Oncology & Hematology Coding Alert

Question: Which ICD-9 codes are appropriate for vaginal carcinoma?

West Virginia Subscriber Answer: Vaginal cancer (184.0, Malignant neoplasm of other and unspecified female genital organs; vagina; 233.3, Carcinoma in situ of breast and genitourinary system; other and unspecified female genital organs) is a relatively rare form of female reproductive cancer, representing only 3 percent of gynecological cancers.   

There are four types:

- Squamous carcinoma -- It begins in the vaginal epithelium, frequently near the cervix, and develops slowly through precancerous stages called vaginal intraepithelial neoplasia (VAIN). This type of cancer is similar to dysplasia, and you should code it by severity. VAIN I and II (623.0, Dysplasia of vagina) represent mild to moderate dysplasia, while VAIN III is considered carcinoma in situ (233.3).

- Adenocarcinoma -- This type starts in the vaginal glands (184.0).

- Clear cell adenocarcinoma -- This type of cancer developed in the young children of women who took diethylstilbestrol (DES) during pregnancy before 1971 (184.0).

- Melanoma -- Although melanoma usually begins in skin exposed to the sun, it can start in the vaginal skin and is characterized by dark tumors on the vagina's lower or outer structures (184.0).