Harvard Pilgrim considers pudendal nerve decompression experimental and investigational for the treatment of pudendal neuralgia. During a recent policy review, we identified an inconsistency between the stated Pudendal Nerve Decompression Medical Policy and claims processing for several related ICD-10 codes. As a result, we have updated our code editing systems to correct this discrepancy.
Effective for claims processed as of March 30, 2017, the following codes are considered not medically necessary and will deny for payment in accordance with our Pudendal Nerve Decompression Medical Policy:
- F52.21 — Male erectile disorder [persistent genital arousal disorder]
- F52.22 — Female sexual arousal disorder [persistent genital arousal disorder]
- G58.8 — Other specified mononeuropathies
- G58.9 — Mononeuropathy, unspecified [pudendal nerve entrapment]
- M54.10 —Radiculopathy, site unspecified
- M79.2 — Neuralgia and neuritis, unspecified [pudendal]
- N30.10 — Interstitial cystitis (chronic) without hematuria
- N30.11 — Interstitial cystitis (chronic) with hematuria
For complete information, please refer to the Pudendal Nerve Decompression Medical Policy.