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ICD-10 Guide
ICD-10 CodesB02.22

B02.22

Postherpetic trigeminal neuralgia

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 B02.22 is a billable code used to indicate a diagnosis of postherpetic trigeminal neuralgia.

Key Diagnostic Point:

Postherpetic trigeminal neuralgia (PHTN) is a chronic pain condition that occurs following an outbreak of herpes zoster (shingles), which is caused by the reactivation of the varicella-zoster virus (VZV). This condition is characterized by severe, persistent facial pain in the distribution of the trigeminal nerve, often described as burning, stabbing, or electric shock-like sensations. The pain can be triggered by light touch or temperature changes, significantly impacting the patient's quality of life. PHTN typically develops in older adults, particularly those with a history of shingles, and is more common in individuals with weakened immune systems. The pain may persist for months or even years after the shingles rash has healed, making early diagnosis and management crucial. Treatment options include medications such as anticonvulsants, antidepressants, and topical agents, as well as interventional procedures in refractory cases. Understanding the pathophysiology of PHTN, including the role of nerve damage and inflammation, is essential for effective management and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of the relationship between herpes zoster and trigeminal neuralgia.
  • Differentiation from other types of neuralgia and pain syndromes.
  • Documentation must specify the duration and severity of symptoms.
  • Potential for co-morbid conditions affecting coding accuracy.

Audit Risk Factors

  • Inadequate documentation of prior herpes zoster infection.
  • Failure to specify the location of pain accurately.
  • Misclassification of pain type or duration.
  • Lack of evidence for chronicity in medical records.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed history of pain, including onset, duration, and triggers; neurological examination findings.

Common Clinical Scenarios

Patients presenting with facial pain post-herpes zoster; evaluation of pain management strategies.

Billing Considerations

Ensure documentation reflects the chronic nature of the pain and any treatments attempted.

Pain Management

Documentation Requirements

Comprehensive pain assessments, treatment plans, and response to therapies.

Common Clinical Scenarios

Management of refractory pain in patients with PHTN; interventional procedures for pain relief.

Billing Considerations

Document all modalities used for pain management to support coding and billing.

Coding Guidelines

Inclusion Criteria

Use B02.22 When
  • According to ICD
  • 10 guidelines, B02
  • 22 should be used when the patient has a documented history of herpes zoster and presents with trigeminal neuralgia symptoms
  • It is important to ensure that the diagnosis is supported by clinical documentation

Exclusion Criteria

Do NOT use B02.22 When
No specific exclusions found.

Related CPT Codes

64400CPT Code

Injection, anesthetic agent into the trigeminal nerve

Clinical Scenario

Used for patients with refractory PHTN pain.

Documentation Requirements

Document the indication for the procedure and the patient's pain history.

Specialty Considerations

Pain management specialists should ensure comprehensive pain assessments are included.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like PHTN, improving the accuracy of patient records and reimbursement processes. It emphasizes the importance of linking symptoms to prior infections.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like PHTN, improving the accuracy of patient records and reimbursement processes. It emphasizes the importance of linking symptoms to prior infections.

Reimbursement & Billing Impact

reimbursement processes. It emphasizes the importance of linking symptoms to prior infections.

Resources

Clinical References

  • •
    CDC - Shingles (Herpes Zoster)

Coding & Billing References

  • •
    CDC - Shingles (Herpes Zoster)

Frequently Asked Questions

What is the primary cause of postherpetic trigeminal neuralgia?

Postherpetic trigeminal neuralgia is primarily caused by the reactivation of the varicella-zoster virus, which leads to inflammation and damage to the trigeminal nerve following a shingles outbreak.