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Piriformis muscle injection

  1. #1
    Question Piriformis muscle injection
    Medical Coding Books
    I have an op report that one of our pain MD's dictated....which I've never coded before. He stated he a right piriformis muscle injection under fluroscopy...Would this be a 64445 with 77003 or????
    Thanks in advance.

  2. #2
    I would go for the 64445 as well, because the piriformis is
    "A muscle in the pelvic girdle that is closely associated with the sciatic nerve."

    Other option would be the 64450 which is other peripheral nerve or branch.

    ...and of course the 77003

    hope this helps!!!

  3. #3
    I think you may want to use 77002 for fluoroscopy in this instance. Check out CPT Assistant June 2008 on use of fluoroscopy.

  4. #4
    I agree with coderguy, the 77002 is the appropriate fluoro code for this type of injection

  5. #5
    Default piriformis muscle injection
    This does help...thank you.

  6. #6
    I think 20552 with 77002 would be the correct code.

  7. Default
    This is from a M'care B news issue:

    NAS has also noted that providers have been using both CPT codes 64999 (unlisted procedure nervous system) and 64445 (Injection anesthetic agent; sciatic nerve, single) for the injection of the piriformis muscle and surrounding muscle groups. This is not the correct way to code. When the clinical notes reflect direct nerve block to the sciatic nerve, 64445 should be used. When the injection focus is in the piriformis muscle or surrounding muscle groups, 64999 should be used. When both of these codes are billed on the same date of service, 64999 will be denied.

    Here is the link if you wish to read the entire article

  8. Smile Karen Pair CPC
    I do not agree with 64445 or 64450 since these are blocking the nerve. The piriformis is a muscle so I have been using 20552 for trigger point in the muscle and 77002. I have read this is the way to code in one of our pain or ortho alerts.

  9. #9
    Philadelphia, PA
    I agree with Karenpair, piriformis is a muscle injection not a nerve block.

  10. Default
    Karen and SS62,

    I agree that a piriformis "muscle" injection is not a nerve block. The problem with this is: billing 20552 is not considered a medical necessity when billed with the dx code 355.0 piriformis syndrome, which is the common dx I'm seeing. Any ideas on another code choice? Here are some that I have seen canvassed:

    64999 - This code is denied by almost every payer there is... and is technically incorrect because it is an unlisted nervous system procedure.

    20550 - may be correct technically, but cheats the physician out of reimbursement because the piriformis injection is more difficult to perform than this.

    20552 - as above, the dx does not est. medical necessity

    64445 - this is specifically a nerve injection and if the physician does not document blocking the nerve it is innappropriate to use it.

    64450 - peripheral nerve. i read on one site that a peripheral nerve does run through the piriformis muscle, but I'm not convinced that this is appropriate either.


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