Postherpetic neuralgia sits at the crossroads of neurology and pain management, and it creates coding headaches when documentation is vague. Teams often ask for the icd 10 code for postherpetic neuralgia, but the right answer depends on how precisely the clinician describes the pain pattern and the cranial or peripheral nerves involved. If you want your claim to clear on first pass, align your code choice to the official tabular list and guidelines, because the coding rules are not rumor, the policies live in government sources that anyone can read, including the CDC’s ICD-10-CM tabular and index pages, which explain the B02 family for herpes zoster and its late effects, and the CMS ICD-10-CM Official Guidelines, which spell out how to sequence conditions, use combination codes, and capture manifestations for FY 2025..
For practical claim setup, many revenue teams translate policy into clean forms using the structure presented in PROMBS’s CMS-1500 Claim Form Guide and prevent avoidable edits by training clinicians with plain-English guidance like PROMBS’s Mastering Modifiers 59, 25, and 91, while specialty indexing across neurology, primary care, and pain management is often standardized using the layouts summarized on PROMBS Specialties.
What are the symptoms that support coding?
Why does the terminology matter?
What is the ICD-10 code
What are the Global burden and rates
Postherpetic neuralgia (PHN) affects a meaningful minority of people who get herpes zoster. According to recent meta-analyses, about 10 % to 18 % of individuals with shingles develop PHN in the U.S., and older age groups show much higher risks. One study showed that among patients over age 50, around 13 % develop PHN and for those over 60 the risk climbs to nearly 60 % in some cohorts.
International data support similar patterns. In rural Italy, out of nearly 58,500 primary-care patients screened for chronic neuropathic pain, about 0.24 % had PHN, compared to 0.31 % with diabetic neuropathy and 0.07 % with trigeminal neuralgia. PMC+1 Epidemiologic studies also place the incidence of PHN at roughly 35-38 per 100,000 person-years in certain adult populations. Oxford Academic
These statistics mean providers need to expect PHN in older shingles cases and ensure documentation is detailed early, not just when pain persists.
Which chapter applies to Postherpetic neuralgia
PHN lives in Chapter 1 (A00–B99) with herpes zoster (B02), which signals that PHN is a consequence of infection rather than an idiopathic neuralgia, a nuance you can see in the CDC chapter.
Did you know clinicians see PHN most frequently in older adults, and that complication risk is a recurring theme in patient and clinician materials, which CDC highlights on its shingles pages at cdc.gov. From a payment perspective, documentation clarity is not a nicety, it is a control lever, because CMS emphasizes in its Payment Integrity material on cms that correct coding paired with specific notes reduces improper payments.
Which CPT codes are used?
E/M and medication management
Interventional pain
Which treatments are recognized?
Conservative options, gabapentinoids, TCAs, SNRIs, topical lidocaine/capsaicin, precede interventions in most coverage pathways. For evidence and safety, clinicians can review neutral summaries because HHS’s AHRQ catalogs research on non-opioid and interventional pain strategies at ahrq. Treatment choice does not change the icd 10 code for postherpetic neuralgia, but it impacts whether higher-level CPT codes meet medical necessity.
PHN vs Diabetic Neuropathy vs Trigeminal Neuralgia
| Feature | Postherpetic Neuralgia (PHN) | Diabetic Neuropathy | Trigeminal Neuralgia |
|---|---|---|---|
| Cause | PHN reflects a late effect of herpes zoster, which population studies summarize in detail as persistent neuropathic pain after shingles in older adults, as reported in Open Forum Infectious Diseases by Marcum et al. where incidence and PHN sequela are quantified. | Chronic hyperglycemia causes metabolic and microvascular injury to peripheral nerves, a mechanism described in the American Diabetes Association’s neuropathy standards. | Classical trigeminal neuralgia is typically due to vascular compression or idiopathic irritation of the trigeminal root, as defined in the International Headache Society’s ICHD-3 criteria. |
| Onset timing | Pain begins after the shingles rash resolves and commonly persists ≥3 months, a chronology highlighted in CDC shingles complications guidance. | Symptoms evolve gradually over years in parallel with diabetes duration and control, a pattern summarized in StatPearls, Diabetic Peripheral Neuropathy on NCBI Bookshelf. | Attacks start abruptly in short paroxysms with triggerable episodes, which the IHS ICHD-3 diagnostic description emphasizes for timing and provocation. |
| Distribution | Pain follows the prior zoster dermatome and is often unilateral, which CDC clinical materials describe when outlining PHN patterns. | Findings are classically distal and symmetric with a “stocking–glove” pattern, a distribution described in StatPearls, Diabetic Peripheral Neuropathy on NCBI Bookshelf. | Pain tracks to one or more unilateral trigeminal divisions (V1/V2/V3), consistent with the IHS ICHD-3 anatomic criteria. |
| Pain features | Burning pain with prominent allodynia and continuous background discomfort are typical, as summarized in CDC shingles complication descriptions (see CDC Shingles overview at cdc.gov). | Numbness, tingling, burning, and sensory loss predominate rather than brief electric shocks, per NCBI StatPearls—Diabetic Peripheral Neuropathy. | Severe, shock-like paroxysms triggered by light touch or chewing define the syndrome in the IHS ICHD-3 diagnostic text. (see IHS ICHD-3 at ichd-3.org). |
| Diagnostic tools | Diagnosis rests on a history of shingles, temporal linkage, dermatomal mapping, and allodynia on exam, which CDC clinician pages outline for PHN. | Evaluation includes glycemic history, monofilament/vibration testing, and nerve conduction studies, as detailed in NCBI StatPearls—Diabetic Peripheral Neuropathy. | Clinical diagnosis with identification of a trigger zone and response to carbamazepine is standard, with MRI reserved for secondary causes, per the IHS ICHD-3 description. |
| ICD-10 coding note | Use B02.2- when a specific nerve pattern is documented and B02.29 when unspecified, consistent with the CDC ICD-10-CM tabular and CMS ICD-10-CM Official Guidelines. | Diabetic neuropathy codes fall under E08–E13 with neuropathy manifestations, following the CMS ICD-10-CM Official Guidelines. | Trigeminal neuralgia is coded in the G50.x series when clinical criteria match the IHS ICHD-3 description, with laterality and division specified where applicable. |
Linking treatment to necessity
PHN code map
Give coders a one-glance map that ties common note phrases to the right ICD. The line above can link “tabular list” to the CDC’s tool and “guidelines” to the CMS rules on cms.gov.
| Note phrase | ICD-10-CM choice | Why it fits |
|---|---|---|
| “Postherpetic neuralgia,” no nerve detail | B02.29 | Captures PHN when the distribution is unspecified under the B02.2- sequela framework. |
| “Postherpetic trigeminal neuralgia” | B02.2- trigeminal child | Uses a specific child code when a cranial nerve is named per the tabular. |
| “Postherpetic polyneuropathy” | B02.2- polyneuropathy child | Matches multi-nerve documentation. |
| “Neuropathic pain after shingles T8–T10” | B02.29 or specific B02.2- per jurisdiction | Choose specificity per MAC LCD and chart detail. |
How should one document to avoid denials?
The fastest way to fewer denials is a paragraph that reads like a proof statement.
The four sentences that matter
State timing (“four months after zoster”), anatomy (“intercostal T8–T10”), symptoms (burning, allodynia), and treatment course (meds tried, response). The sequela framework is explicit in the FY 2025 rules, and you can check the linkage expectation right in the CMS ICD-10-CM Official Guidelines.
Note-to-claim alignment
Make diagnosis pointers follow the exact PHN sentence by using the field mapping in PROMBS’s CMS-1500 Claim Form Guide so the claim mirrors the note line-for-line.
Decision path for code selection
Step 1: Does the note explicitly link current pain to prior zoster?
- Yes → Go to Step 2.
- No → Add “post-zoster neuralgia” linkage sentence, then proceed.
Step 2: Is a specific nerve or dermatomal pattern named?
- Yes → Use the appropriate B02.2- child that matches the distribution listed in the CDC tabular on icd10cmtool.cdc.gov.
- No → Use B02.29 and consider adding distribution detail for future visits.
Step 3: Will you report interventional CPT codes?
- Yes → Confirm medical necessity and LCD language using the Medicare Coverage Database on cms.gov; document conservative treatment history.
Why do claims get denied?
Denials cluster around three gaps. Vague impression text fails to link pain to zoster. Non-specific anatomy blocks selection of a B02.2- child. Interventions are billed without a documented trial of conservative therapy. Documentation training and a pre-export scrub solve most of it, which echoes the industry’s broader message because AHIMA’s documentation education on ahima.org ties coding accuracy to specific clinical language, and finance leaders see the downstream effect since HFMA emphasizes at hfma.org that clearer notes cut denials and shorten AR.
Quick fixes that work
Frame this on your coder hub, introduce it with a sentence that links “rules” to the CMS ICD-10-CM Official Guidelines FY 2025 PDF on CMS.gov, which provides the full sequencing, specificity, and documentation expectations for diagnosis coding.
| Risk | What reviewers expect | Practical fix |
|---|---|---|
| No zoster linkage | Sequela wording that ties pain to prior zoster | Add “post-zoster neuralgia” to the impression |
| No anatomy | Nerve/dermatome to justify specific child code | Document “trigeminal V1” or “intercostal T8–T10” |
| Interventions without evidence | Stepwise care prior to procedures per LCD | List failed meds; cite LCD language from CMS’s database |
What doctors and billers ask for diagnosis
Real queries are literal: “What is the icd 10 code for postherpetic neuralgia with trigeminal involvement,” “Does PHN need a history code,” “Which LCD supports intercostal block for PHN.” You can shorten the search by pointing staff directly to the tabular and rules because the CDC code lookup on icd10cmtool.cdc.gov and the CMS guideline pages on cms.gov answer the “which code/why” questions in the same language auditors cite.
Capturing SERP features
How to claim a mapping card?
Open with a sentence that ties the mapping to your revenue-cycle SOP because PROMBS’s field-by-field layout in the CMS-1500 Claim Form Guide makes this easy.
| Note sentence | Claim field | Example |
|---|---|---|
| “Post-zoster neuralgia four months after rash, T8–T10 left” | ICD-10 (24E) | B02.29 for unspecified distribution (or specific B02.2- if named) |
| “Allodynia; burning pain, sleep disruption” | E/M CPT (24D) | Level by MDM/time per AMA CPT |
| “Failed gabapentin, partial duloxetine response” | Medical necessity | Supports higher-level management or procedure planning |
| “Discussed intercostal block per LCD Jxx-xxxx” | Auth/LCD | Cross-check policy using CMS’s Coverage Database |
Why should you partner with Pro-MBS for postherpetic neuralgia billing and coding?
If you want the icd 10 code for postherpetic neuralgia to pay cleanly every time, standardize three things: precise note phrases, correct ICD specificity, and claim fields that mirror the note. Pro-MBS operationalizes that flow across service lines by aligning clinician templates, scrubber rules, and claim mapping to the same sources your payers quote. You can see how our internal playbooks knit clinical and billing together by reviewing PROMBS’s [Specialties] overview at prombs.com/specialties, and you can tighten your front end to reduce medical-necessity denials by adapting the tactics in PROMBS’s guide to cut prior authorization denials by 30%, while your billing team keeps forms error-proof with PROMBS’s CMS-1500 Claim Form Guide.
