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A doseresponse relationship was established, which means the more people smoke, the higher their risk of hearing loss

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Think of R91.8 as "specified-but-not-fitting-other-categories" while R91.9 is "we literally have no idea what this is." In practical coding, when you need an ICD 10 code for lung nodule unspecified because documentation doesn't clarify solitary versus multiple, default to R91.8 rather than falling back to R91.9

she quit for good in the early 90s, recalling her brand of choice as Craven A Menthol, oddly also in a green pack (personal communication, November 14, 2025)