# piriformis injection



## ortho1991 (Nov 10, 2010)

Hi All

I hope someone can help.  Dr. wants to do a piriformis injection in the office.  Not sure what code to use. 20610 ?? 20552?? Any help will be appreciated.

Here is the note in short.   Patient would like to have piriformis injection. A line was drawn between the freater trachanter, posterior superior iliac spine, and the midpoint as the region of the piriformis.  A point of maximal tenderness was found at this region.  A solution of 2 cc of 0.25% bupivacane and well as 2cc of lidocaine and 80 mg of Depo-Medrol was drawn. needle was guided towards the point of maximal tenderness.  The injectate was then injected into the piriformis region.

Thank you


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## dwaldman (Nov 10, 2010)

20552 w/ 726.5 could work. AHA Coding Clinic states pirfiromis muscle syndrome is coded as 355.0 but this might not be an approved code for a trigger point injection. I think I saw an article that stated there was a certain Medicare carrier stating that they wanted this billed as unlisted code and some providers might consider unlisted due to fact the this type of injection might be more difficult than your typical trigger point injection and the RVUs might not accurately described the work involved in doing the procedure you mentioned. You could show the physician the reimbursement for 20552 and let him consider does he feel that 20552 reimbursement would cover the work involved or if he would want to use unlisted code. Other articles I have seen state to make sure they are not targeting the sciatic nerve w/ 64445 since they are same anatomical region. But I didn't see this mentioned in your OP report. You could show him the reimbursement for 64445 and ask him if he would want to use this as a compare code for the unlisted procedure in the letter you send with the claim.


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## ortho1991 (Nov 12, 2010)

Thank you, your reply was very helpful.


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