# Ischial tuberosity inj



## mattrobin

My Physician performed a Ischial tuberosity injection under fluoroscopy.  What CPT would you use for this procedure?  Thanks.


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## ckkohler

I have been advised, by the pain management consultant I work with, to use 20610; for fluorscopy - you would use 77002-26.  Hope this helps!


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## dwaldman

I would also confirm what is being injected on the internet I found where they describe it to be the tendon origin for adductor and hamstring muscles and then another description of abursa overlying this area that can also cause pain. If it is at the tendon origin then 20551 could be used. I have wondered if all bursa in the pelvic/hip region are considered the same as the trochanteric bursa which falls under a major bursa or if some of these smaller bursa in these regions would fall under 20605.

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DESCRIPTION:


The ischial tuberosity is a swollen part or broadening of the bone in the frontal portion of the ischium, the lowest of the three major bones that make up each half of the pelvis. As the point of fusion of the ischium and the pubis, it is attached to various muscles and supports the weight of the body when one is sitting. Ischial tuberosity pain may be experienced by a wide range of athletes, including soccer players, cyclists, baseball players, figure skaters, cheerleaders and any type of jumpers or runners. It is often misdiagnosed as ischial bursitis, an extremely painful condition.

How does an ischial tuberosity injury develop?
The ischial tuberosity is the point of origin of the adductor and hamstring muscles of the thigh, as well as the sacrotuberus ligaments. The forceful pull of these muscles, such as can happen during a variety of sports, as a result of a trauma such as a fall or other type of injury, or through the overuse of the hamstrings, as is common among runners and soccer players, results in a separation or detachment, also called an avulsion, of an open ischial apophysis.

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Ischial bursitis is an inflammation of the bursa that covers what is known as the ischial tuberosity, that is, the protrusion of bone in the pelvis upon which one sits when in a seated position. A bursa is a flat and closed sac that protects the tendons from actual bone as they slide over the ischial tuberosity; also, this bursa keeps the ischial tuberosity and gluteus maximus muscle in the buttocks apart. This condition has previously been referred to as "tailor's seat" or "weaver's bottom" because these occupations dealt with extended periods of sitting, which aggravates the bursitis.

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## dwaldman

When looking at picture of the bursa of the hip/pelvic region. iliopsoas bursa and gluetus medius bursa do look small, but I did notice the ischial bursa overlying the ischial tuberosity looked similiar in size to the trochanteric bursa injection and as ckkohler stated 20610 could be reported for injection of this bursa.


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