AAPC - Back to school
Page 1 of 2 12 LastLast
Results 1 to 10 of 15

Thread: Piriformis muscle injection

  1. #1

    Question Piriformis muscle injection

    AAPC: Back to School
    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
    Join Date
    Apr 2007


    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
    Join Date
    Apr 2007


    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
    Join Date
    Apr 2007


    I think 20552 with 77002 would be the correct code.

  7. #7


    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. #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
    Join Date
    Apr 2007
    Philadelphia, PA


    I agree with Karenpair, piriformis is a muscle injection not a nerve block.

  10. #10


    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.


Page 1 of 2 12 LastLast

Similar Threads

  1. Piriformis muscle block???
    By Melissa Harris CPC in forum Anesthesia
    Replies: 3
    Last Post: 02-20-2014, 08:08 PM
  2. Piriformis muscle injection ?--Help
    By teridmac in forum Anesthesia
    Replies: 3
    Last Post: 05-10-2013, 07:22 PM
  3. piriformis muscle injection
    By millortsui in forum Anesthesia
    Replies: 5
    Last Post: 04-26-2011, 07:57 PM
  4. Piriformis muscle injections...coding help
    By Debra in forum Interventional Radiology
    Replies: 0
    Last Post: 12-05-2009, 08:30 AM
  5. Gluteal Resection w/piriformis muscle transfer
    By bmcduo2 in forum General Surgery
    Replies: 0
    Last Post: 03-21-2008, 09:53 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.