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v1.0.0
ICD-10 Guide
ICD-10 CodesR85.81

R85.81

Anal high risk human papillomavirus (HPV) DNA test positive

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R85.81 is a billable code used to indicate a diagnosis of anal high risk human papillomavirus (hpv) dna test positive.

Key Diagnostic Point:

The ICD-10 code R85.81 is used to indicate a positive result from an anal high-risk human papillomavirus (HPV) DNA test. This finding is significant as it suggests the presence of high-risk HPV types that are associated with an increased risk of anal dysplasia and anal cancer. Patients may be asymptomatic or may present with symptoms such as anal discomfort, bleeding, or changes in bowel habits. The detection of high-risk HPV is crucial for early intervention and management, particularly in high-risk populations such as those with a history of anal intercourse, immunocompromised individuals, or those with a history of cervical dysplasia. The clinical context surrounding a positive HPV DNA test includes the need for further diagnostic evaluation, such as anal Pap smears or biopsies, to assess for potential precancerous lesions or malignancy. Regular screening and follow-up are essential components of care for patients with a positive HPV test to mitigate the risk of progression to cancer.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Understanding the implications of high-risk HPV types
  • Differentiating between HPV types and their associated risks
  • Navigating the relationship between HPV and anal dysplasia/cancer
  • Documenting patient history and risk factors accurately

Audit Risk Factors

  • Inadequate documentation of patient history and risk factors
  • Failure to document follow-up plans or additional testing
  • Misclassification of HPV type or risk level
  • Inconsistent coding practices across different providers

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Documentation should include patient history, risk factors for HPV, and any symptoms present. Follow-up plans and results of any additional tests should also be documented.

Common Clinical Scenarios

Patients presenting for routine screening, those with a history of anal dysplasia, or those with immunocompromised status.

Billing Considerations

Consider the patient's overall health status and any comorbidities that may affect management.

Emergency Medicine

Documentation Requirements

Acute care documentation should include presenting symptoms, any immediate interventions, and plans for follow-up testing or referrals.

Common Clinical Scenarios

Patients presenting with acute anal pain, bleeding, or other symptoms potentially related to HPV.

Billing Considerations

Emergency settings may require rapid assessment and referral to specialists for further evaluation.

Coding Guidelines

Inclusion Criteria

Use R85.81 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used in conjunction with appropriate documentation of the patient's clinical scenario and any related findings

Exclusion Criteria

Do NOT use R85.81 When
No specific exclusions found.

Related CPT Codes

87624CPT Code

HPV DNA test

Clinical Scenario

Used when a patient is tested for high-risk HPV types.

Documentation Requirements

Document the reason for testing and any relevant patient history.

Specialty Considerations

Ensure that the test is indicated based on clinical guidelines.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of HPV-related findings, improving the accuracy of data collection and patient management strategies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of HPV-related findings, improving the accuracy of data collection and patient management strategies.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of HPV-related findings, improving the accuracy of data collection and patient management strategies.

Resources

Clinical References

  • •
    CDC HPV Information

Coding & Billing References

  • •
    CDC HPV Information

Frequently Asked Questions

What does a positive R85.81 indicate?

A positive R85.81 indicates the presence of high-risk HPV types in the anal region, which may require further evaluation and monitoring for potential dysplasia or cancer.