Oncology & Hematology Coding Alert

Question: Our oncologist diagnosed a stage 0 vulvar neoplasm. The histopathology report states that the cancerous cells were limited to the surface of the vulvar skin and were not located beyond the skin. The patient is being investigated for HPV. What diagnosis codes can we submit?

New Mexico Subscriber

Answer:  According to the description shared, the oncologist seems to be treating a patient with carcinoma in situ of the vulva. Therefore, you would report ICD-9-CM code 233.32 (Carcinoma in situ, vulva) for this diagnosis. Later this year, when ICD-10-CM is effective, you will report the code D07.1 (Carcinoma in situ of vulva).

Check your clinician’s documentation for the vulvar lesion size and margin. The cause of vulvar dysplasia is not important for reporting the correct code. For instance, an infection, such as the human papilloma virus (HPV), or irritant may cause vulva dysplasia. But it is the vulvar dysplasia that would be coded in support of the lesion removal as the determining factor, and not the cause of the condition.

ICD-9-CM: has the following codes to report vulvar dysplasia:

• 624.01 — Vulvar intraepithelial neoplasia I (VIN I)
  
• 624.02 — Vulvar intraepithelial neoplasia II (VIN II)
  
• 233.32 — Carcinoma in situ, vulva.
  

Should the oncologist fail to document the type/severity of vulvar dysplasia, the unspecified option is: 624.8 Other specified noninflammatory disorder of vulva and perineum

ICD-10-CM: When your diagnosis system changes, the codes above will become:

• N90.0 — Mild vulvar dysplasia
  
• N90.1 — Moderate vulvar dysplasia
  
• D07.1 — Carcinoma in situ of vulva
  

Should the oncologist fail to documenting the type/severity of vulvar dysplasia, the unspecified option will be: N90.3 Dysplasia of vulva, unspecified

Did you know? If the pathology report returns with indications of dysplasia, the neoplasm is in transition from being benign to becoming malignant. If the process continues and the mass is left untreated, the neoplasm could eventually become invasively malignant.