ICD-10 Coding: HPV Cancers

Local radio station personality goes public with his cancer fight.

In August 2018, Marty Griffin, KDKA radio personality, announced to his listening audience that he had cancer. His cancer is related to human papilloma virus (HPV), which infects 80 million people, according to the Centers for Disease Control and Prevention (CDC). He also announced that he would be undergoing chemotherapy, radiation therapy, and immunotherapy as treatment.  

The situation was very saddening, because Marty had lost both parents to cancer in the past year. Marty is married to Kristine Sorensen, a KDKA-TV anchor, and they have three children. Their concerns include how this diagnosis will impact their family. At the beginning of this week, Marty was beginning to experience the side effects of his treatment, having a hoarse voice and not feeling very well. 

In response to his current situation, Marty has created a website, www.Sparkt.com, which provides a pictorial history of his treatment journey and resources regarding HPV. The HPV virus can cause cancer of the cervix, vulva, vagina, penis, or anus. Other primary sites of cancer origination include the back of the throat or tonsils. HPV is also the virus that causes genital warts.  

The CDC states that 80 percent of people will get an HPV infection in their lifetimes. During Marty’s research, he found that the HPV vaccine could prevent over 90 percent (or 31,200 annual cases) of HPV-related cancers. The HPV vaccine was introduced 10 years ago, and infections have dropped 71 percent among teen girls since then. The two-dose vaccine should be given between the ages 11-12.   

The ICD-10-CM coding for this virus begins with vaccine administration. The code for vaccine administration or immunization is Z23 (Encounter for immunization). This code is not specific to the type of vaccine provided. There is a coding note indicating that the procedure code will identify the type of vaccine administered. For the virus, there is a screening code (Z11.51) that captures the screening for HPV. The results can be captured as DNA-positive for cervical (R87.810) and vaginal (R87.811), high-risk, or DNA-negative for cervical (R87.820) and vaginal (R87.821). The subcategory R87.82- has an instructional note to use an additional code for associated human papillomavirus (B97.7). This code identifies the causal organism in a condition classified elsewhere.  

For women, vaginal intraepithelial neoplasia (VAIN) and vulvar intraepithelial neoplasia (VIN) are related to the HPV virus. VAIN has grades I (N89.0), II (N89.1), and III (D07.2), with type III identified as severe dysplasia. VIN also has grades I (N90.0), II (N90.1), and III (D07.1), which is identified as severe dysplasia. Vaginal cancer has no symptoms early, but patients can develop pelvic pain and vaginal discharge later. Vulvar cancer does have symptoms, which include color and skin changes, sores or lumps, itching, burning, and vulvar bleeding. It is important to note that not all vaginal/vulvar cancers are caused by HPV. For men and women, anal cancer and genital warts are also a concern after a diagnosis of HPV. Anal cancer is coded as C21.- and genital warts are coded as A63.0 (anogenital warts). The CDC notes that there are 40 new cases of genital warts diagnosed every hour.

Marty has squamous cell carcinoma of the oropharynx, which was first detected as a small lump in his throat. After a biopsy, the cancer was diagnosed. This cancer is coded as C10.9 (malignant neoplasm of oropharynx, unspecified) unless the specific location within the oropharynx is identified.

In closing, I would like to reference Marty’s mission: to cure his own cancer and put an end to HPV-related cancers for good. I encourage everyone to review the aforementioned information regarding the HPV vaccine and consider the positive effects of early vaccination.  

Program Note 

Listen to Laurie Johnson report this story during today’s Talk Ten Tuesdays, 10-10:30 a.m. ET.