and medicaments (L27.0-L27.1)
L25.2
Unspecified contact dermatitis due to dyes
L25.3
Unspecified contact dermatitis due to other chemical products

Cement, Insecticide
L25.4
Unspecified contact dermatitis due to food in contact with skin

Excludes: dermatitis due to ingested food (L27.2)
L25.5
Unspecified contact dermatitis due to plants, except food
L25.8
Unspecified contact dermatitis due to other agents
L25.9
Unspecified contact dermatitis, unspecified cause

Contact: dermatitis (occupational) NOS, eczema (occupational) NOS
L30.-
Other dermatitis

Excludes: dermatitis: contact (L23-L25), dry skin (L85.3), small plaque
parapsoriasis (L41.3), stasis dermatitis (I83.1-I83.2)
L30.9 Dermatitis,
unspecified

Eczema NOS
L40.-
Psoriasis
L40.0 Psoriasis
vulgaris

Nummular psoriasis, Plaque psoriasis
L50 -L54 Urticaria and erythema
L50.-
Urticaria

Excludes: allergic contact dermatitis (L23.-), angioneurotic oedema(T78.3),
hereditary angio-oedema (E84.1), Quincke's oedema(T78.3), urticaria:
giant (T78.3), papulosa (L28.2), pigmentosa (Q82.2), serum (T80.6), solar
(L56.3)
L50.0 Allergic
urticaria
L50.4 Vibratory
urticaria
L50.6 Contact
urticaria
L50.8 Other
urticaria

Urticaria: chronic, recurrent periodic
L56.-
Other acute skin changes due to ultraviolet radiation
L56.2
Photocontact dermatitis [berloque dermatitis]
L56.4
Polymorphous light eruption

Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
26

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

L57.-
Skin changes due to chronic exposure to nonionizing radiation
L57.8
Other skin changes due to chronic exposure to nonionizing radiation

Farmer's skin, Sailor's skin, Solar dermatitis
L58.-
Radiodermatitis
L58.0 Acute
radiodermatitis
L58.1 Chronic
radiodermatitis
L58.9 Radiodermatitis,
unspecified
L70.-
Acne

Excludes: acne keloid (L73.0)
L70.8 Other
acne

(includes acne caused by oils)
L92.-
Granulomatous disorders of skin and subcutaneous tissue

Excludes: actinic granuloma (L57.5)
L92.3
Foreign body granuloma of skin and subcutaneous tissue
M00-M99 Diseases of the musculoskeletal system and connective tissue
M10.-
Gout

[See site code pages 628-629]
M10.1
Lead-induced gout
M13.-
Other arthritis

[See site code pages 628-629]

Excludes: arthrosis (M15-M19)
M13.8
Other specified arthritis

Allergic
arthritis
M13.9 Arthritis,
unspecified

Arthropathy
NOS
M15.-
Polyarthrosis

Includes: arthrosis with mention of more than one site

Excludes: bilateral involvement of single joint (M16-M19)
M15.9 Polyarthrosis,
unspecified

Generalized osteoarthritis NOS
M16.-
Coxarthrosis [arthrosis of hip]
M16.9 Coxarthrosis,
unspecified
M17.-
Gonarthrosis [arthrosis of knee]
M17.9 Gonarthrosis,
unspecified
M18.-
Arthrosis of first carpometacarpal joint
M18.9
Arthrosis of first carpometacarpal joint, unspecified
M19.-
Other arthrosis

[See site code pages 628-629]

Excludes: arthrosis of spine (M47.-), hallux rigidus (M20.2), polyarthrosis
(M15.-)
M19.2
Other secondary arthrosis

Secondary arthrosis NOS
M19.8
Other specified arthrosis

(code for arthrosis in the carpal- and elbow regions caused by vibration)
M19.9 Arthrosis,
unspecified
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
27

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

M23.-
Internal derangement of knee

(see ICD-10 for site of involvement, if needed)

Excludes: ankylosis (M24.6), current injury - see injury to the knee and
lower leg (S80-S89), deformity of knee (M21.-), disorders of patella
(M22.-), osteochondritis dissecans (M93.2), recurrent dislocation or
subluxation (M24.4), patella (M22.0-M22.1)
M23.9
Internal derangement of knee, unspecified
M25.-
Other joint disorders, not elsewhere classified

[See site code pages 628-629]

Excludes: abnormality of gait and mobility (R26.-), calcification of: bursa
(M71.4), shoulder (joint) (M75.3), tendon (M65.2), deformities classified
to M20-M21, difficulty in walking (R26.2)
M25.5
Pain in joint
M25.9
Joint disorder, unspecified
M34.-
Systemic sclerosis

Includes: scleroderma

Excludes: scleroderma: circumscribed (L94.0)
M34.2
Systemic sclerosis induced by drugs and chemicals

Use additional external cause code (Chapter XX), if desired, to identify
cause.
M35.-
Other systemic involvement of connective tissue
Excludes: reactive perforating collagenosis (L87.1)
M35.0
Sicca syndrome [Sjögren]

Sjögren's syndrome with: keratoconjunctivitis+ (H19.3*),
lunginvolvement+ (J99.1*), myopathy+ (G73.7*), renal tubulo-interstitial
disorders+ (N16.4*)
M51.-
Other intervertebral disc disorders

Includes: thoracic, thoracolumbar and lumbosacral disc disorders
M51.1
Lumbar and other intervertebral disc disorders with radiculopathy

Sciatica due to intervertebral disc disorder

Excludes: lumbar radiculitis NOS (M54.1)
M53.-
Other dorsopathies, not elsewhere classified

[See site code page 649]
M53.1 Cervicobrachial
syndrome

Excludes: cervical disc disorder (M50.-), thoracic outlet syndrome
(G54.0)
M54.-
Dorsalgia

[See site code page 649]

Excludes: psychogenic dorsalgia (F45.4)
M54.2 Cervicalgia

Excludes: cervicalgia due to intervertebral cervical disc disorder (M50.-)
M54.4
Lumbago with sciatica

Excludes: that due to intervertebral disc disorder (M51.1)
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
28

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

M65.-
Synovitis and tenosynovitis

[See site code pages 628-629]

Excludes: chronic crepitant synovitis of hand and wrist (M70.0), current
injury - see injury of ligament or tendon by body region, soft tissue
disorders related to use, overuse and pressure (M70.-)
M65.4
Radial styloid tenosynovitis [de Quervain]
M65.9
Synovitis and tenosynovitis, unspecified
M70.-
Soft tissue disorders related to use, overuse and pressure

[See site code pages 628-629]

Includes: soft tissue disorders of occupational origin

Excludes: bursitis (of): NOS (M71.9), shoulder (M75.5)enthesopathies
(M76-M77)
M70.0
Chronic crepitant synovitis of hand and wrist
M70.2 Olecranon
bursitis
M70.4 Prepatellar
bursitis
M70.6 Trochanteric
bursitis

Trochanteric
tendinitis
M70.8
Other soft tissue disorders related to use, overuse and pressure
M70.9
Unspecified soft tissue disorder related to use, overuse and pressure
M75.-
Shoulder lesions

Excludes: shoulder-hand syndrome (M89.0)
M75.0
Adhesive capsulitis of shoulder

Frozen shoulder, Periarthritis of shoulder
M75.1
Rotator cuff syndrome

Rotator cuff or supraspinatus tear or rupture (complete)(incomplete),
not specified as traumatic, Supraspinatus syndrome
M75.2 Bicipital
tendinitis
M75.3
Calcific tendinitis of shoulder

Calcified bursa of shoulder
M75.5
Bursitis of shoulder
M75.8
Other shoulder lesions
M75.9
Shoulder lesion, unspecified

(exclude shoulder-hand-syndrome: M89.0)
M77.-
Other enthesopathies

[See site code pages 628-629]

Excludes: bursitis: NOS (M71.9), due to use, overuse and pressure (M70.-),
osteophyte (M25.7), spinal enthesopathy (M46.0)
M77.0 Medial
epicondylitis
M77.1 Lateral
epicondylitis

Tennis
elbow
M77.9 Enthesopathy,
unspecified

Bone spur NOS, Capsulitis NOS, Periarthritis NOS, Tendinitis NOS
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
29

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

M79.-
Other soft tissue disorders, not elsewhere classified

[See site code pages 628-629]

Excludes: soft tissue pain, psychogenic (F45.4)
M79.0 Rheumatism,
unspecified

Fibromyalgia,
Fibrositis
Excludes: palindromic rheumatism (M12.3)
M79.1 Myalgia

Excludes: myositis (M60.-)
N14.-
Drug- and heavy-metal-induced tubulo-interstitial and tubular conditions

Use additional external cause code (Chapter XX), if desired, to identify toxic
agent.
N14.3
Nephropathy induced by heavy metals
N14.4
Toxic nephropathy, not elsewhere classified
R00 -R09 Symptoms and signs involving the circulatory and respiratory systems
R04.-
Haemorrhage from respiratory passages
R04.0 Epistaxis

Haemorrhage from nose, Nosebleed
R05.x
Cough

Excludes: cough with haemorrhage (R04.2), psychogenic cough (F45.3)
R06.-
Abnormalities of breathing

Excludes: respiratory: arrest (R09.2), distress (syndrome)(of): adult (J80),
newborn (P22.-), failure (J96.-)
R06.0 Dyspnoea

Orthopnoea, Shortness of breath
R06.8
Other and unspecified abnormalities of breathing

Apnoea NOS, Breath-holding (spells), Choking sensation, Sighing

Excludes: apnoea (of): sleep (G47.3)
R07.0
Pain in throat and chest

Excludes: dysphagia (R13), epidemic myalgia (B33.0), pain in: breast (N64.4),
neck (M54.2), sore throat (acute) NOS (J02.9)
R07.0
Pain in throat
R07.1
Chest pain on breathing

Painful respiration
R10 -R19 Symptoms and signs involving the digestive system and abdomen
R10.-
Abdominal and pelvic pain

Excludes: dorsalgia (M54.-), flatulence and related conditions (R14), renal
colic (N23)
R10.1
Pain localized to upper abdomen

Epigastric
pain
R10.4
Other and unspecified abdominal pain

Abdominal tenderness NOS, Colic: NOS
R11
Nausea and vomiting

Excludes: haematemesis (K92.0), vomiting (of): following gastrointestinal
surgery (K91.0), psychogenic (F50.5).

Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
30

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

R16.-
Hepatomegaly and splenomegaly, not elsewhere classified
R16.0
Hepatomegaly, not elsewhere classified

Hepatomegaly
NOS
R17
Unspecified jaundice
R19.-
Other symptoms and signs involving the digestive system and abdomen
R19.8
Other specified symptoms and signs involving the digestive system
and abdomen
R20 -R23 Symptoms and signs involving the skin and subcutaneous tissue
R20.-
Disturbances of skin sensation

Excludes: dissociative anaesthesia and sensory loss (F44.6), psychogenic
disturbances (F45.8)
R20.0
Anaesthesia of skin
R20.2
Paraesthesia of skin

Formication, Pins and needles, Tingling skin

Excludes: acroparaesthesia (I73.8)
R23.-
Other skin changes
R23.0 Cyanosis

Excludes: acrocyanosis (I73.8), cyanotic attacks of newborn (P28.2)
R23.4
Changes in skin texture

Desquamation, Induration of skin, Scaling

Excludes: epidermal thickening NOS (L85.9)
R23.8
Other and unspecified skin changes
R25 -R29 Symptoms and signs involving the nervous and musculoskeletal systems
R25.-
Abnormal involuntary movements

Excludes: specific movement disorders (G20-G26), stereotyped movement
disorders (F98.4), tic disorders (F95.-)
R25.0
Abnormal head movements
R25.3 Fasciculation

Twitching NOS
R26.-
Abnormalities of gait and mobility

Excludes: ataxia: NOS (R27.0), hereditary (G11.-), locomotor (syphilitic)
(A52.1), immobility syndrome (paraplegic) (M62.3)
R26.0 Ataxic
gait

Staggering gait
R26.2
Difficulty in walking, not elsewhere classified
R26.8
Other and unspecified abnormalities of gait and mobility
Unsteadiness on feet NOS
R27.-
Other lack of coordination
Excludes: ataxic gait (R26.0), hereditary ataxia (G11.-), vertigo NOS (R42)
R27.0 Ataxia,
unspecified
R27.8
Other and unspecified lack of coordination
R31.x
Unspecified haematuria
R40 -R46 Symptoms and signs involving cognition, perception, emotional state and
behaviour
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
31

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

R40.-
Somnolence, stupor and coma

Excludes: coma: diabetic (E10-E14 with common fourth character .0),
hepatic (K72.-) hypoglycaemic (nondiabetic) (E15), uraemic (N19)

R40.0 Somnolence

Drowsiness
R40.1 Stupor

Semicoma

Excludes: stupor: catatonic (F20.2), depressive (F31-F33), dissociative
(F44.2), manic (F30.2)
R40.2 Coma,
unspecified

Unconsciousness NOS

(among others - from exposure to toxic materials)
R41.-
Other symptoms and signs involving cognitive functions and awareness

Excludes: dissociative [conversion] disorders (F44.-)
R41.3 Other
amnesia

Amnesia
NOS
Excludes: amnestic syndrome: due to psychoactive substance use (F10-
F19 with common fourth character .6); organic (F04); transient global
amnesia (G45.4)
R41.8
Other and unspecified symptoms and signs involving cognitive
functions and awareness
R42
Dizziness and giddiness

Lightheadedness, Vertigo NOS
Excludes: vertiginous syndromes (H81.-)
R43.-
Disturbances of smell and taste
R43.0 Anosmia
R43.1 Parosmia
R43.8
Other and unspecified disturbances of smell and taste

Mixed disturbance of smell and taste
R45.-
Symptoms and signs involving emotional state
R45.0
Nervousness

Nervous
tension
R45.6 Physical
violence
R45.7
State of emotional shock and stress, unspecified

(Includes acute reactive shock disorder (see Z56.6))
R49.-
Voice disturbances

Excludes: psychogenic voice disturbance (F44.4)
R49.0 Dysphonia

Hoarseness
R49.8
Other and unspecified voice disturbances

Change in voice NOS
R51
Headache

Facial pain NOS

Excludes: atypical facial pain (G50.1), migraine and other headache
syndromes (G43-G44), trigeminal neuralgia (G50.0)
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
32

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

R52.-
Acute pain
R52.9 Pain,
unspecified

Generalized pain NOS
R53
Malaise and fatigue

Asthenia NOS, Debility: NOS, chronic, nervous; General physical
deterioration, Lethargy, Tiredness

Excludes: debility: congenital (P96.9), senile (R54), exhaustion and fatigue
(due to) (in): combat (F43.0), excessive exertion (T73.3), exposure
(T73.2), heat (T67.-), neurasthenia (F48.0), fatigue syndrome (F48.0):
postviral (G93.3)
R55.x
Syncope and collapse
Blackout,
Fainting

Excludes: neurocirculatory asthenia (F45.3), orthostatic hypotension
(I95.1), neurogenic (G90.3), shock: NOS (R57.9), cardiogenic (R57.0),
postoperative (T81.1), Stokes-Adams attack (I45.9), syncope: carotid
sinus (G90.0), heat (T67.1), psychogenic (F48.8), unconsciousness NOS
(R40.2)
R61.-
Hyperhidrosis
R61.9 Hyperhidrosis,
unspecified

Excessive sweating, Night sweats
R68.-
Other general symptoms and signs
R68.8
Other specified general symptoms and signs

(suggested/recommended for multisymptomatic "idiopathic/environmental intolerance"
(IEI), including "multiple chemical sensitivity" (MCS); "electromagnetic
intolerance" ("el-allergy") etc. if the patient has not one major symptom which should
preferably be coded )
R70 -R79 Abnormal findings on examination of blood, without diagnosis
R74.-
Abnormal serum enzyme levels
R74.0
Elevation of levels of transaminase and lactic acid dehydrogenase
[LDH]
R77.-
Other abnormalities of plasma proteins

Excludes: disorders of plasma-protein metabolism (E88.0)
R77.2
Abnormality of alpha-fetoprotein
R79.-
Other abnormal findings of blood chemistry
R79.0
Abnormal level of blood mineral

lead, cobalt, copper, iron, magnesium, mineral NEC, zinc
R90 - R94 Abnormal findings on diagnostic imaging and in function studies, without
diagnosis
R94.-
Abnormal results of function studies
R94.2
Abnormal results of pulmonary function studies

Reduced: ventilatory capacity, vital capacity, bronchial hyperreactivity
S00 -T98 CHAPTER XIX
Injury, poisoning and certain other consequences of external cause
T20 - T32 Burns and corrosions
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
33

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

T65.-
Toxic effect of other and unspecified substances
T65.0 Cyanides

Excludes: hydrogen cyanide (T57.3)
T65.1
Strychnine and its salts
T65.2
Tobacco and nicotine
T65.3
Nitroderivatives and aminoderivatives of benzene and its homologues

Aniline [benzenamine], Nitrobenzene, Trinitrotoluene
T65.4 Carbon
disulfide
T65.5
Nitroglycerin and other nitric acids and esters

1,2,3-Propanetriol
trinitrate
T65.6
Paints and dyes, not elsewhere classified
T65.8
Toxic effect of other specified substances
T65.9
Toxic effect of unspecified substance

Poisoning
NOS
(only for cases with acute intoxication with many disorders
simultaneously)
T66 -T78 Other and unspecified effects of external causes
T66.x
Unspecified effects of radiation
Radiation
sickness
Excludes: specified adverse effects of radiation, such as: burns (T20-T31),
leukaemia (C91-C95), radiation: gastroenteritis and colitis (K52.0),
pneumonitis (J70.0), related disorders of the skin and subcutaneous
tissue (L55-L59), sunburn (L55.-)
T67.-
Effects of heat and light
Excludes: burns (T20-T31), erythema [dermatitis] ab igne (L59.0),
malignant hyperthermia due to anaesthesia (T88.3), radiation-related
disorders of the skin and subcutaneous tissue (L55-L59), sunburn
(L55.-), sweat disorders due to heat (L74-L75)
T67.0
Heatstroke and sunstroke

Heat: apoplexy, pyrexia. Siriasis. Thermoplegia
T67.1 Heat
syncope

Heat
collapse
T67.2 Heat
cramp
T67.3
Heat exhaustion, anhydrotic

Heat prostration due to water depletion

Excludes: heat exhaustion due to salt depletion (T67.4)
T67.4
Heat exhaustion due to salt depletion

Heat prostration due to salt (and water) depletion
T67.8
Other effects of heat and light
T67.9
Effect of heat and light, unspecified
T68.x
Hypothermia

Accidental hypothermia

Excludes: frostbite (T33-T35), hypothermia (of): following anaesthesia
(T88.5), newborn (P80.-), not associated with low environmental
temperature (R68.0)
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
37

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

T70.-
Effects of air pressure and water pressure
T70.0 Otitic
barotrauma

Aero-otitis media, Effects of change in ambient atmospheric pressure or
water pressure on ears
T70.1 Sinus
barotrauma

Aerosinusitis. Effects of change in ambient atmospheric pressure on
sinuses
T70.2
Other and unspecified effects of high altitude

Alpine sickness, Anoxia due to high altitude, Barotrauma NOS.

Hypobaropathy, Mountain sickness

Excludes: polycythaemia due to high altitude (D75.1)
T70.3
Caisson disease [decompression sickness]

Compressed-air disease, Diver's palsy or paralysis
T70.4
Effects of high-pressure fluids

Traumatic jet injection (industrial)
T70.8
Other effects of air pressure and water pressure

Blast injury syndrome
T70.9
Effect of air pressure and water pressure, unspecified
T71.x
Asphyxiation

Suffocation (by strangulation), Systemic oxygen deficiency due to:

Low oxygen content in ambient air, mechanical threat to breathing
Excludes: anoxia due to high altitude (T70.2). asphyxia from: carbon
monoxide (T58), inhalation of food or foreign body (T17.-), other gases,
fumes and vapours (T59.-), respiratory distress (syndrome) in: adult (J80)
T73.-
Effects of other deprivation
T73.3
Exhaustion due to excessive exertion

Overexertion
T73.9
Effect of deprivation, unspecified

T75.-
Effects of other external causes
Excludes: adverse effects NEC (T78.-), burns (electric) (T20-T31)
T75.0
Effects of lightning

Shock from lightning, Struck by lightning NOS
T75.1
Drowning and nonfatal submersion

Immersion, Swimmer's cramp
T75.2
Effects of vibration

Pneumatic hammer syndrome, Traumatic vasospastic syndrome, Vertigo
from infrasound

(Traumatic vasospastic syndrome where the diagnosis is somewhat uncertain - or if
there is a mixture of disorders from the vibration. Use preferably I73.0 or G56.-
arthrosis or M19.8. If no disorder can be identified use Z57.7 (+ Y76.x)
T75.4
Effects of electric current

Electrocution, Shock from electric current.
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
38

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

T78.-
Adverse effects, not elsewhere classified

This category is to be used as the primary code to identify the effects, not
elsewhere classifiable, of unknown, undetermined or ill-defined causes. For
multiple coding purposes this category may be used as an additional code to
identify the effects of conditions classified elsewhere.
Excludes: complications of surgical and medical care NEC (T80-T88)
T78.2
Anaphylactic shock, unspecified

Allergic shock, Anaphylactic reaction NOS, Anaphylaxis

Excludes: anaphylactic shock due to: adverse effect of correct medicinal
substance properly administered (T88.6), adverse food reaction (T78.0),
serum (T80.5)
T78.4 Allergy,
unspecified

Allergic reaction NOS, Hypersensitivity NOS, Idiosyncracy NOS

Excludes: allergic reaction NOS to correct medicinal substance properly
administered (T88.7), specified types of allergic reaction such as: allergic
gastroenteritis and colitis (K52.2), dermatitis (L23-L25, L27.-), hay fever
(J30.1)
T78.8
Other adverse effects, not elsewhere classified

("Other specified general symptoms and signs" (R68.8) is recommended for conditions
like "idiopathic environmental intolerance" (IEI), incl. MCS; electromagnetic
intolerance ("el-allergy") etc.)
T90-T98 Sequelae of injuries, burns, corrosions and frostbite, toxic effects of substances,
other and unspecified effects of external causes
T90.9
Sequelae of unspecified injury of head

Sequelae of injury classifiable to S09.9

(See also F07.- Personality and behavioural disorders due to brain disease, damage and
dysfunction Alteration of personality and behaviour can be a residual or concomitant
disorder of brain disease, damage or dysfunction.)
T91.8
Sequelae of other specified injuries of neck and trunk

Sequelae of injury classifiable to S13.-, S14.2-S14.6, S15-S18, S19.7-S19.8,
S23.-, S24.2-S24.6, S25.-, S28.-, S29.0-S29.8, S33.-, S34.2-S34.8, S35.-, S38.-,
S39.0-S39.8, T09.2 and T09.4 -T09.8

(Among others sequelae from Whiplash)
Y96
Work-related condition
Y97
Environmental-pollution-related condition
Z00 - Z99 Persons encountering health services for examination and investigation
Z00.-
General examination and investigation of persons without complaint and
reported diagnosis

Excludes: examination for administrative purposes (Z02.-), special
screening examinations (Z11-Z13)
Z00.6
Examination for normal comparison and control in clinical research
programme
Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
39

Nordic version for Occupational Disorders adapted to International Statistical
Classification of Diseases and Related Health Problems (ICD-10)
ICD-10
ICD-10 codes for the most frequently encountered occupational
disorders in the Nordic countries
(Edited June 2000)

Z03.-
Medical observation and evaluation for suspected diseases and conditions

Includes: persons who present some symptoms or evidence of an
abnormal condition which requires study, but who, after examination
and observation, show no need for further treatment or medical care.
Excludes:
person with feared complaint in whom no diagnosis is made
(Z71.1)
Z03.3
Observation for suspected nervous system disorder
Z03.6
Observation for suspected toxic effect from ingested substance

Observation for suspected: adverse effect from drug, adverse effect from
poisoning
Z03.8
Observation for other suspected diseases and conditions
Z04.-
Examination and observation for other reasons
Includes: examination for medicolegal reasons
Z04.2
Examination and observation following work accident
Z04.8
Examination and observation for other specified reasons

Request for expert evidence
Z04.9
Examination and observation for unspecified reason

Observation NOS
Z10.-
Routine general health check-up of defined subpopulation

Excludes: medical examination for administrative purposes (Z02.-)
Z10.0
Occupational health examination

Excludes: pre-employment examination (Z02.1)
Z53.-
Persons encountering health services for specific procedures, not carried out

Excludes: immunization not carried out (Z28.-)
Z53.8
Procedure not carried out for other reasons

(patient did not show up)
Z56.-
Problems related to employment and unemployment

Excludes: occupational exposure to risk-factors (Z57.-), problems related
to housing and economic circumstances (Z59.-)
Z56.3
Stressful work schedule
Z56.4
Discord with boss and workmates
Z56.5 Uncongenial
work

Difficult conditions at work
Z56.6
Other physical and mental strain related to work

Abbreviations: NOS=not otherwise specified; NEC= not elsewhere classified
Text in italics are our comments
40

APPENDIX I

Neurotoxic conditions (Central- and Peripheral nervous system)
i.e. conditions/symptoms caused or suspected to be caused by toxic effects on the nervous system of solvents, heavy metals, gases and other toxic agents

(The text in italics is our comments and suggestions).

This is the most difficult group of the Nordic occupational disorders to classify with the ICD-10 system.
· ICD-10 does not have a system which discriminates clearly between acute intoxications and chronic disorders. This distinction is important in occupational medicine.
· ICD-10 does not have codes which present themselves as good candidates for coding the "syndromes" of occupational central nervous system disorders where objective clinical findings are not clearly pathological. Such "syndromes" in ICD-10 are covered with the F codes of psychiatry which many will be reluctant to use in cases where one suspect (or at least keep open the possibility) the cause to be occupational chemical exposure. In general these "syndromes" do not have a symptom which stands out more clearly than other complaints, thus it is difficult to code these disorders with an R code for a symptom too. Some Nordic clinics use the F codes for these "syndromes", other clinics shy the F codes and use R codes. We have therefore chosen to present both possibilities.

Acute intoxication

Central nervous system
R00 R94
If one symptom is dominating in an acute disorder and the final diagnosis is not clear, this symptom should be coded with an R code, followed by Y96 or Y97.

T51 - T65
If no symptom is dominating, then the acute disorder should be coded with a T-code for general toxic effects (T51-65), followed by Y96 or Y97. Codes for toxic exposures listed in T51-T56 should generally only be used as additional diagnoses in diagnosed diseases, but we advise to use them in cases of acute intoxication with general diffuse/unclear symptoms.

(Beware that T51-65 is not quite logically presented. One has to look through these codes to find the most appropriate).

Peripheral nervous system
G62.2 Polyneuropathy due to other toxic agents

Use additional external cause code (Chapter XX), if desired, to identify cause.

43

Chronic disorder

Central nervous system
G92
Toxic encephalopathy
Suggested to be used in chronic toxic encephalopathy when the diagnosis is reasonably verified by consistent pathological outcome of neuropsychological tests

G93.4 Encephalopathy, unspecified

Exclude:

encephalopathy: alcoholic (G31.2); toxic (G92).

Alternative: F diagnoses

F06.7 Mild cognitive disorder
(For definition and explanation, see ICD-10 Vol. 1) Suggested to be used in patients with marked cognitive symptoms suggesting slight encephalopathy, but where only slight or not significantly pathological findings in neuropsychological tests suggests organic dysfunction (i.e. reduction in test performance between 1 and 2 Standard Deviations from reference). The diagnosis is suggested even if F06.7 is described to be made only in association with a specified physical disorder, as we find no better code for suspected encephalopathies where the symptomatology suggests the diagnosis but the objective findings are vague and inconclusive. If neurasthenic symptoms dominate and test performances are within normal range, the diagnosis F48.0 Neurasthenia is suggested.

F48.0 Neurasthenia
(Suggested to be used in solvent / metal exposed persons with mainly subjective symptoms of increased fatigue after mental efforts, etc., including difficulty in concentrating etc. but without reduced performance in neuropsychological tests indicating organic illness. (Includes R53 Malaise and fatigue, asthenia NOS, tiredness, "Fatigue syndrome", but not G93.3 Postviral fatigue syndrome. )

Alternative: R diagnoses

R41.3 Amnesia NOS.
Suggested for memory problems without frank dementia (Exclusion: F04
organic).

R41.8 Other and unspecified symptoms and signs involving cognitive functions and
awareness

44

R43.1 Parosmia
(Dysosmia, cacosmia) May be used when intolerance to the mere smell of
solvents or gases induces symptoms.

In cases of suspected solvent / metal induced illness with subjective symptoms (i.e.
headache, memory disturbances, asthenia, mood disturbances etc,) but where no
objective findings are made, it is recommended to use a symptom diagnosis (R.XX)
supplemented with "Z03.3" diagnosis for observation.

Z03.3 Observation for suspected nervous system disorder
Includes: persons who present some symptoms or evidence of an
abnormal condition which requires study, but who, after examination and
observation, show no need for further treatment or medical care.

Z57.5 Occupational exposure to toxic agents in other industries (i. e. than agriculture)
Solids, liquids or vapours.
(I.e. patient's contact with the health service because of relevant exposure
where no disorder could be detected)

Peripheral nervous system
G62.2 Polyneuropathy due to other toxic agents

Use additional external cause code (Chapter XX), if desired, to identify

cause.

45

APPENDIX II

Vibration-related disorders
i. e. conditions/symptoms caused or suspected to be caused by vibration

(The text in italics is our comments and suggestions).

We advise that the diagnoses for organ disorders are used (like vasospastic,
(mono)neuropaties, arthroses)

I73.0
Raynaud's syndrome
Raynaud's: disease, gangrene, phenomenon (also secondary)
(often viewed as a necessary sign for disorders from vibration)

G56.0 Carpal tunnel syndrome

G58.8 Other specified mononeuropathies

M19.2 Other secondary arthrosis

Secondary arthrosis NOS

M19.8 Other specified arthrosis
(code for arthrosis both in the carpal- and elbow regions at the same time,
caused by vibration)

(If to be specified to a single joint see M16-M18)

R20.2 Paraesthesia of skin

T75.2
Effects of vibration

Pneumatic hammer syndrome, Traumatic vasospastic syndrome,

Vertigo from infrasound
(T75.2: Preferably not used as the disease/symptom code. Use primarily I73.0
(Mb. Raynaud) or G56.0 (carpal tunnel syndrome); M19.2 Secondary
arthrosis of other joints or M19.8 Other specifies arthrosis. May be used for
traumatic vasospastic syndrome where the diagnosis is somewhat uncertain -
or if there is a mixture of disorders from the vibration. If no disorder can be
identified use Z57. 7).

Z03.8 Observation for other suspected diseases and conditions
Includes: persons who present some symptoms or evidence of an abnormal
condition which requires study, but who, after examination and observation,
show no need for further treatment or medical care.

Z57.7 Occupational exposure to vibration
(patient's contact with the health service because of exposure to vibration
where no disorder could be detected)

46

APPENDIX III

Asbestos - related conditions
i. e. conditions/symptoms caused or suspected to be caused by asbestos

(The text in italics is our comments and suggestions).

C34
Malignant neoplasm of bronchus and lung
C34.9 Bronchus or lung, unspecified
(if specific localisation is needed, see C34.-)

C45 Mesothelioma
C45.0
Mesothelioma of pleura

Excludes: other malignant neoplasms of pleura (C38.4)
C45.1
Mesothelioma of peritoneum

Mesentery. Mesocolon. Omentum. Peritoneum (parietal)(pelvic)

Excludes: other malignant neoplasms of peritoneum (C48.-)
C45.2
Mesothelioma of pericardium

Excludes: other malignant neoplasms of pericardium (C38.0)
C45.9 Mesothelioma,
unspecified

J61
Pneumoconiosis due to asbestos and other mineral fibres
Asbestosis
(The specification of whether the pneumoconiosis is associated with exposure to asbestos or to other mineral fibers, must be done through the local exposure code system of each health unit. These exposure systems does not belong to the ICD-10 system.
The code should not be used unless there is a diagnosis of lung fibrosis. The code should not be used if there are only dyspnoea, pleural plaques and asbestos exposure)

J90
Pleural effusion, not elsewhere classified

Pleurisy with effusion

(We advise that pleural effusion associated with exposure to asbestos is coded here)

J92
Pleural plaque

Includes:
pleural thickening
J92.0
Pleural plaque with presence of asbestos
J92.9
Pleural plaque without asbestos

J94.8
Other specified pleural conditions
(We advise that visceral pleural fibrosis, or asbestos related adherence in persons
with known exposure to asbestos is coded here.)

Z03.8 Observation for other suspected diseases and conditions
Includes: persons who present some symptoms or evidence of an abnormal
condition which requires study, but who, after examination and observation,
show no need for further treatment or medical care.

47

Z57.2
Occupational exposure to dust
(patient's contact with the health service because of exposure to asbestos or mixed
dust where no disorder could be detected)

48

APPENDIX IV

Conditions with aetiology attributed to environmental factors - mechanisms not yet understood

(The text in italics is our comments and suggestions)

These conditions are not yet accepted medical diagnoses, although they are widely in use in scientific publications. The symptoms of the conditions are to some extent overlapping and there are no clear cut syndromes. The aetiology and pathophysiology is uncertain. An important part of the symptoms should always be eliminated given that the "causes" are entirely avoided (even though this often seems very difficult).
The recommendation from WHO (1997), so far, is to use wide definitions, like:
Idiopathic environmental intolerance (IEI)

We have concluded that our advice in regard to ICD-10 (where none of the above mentioned "conditions" have codes) is:
1. Disease/symptom code: Take the most prominent symptom and use the R-code for that condition. Alternatively use R68.8 "Other specified general symptoms and signs" if there is no single prominent symptom.
2. To underscore that the condition has no accepted aetiology: We suggest to "tag" the disease/symptom code with R69 "Unknown and unspecified causes of morbidity" (like we "tag" the other disease/symptom codes with Y96 or Y97 to express the occupational/environmental aetiology of the disorder).

The use of psychiatric diagnosis (F45,-, F45.0 or F45.9) for these conditions has been discussed. However, we advice that they should not be used by occupational physicians at the present state of knowledge.
F45.-, F45.0 or F45.9 should only be used when a full somatization syndrome
("Environmental somatization syndrome" (ESS)) is diagnosed by a psychiatrist.

We will, however, give some examples on commonly used "names" and suggestions for description of these conditions. They are often named after the attributed environmental factor that the patient (or others) claims to elicit the symptoms.
Because of the uncertainty regarding the medical definitions and acceptance of these conditions as medical entities at present, we suggest that the clinics, if they need it for their own registry or research purposes, make their own codes for these conditions. This could also be organised on a national basis.

"Sick building syndrome" (SBS)
"Indoor climate syndrome". "Office workers syndrome/illness", etc.
To be used where multiple non-specific symptoms are reported in increased frequency in a population of workers compared to a reference population (mainly general symptoms + mucous membrane irritation symptoms + dermal symptoms).
Is also used for single patients who react specifically in a certain indoor environment, and in whom the symptoms abate when the specific environment is left. The most common attributions in single patients are office machines, use of visual display units (VDT-equipment), copying machines, laser printers in addition to "indoor pollution" (dust, particles, solvents or other gases, particles/fibres etc.),

49

flooring material or water damage.

"Multiple chemical sensitivity" (MCS).
Symptoms from multiple organ systems triggered by very low concentrations of >chemically unrelated pollutants ("smell"), i.e. organic solvents, disinfectants (incl. formaldehyde), chlorine, ammonia/amines, perfumes, "mould metabolites" etc.

"Electromagnetic intolerance"
"El-allergy".
Usually general symptoms (tiredness, nausea, memory- and concentration difficulties etc.) related to use of TV/PC/data-screens, electrical transformers or fluorescent lamps. Symptoms disappear in "non-electrical environments".

"Chronic fatigue syndrome"
"Myalgic encephalitis"
Use preferably ICD-10 code F48 Fatigue syndrome or G93.3 Postviral fatigue syndrome or R53 Malaise and fatigue.

"Chronic heavy metal intoxication"
"Amalgamism". "Mercury intoxication from dental amalgam fillings", "Oral galvanism",
Symptoms usually attributed to release of mercury from dental fillings. The
"intoxication" is not supported by elevated concentration of mercury or other
heavy metals in blood or urine. (Increased excretion of mercury or lead after use
of chelators is usually not accepted as valid diagnostic criteria).

Other idiopathic environmental intolerance
A number of non-occupational causes may be presented with multiple or unclear
attributions to environmental factors, like "hypoglycaemia" or ill defined "food intolerance"
(often attributed to "candida" or "E-labelled food additives").

50

APPENDIX V

Strength of association between the disease/symptom and the occupational exposure

(The text in italics is our comments and suggestions)

1. Established association
The disease/symptom developed within a usual timeframe to the claimed exposure,
and other disorders or exposures cannot explain the condition.
The association between the disease/symptom and the claimed exposure must be
thoroughly documented in the literature.

2. Likely association
The disease/symptom developed within a usual timeframe to the claimed exposure,
and other disorders or exposures can not explain the condition.
The association between the disease/symptom and the claimed exposure should be
documented in the literature or could be supported by relevant experimental
documentation.

3. Possibly association
The disease/symptom developed within a usual timeframe to the claimed exposure, but
other disorders or exposures can also explain the disease/symptom.

4. Low/unlikely association
The disease/symptom developed within an unusual timeframe to the claimed exposure,
and/or other disorders or other exposures can give a more likely explanation of the
actual disease/symptom.

5. Association claim is not logical
The claimed disease/symptom does not represent any disorder.

6. An association can not be evaluated
The information available on the disease/symptom and/or on the exposure is
contradictory or insufficient.

51

Document Outline

Contents
Preface
1. Introduction
- 1.1 Complete coding of an occupational disorder
- 1.2 Construction of the Nordic list of occupational disordersŽ
Nordic version for Occupational Disorders adapted to International Statistical Classification of Diseases
- Ch I. Infectious and parasitic diseases
- Ch II. Neoplasms
- Ch III. Diseases of the blood
- Ch V. Mental and behavioural disorders
- Ch VI. Diseases of the nervous system
- Ch VII. Diseases of the eye and adnexa
- Ch VIII. Diseases of the ear and mastoid process
- Ch IX. Diseases of the circulatory system
- Ch. X. Diseases of the respiratory system
- Ch XI. Diseases of the digestive system
- Ch XII. Diseases of the skin and subcutaneous tissue
- Ch XIII. Diseases of the musculoskeletal system and connective tissue
- Ch XIV. Diseases of the genitourinary system
- Ch XVIII. Symptoms, signs [involving the circulatory and respiratory systems]
- Ch XIX. Injury, poisoning and certain other consequences of external causes
- Ch XX. External causes of morbidity and mortality
- Ch XXI. ... contact with health services
APPENDIX I
APPENDIX II
APPENDIX III
APPENDIX IV
APPENDIX V