2024 ICD-10-CM Diagnosis Code Z11.51

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10-CM Code Edits are applicable to this code:

• Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Present on Admission (POA)

Z11.51 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.

CMS POA Indicator Options and Definitions

POA Indicator	Reason for Code	CMS will pay the CC/MCC DRG?
Y	Diagnosis was present at time of inpatient admission.	YES
N	Diagnosis was not present at time of inpatient admission.	NO
U	Documentation insufficient to determine if the condition was present at the time of inpatient admission.	NO
W	Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.	YES
1	Unreported/Not used - Exempt from POA reporting.	NO

Convert Z11.51 to ICD-9-CM

• ICD-9-CM Code: V73.81 - Special screen exam HPV

Patient Education

Human Papillomavirus (HPV) Test

What is an HPV test?

HPV stands for human papillomavirus. There are many types of HPVs. Some of them are spread through close skin-to-skin touching during sex with a person who has the virus. These HPVs are the most common cause of sexually transmitted diseases (STD).

Certain types of HPV cause genital warts. Other types, called "high-risk HPV," can cause cancer, especially cancer of the cervix. The cervix is the lower part of the uterus where a baby grows during pregnancy. Most cervical cancers are caused by HPV. That means if you have a cervix and are infected with certain types of HPV, you have a higher risk of getting cervical cancer.

HPV tests use a sample of cells from your cervix to look for signs of infection with high-risk HPVs that can lead to cervical cancer. Knowing whether you have HPV helps your healthcare provider understand your risk for developing cervical cancer. If you have an HPV infection, you can discuss whether you need other tests and how often you should be checked for cervical cancer.

Usually, your immune system gets rid of an HPV infection naturally within two years without causing any health problems. But in certain cases, high-risk HPV infections can stay in the body for many years, even decades. These long-lasting infections can lead to cancer.

Other names: genital human papillomavirus, high risk HPV, HPV DNA, HPV RNA

What is it used for?

The test is used to check a sample of cervical cells for signs of infection with high-risk HPV that can lead to cervical cancer. The test is often done at the same time as a Pap smear, which is a test that checks cervical cells for abnormal changes caused by HPV. When an HPV test and a Pap smear are done at the same time, it's called an HPV/Pap cotest.

An HPV test may also be used to make treatment decisions after a diagnosis of oropharyngeal cancer. This cancer grows in the back of the throat, including the tonsils and the base of the tongue. It is mostly caused by HPV. Oropharyngeal cancer from HPV has its own treatment and usually has a better chance of recovery than other throat cancers.

Why do I need an HPV test?

You may need an HPV test to screen for cervical cancer if you:

• Had an abnormal result on a Pap smear. An HPV test can show whether HPV caused the abnormal changes in your cervical cells.
• Are age 30 through 65. An HPV test alone or an HPV/Pap cotest is recommended every five years as long as you have had normal test results.

If you are between ages 21 and 29, you should have a Pap smear every three years. But you don't need HPV testing if your Pap smear results are normal. While HPV infections are common in this age group, they usually clear up on their own within a year or two without causing any problems. Some medical experts recommend starting HPV testing at age 25 and getting tested every 5 years if your last test was normal.

If you have a high risk for developing cervical cancer, you may need to get tested more often. Your risk may be higher if you:

• Had an abnormal HPV test, Pap smear, or cervical biopsy in the recent past
• Have HIV
• Have a weakened immune system
• Have had cervical cancer
• Were exposed to a drug called DES (Diethylstilbestrol) before you were born. Between 1940-1971, DES was sometimes prescribed to prevent miscarriages. It was later linked to an increased risk of certain cancers in the female children exposed to it before birth.

Ask your provider which cervical cancer screening test is right for you and how often you should be tested.

If you have been diagnosed with oropharyngeal cancer, you may also need an HPV test of your throat, tonsils, or tongue to find out which treatment you should have.

What happens during an HPV test?

If you're getting an HPV test to screen for cervical cancer, you will lie on an exam table. Your provider will use a plastic or metal instrument called a speculum to widen the vagina, so the cervix can be seen. Your provider will then use a small, soft brush or swab to collect cells from the cervix. The cell sample is sent to a lab for testing.

HPV testing is often done as part of a routine pelvic exam. During a pelvic exam, your provider examines your uterus, ovaries, and genital area. But a pelvic exam doesn't always include an HPV test. So, when you have a pelvic exam, ask your provider whether you'll have and HPV test, too.

At-home tests to screen for cervical HPV are available. These kits provide a special swab so you can collect a sample of cells from your cervix and vagina to send to a lab. Talk with your provider if you are considering at-home HPV testing.

If you have oropharyngeal cancer, you probably won't need another test to find out whether HPV caused your cancer. That's because oropharyngeal cancer is usually diagnosed by examining a sample of throat tissue that's removed during a biopsy. The tissue sample is usually checked for HPV, too.

Will I need to do anything to prepare for the test?

You should not have the test while you are having your period. For two days before your test, you should not:

• Use tampons
• Use birth control foam, jelly, or cream
• Use other creams or medicines in the vagina
• Douche (rinse the vagina with water or other fluid)
• Have vaginal sex

For an at-home test, be sure to read all the instructions before you collect your sample.

Are there any risks to the test?

You may feel some mild discomfort when the cervical cells are collected. Afterward, you may have some very light bleeding. But there are no known risks to an HPV test.

What do the results mean?

Negative/Normal HPV test results mean that high-risk HPV was not found in your sample. Your provider will let you know when you should be tested again.

Positive/Abnormal HPV test results mean that signs of high-risk HPV were found. Some HPV tests also show whether HPV16 or HPV18 was found. These types of HPV are the most common cause of cervical cancer.

A positive test result does not mean you have cancer or will get cancer. It does mean that you have an HPV infection that increases your risk for getting cervical cancer in the future.

There's no treatment to get rid of an HPV infection. So, the next steps will depend on your risk for developing cervical cancer. To estimate your risk, your provider will consider past test results, your age, and other health conditions you have or have had.

Your provider may suggest other tests to check your cervical cells for abnormal changes. You may also need more frequent HPV tests or HPV/Pap cotests.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about an HPV test?

The HPV vaccine is a safe, effective way to protect yourself from HPV infections that can cause cancer and genital warts. The vaccine could prevent many of the cancers that HPV causes, including cancer of the cervix, vagina, throat, anus, and penis.

The vaccine works best when it's given before a person has any exposure to the virus. That's why it's recommended for children before they become sexually active.

The U.S. Centers for Disease Control and Prevention (CDC) recommends that 11 to 12-year-olds have two shots of HPV vaccine 6 to 12 months apart. But the vaccine can be given as early as age 9. Ask your child's provider about when to vaccinate your child against HPV.

Teens and young adults who get their first HPV shot between ages 15 and 26 need to have 3 doses. If you're over 26 and haven't been vaccinated, talk with your provider about the possible benefits of vaccination.

References

1. Allina Health [Internet]. Minneapolis: Allina Health; Human Papillomavirus DNA Detection; [cited 2022 Jul 11]; [about 3 screens]. Available from: https://account.allinahealth.org/library/content/49/150434
2. American Cancer Society [Internet]. Atlanta: American Cancer Society Inc.; c2022. HPV and HPV Testing; [revised 2020 Jul 30; cited 2022 Jul 11]; [about 6 screens]. Available from: https://www.cancer.org/healthy/cancer-causes/infectious-agents/hpv/hpv-and-hpv-testing.html
3. American Cancer Society [Internet]. Atlanta: American Cancer Society Inc.; c2022. Tests to find oral cavity or oropharyngeal cancer; [revised 2021 Mar 23; cited 2022 Jul 11]; [about 6 screens]. Available from: https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/how-diagnosed.html
4. Cancer.net [Internet]. Alexandria (VA): American Society of Clinical Oncology; 2005–2022. HPV and Cancer; 2020 Oct[cited 2022 Jul 11]; [about 3 screens]. Available from: https://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/hpv-and-cancer
5. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; Genital HPV Infection- Basic Fact Sheet; [updated 2022 Apr 12; cited 2022 Jul 11]; [about 4 screens]. Available from: https://www.cdc.gov/std/hpv/stdfact-hpv.htm
6. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; HPV and Men-Fact Sheet; [updated 2022 Apr 18; cited 2022 Jul 11]; [about 4 screens]. Available from: https://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm
7. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; Human Papillomavirus (HPV) Vaccination: What Everyone Should Know; [updated 2021 Nov 16; cited 2022 Jul 11]; [about 3 screens]. Available from: https://www.cdc.gov/vaccines/vpd/hpv/public/index.html
8. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998–2018. HPV Test;[cited 2022 Jul 11]; [about 5 screens]. Available from: https://www.mayoclinic.org/tests-procedures/hpv-test/about/pac-20394355
9. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co., Inc.; c2022. Human Papillomavirus (HPV) Infection; [updated 2021 Jan; cited 2022 Jul 11]; [about 5 screens]. Available from: https://www.merckmanuals.com/home/infections/sexually-transmitted-diseases-stds/human-papillomavirus-hpv-infection
10. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: HPV; [cited 2022 Jul 11]; [about 1 screen]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/hpv
11. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: Pap test; [cited 2022 Jul 11]; [about 2 screens]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pap-test
12. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; HPV and Cancer; [reviewed 2021 Oct 25; cited 2022 Jul 11]; [about 6 screens]. Available from: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer
13. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; HPV and Pap Testing; [cited2022 Jul 11]; [about 7 screens]. Available from: https://www.cancer.gov/types/cervical/pap-hpv-testing-fact-sheet
14. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Next Steps after an Abnormal Cervical Cancer Screening Test: Understanding HPV and Pap Test Results; [updated 2022 Mar 22 ; cited 2022 Jul 11]; [about 10 screens]. Available from: https://www.cancer.gov/types/cervical/understanding-abnormal-hpv-and-pap-test-results#treatment-for-high-grade-cervical-cell-changesnbsp
15. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Oropharyngeal Cancer Treatment (Adult) (PDQ®) – Patient Version; [reviewed 2021 Oct 14; cited 2022 Jul 11]; [about 24 screens]. Available from: https://www.cancer.gov/types/head-and-neck/patient/adult/oropharyngeal-treatment-pdq#_1
16. Testing.com [Internet]. Seattle (WA): OneCare Media; c2022. Human Papillomavirus (HPV) Test; [modified 2021 Nov 9; cited 2022 Jul 11]; [about 13 screens]. Available from: https://www.testing.com/tests/human-papillomavirus-hpv-test/
17. UF Health: University of Florida Health [Internet]. University of Florida; c2022. HPV DNA Test; [updated 2020 Dec 3; cited 2022 Jul 11]; [about 3 screens]. Available from: https://ufhealth.org/hpv-dna-test
18. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2022. Health Information: Human Papillomavirus (HPV) Test of the Cervix;[updated 2021 Nov 22; cited 2022 Jul 11]; [about 3 screens]. Available from: https://patient.uwhealth.org/healthwise/article/en-us/tu6451
19. WomensHealth.gov [Internet]. Washington DC: Office on Women's Health, U.S. Department of Health and Human Services; Human Papillomavirus; [updated 2022 Jan 4; cited 2022 Jul 11]; [about 11 screens]. Available from: https://www.womenshealth.gov/a-z-topics/human-papillomavirus

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Code History

• FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.