Human papillomavirus documentation, coding, and tips for success

High-risk types of human papillomavirus (HPV) cause the majority of cervical, vaginal, vulvar, anal, penile, and throat cancers. Each year in the US, more than 33,000 men and women will receive a diagnosis of cancer caused by HPV. In addition to cancer, hundreds of thousands of women undergo treatment for new cases of pre-cancerous, high-grade cervical dysplasia each year. HPV vaccination prevents infection from these high-risk types of HPV.

Coding for HPV and related cancers

Below is information for outpatient and professional services from the ICD-10-CM Official Guidelines for Coding and Reporting and industry-standard resources:

• Code Z23 (Encounter for immunization) isn’t specific to the type of vaccine provided. A procedure code should be used to identify the type of vaccine.
• When vaccines are provided as part of a well-child encounter, the ICD-10-CM guidelines instruct that code Z00.121 or Z00.129 (routine child health examination) includes immunizations appropriate to the patient's age. Code Z23 may be used as a secondary code if the vaccine is given as part of a preventive health care service, such as a well-child visit.
• Code Z11.51 captures HPV screening. The R87.x codes capture screening results.
• With R87.82x, code B97.7 should be used to capture associated HPV.
• For women, vaginal intraepithelial neoplasia (VAIN) and vulvar intraepithelial neoplasia (VIN) are related to the HPV virus:
  •  Codes for VAIN grades are:
    • Grade I – N89.0
    • Grade II – N89.1
    • Grade III – D07.2 (severe dysplasia)
  • Codes for VIN grades are:
    • Grade I – N90.0
    • Grade II – N90.1
    • Grade III – D07.1 (severe dysplasia)

Coding tips:

• Include patient demographics such as name, date of birth, and date of service in all progress notes.
• Document legibly, clearly, and concisely.
• Ensure care providers sign and date all documents.
• Document how each diagnosis was monitored, evaluated, assessed, and treated, as well as any complications on the associated date of service.
• Take advantage of the Annual Health Assessment or other yearly preventative exams as an opportunity to capture conditions impacting member care.

Cervical cancer screening

The U.S. Preventive Services Task Force recommends screening all women starting at age 21. Through routine HPV or Pap tests, providers can find and remove precancerous cells before they develop into cancer, according to the CDC.

HPV vaccines

To protect against cancers later in life, the CDC recommends the HPV vaccine for:

• All children aged 11 or 12 years (or starting at age 9): Children who get the vaccine before turning 15 need two doses given six to 12 months apart.
• All people up to age 26 who are not fully vaccinated already: People aged 15 or older or with conditions that weaken the immune system need three doses.
• HPV vaccination is not recommended for everyone older than age 26 years. Some adults aged 27 through 45 years who were not already vaccinated might choose to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and possible benefits of vaccination for them.
• For more details, visit the Advisory Committee on Immunization Practices’ HPV recommendations.

Tips for HPV vaccination success:

• Appreciate the significance of achieving high HPV vaccination rates.
• Acknowledge the importance your recommendation has when it comes to parents choosing to get their children vaccinated.
• Use an effective approach by bundling your vaccine recommendation.
• Motivate your team and encourage their immunization conversations with parents.
• Implement systems to ensure you never miss an opportunity to vaccinate.
• Use local health department resources.
• Know your rates of vaccination refusal.
• Maintain strong relationships with patients to help with challenging immunization conversations.
• Learn how to answer some of parents’ most common questions about HPV vaccine.
• Use personal examples of how you choose to vaccinate children in your family.