Orthopedic Coding Alert

Question: There is some disagreement between my provider and I. For an injection of the piriformis with fluoroscopy, I typically use the code 20552. The doctor however insists that we use the code 20610. I want to cover my bases and get this right – so how do I code for this?

South Dakota Subscriber

Answer: For an injection of the piriformis with fluoroscopy, the correct code to use is 20552 (Injection[s]; single or multiple trigger point(s), 1 or 2 muscle[s]). You should use this code for trigger point injections only.

The confusion may be that the code preferred by your provider, 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa [e.g., shoulder, hip, knee, subacromial bursa]; without ultrasound guidance), is reserved for a major joint or bursa. This means that the provider’s preferred code is used in two major situations. The first is when the fluoroscopic observation is done on a major joint like the elbow or the knee. The second is when a bursa, or a fluid filled cavity that causes friction at a joint, is being observed.

The proper code to use then, is 20552, which again, is for trigger point injections. These trigger points are defined as areas of muscle that are irritated by knots or other causes. Since the piriformis is a muscle and the procedure was done on this area, the most comprehensive code you can use is 20552.

Takeaway: Whenever a fluoroscopy is being performed, identify which area of the body is being observed. If it is a major joint or bursa, use 20610. If it is a muscle or other part of the body excluding the major joints, then 20552 is the best code to use.