Health Information Management

Human Papillomavirus (HPV)

JustCoding News: Inpatient, November 11, 2009

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Human Papillomavirus (HPV) is a common virus that infects approximately 50% of all people who have sexual intercourse. HPV is actually a group of approximately 100 viruses, each of which is identified by a number or type.

The word papilloma refers to a kind of wart that the virus causes. Between 60 and 70 types of the virus are considered harmless and cause warts on areas such as the hands and feet. The other 30 or so are considered sexually transmitted, cause warts on genital areas or the anus, and may put the person at risk for certain cancers.

Types/stages
HPV is a group of approximately 100 viruses. Within that group are three types:

  • Viruses that are harmless but cause warts on areas such as hands and feet
  • Low-risk HPV: viruses that can lead to genital warts
  • High-risk HPV: viruses that can cause cancers of the cervix, vulva, vagina, and anus in women, and cancers of the anus and penis in men

Signs/symptoms
Many people infected with HPV don’t know it because they are asymptomatic. Others may suffer from genital warts, but in some cases the genital warts may not be visible. Genital warts, which can vary in size and number, can take on many different appearances, including:

  • Raised
  • Flat
  • Pink or flesh-colored
  • Cauliflower-shaped

Warts typically appear on the anus, cervix, scrotum, groin, thigh, or penis. They can take several weeks or months to appear after infection, making it is easy to unknowingly transmit HPV to others.

The types of HPV linked to cervical and other cancers may cause precancerous changes in tissue cells without causing any symptoms. The virus can go virtually undetected until the patient develops symptoms from the cancer itself. Signs and symptoms from cancer vary depending on the type of cancer.

HPV is diagnosed by the appearance of the genital warts. The types of HPV that cause genital warts are not the same types associated with cancer. Physicians typically diagnose women with HPV 16 and 18, both of which can cause cancer, through an abnormal Pap smear indicating the presence of precancerous/cancerous cells.

Providers can perform a DNA test to detect the virus. Generally a physician performs this test on women who have had mild Pap smear abnormalities. Starting at age 30, this may be a part of the routine Pap test.

Treatment
Currently, there is no cure for HPV. However, the virus often clears up on its own. If it does not, physicians may try to remove abnormal cells (often known as cervical dysplasia), cervical intraepithelial neoplasia, or precancerous cells using one of the following techniques:

  • Cryotherapy
  • Conization
  • Loop Electrosurgical Excision Procedure (LEEP)

Treatments often are postponed until after pregnancy or childbirth because they do present some risk.

Documentation and coding

ICD-9-CM coding

  • Human papillomavirus: code 079.4

Currently, two CPT codes represent the HPV vaccines:

  • Human papillomavirus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), three-dose schedule, for intramuscular use: CPT code 90649
  • Human papillomavirus (HPV) vaccine, types 16, 18, bivalent, three-dose schedule, for intramuscular use: CPT code 90650

ICD-10-CM coding
This code category is provided for use as a supplementary or an additional code to identify the infectious agent in diseases classified elsewhere.

  • Papillomavirus as the cause of diseases classified elsewhere: code B97.7



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