Anesthesia Coding Alert

Question: What are the most appropriate CPT and ICD-9 codes for a trigger point injection to the right piriformis muscle?

Arizona Subscriber
 
 Answer: The most appropriate codes for the injection depend partly on the patients chief complaint and medical history. Code 64445* (injection, anesthetic agent; sciatic nerve) is for a nerve injection. Many coders may not be comfortable using a nerve injection code for a procedure performed on the piriformis muscle. Ask the physician to be more specific. In most cases, the trigger point injection was given to the muscle surrounding the nerve, and 20550* (injection, tendon sheath, ligament, trigger points or ganglion cyst) would be appropriate.
 
Corresponding diagnoses include 729.1 (myalgia and myositis, unspecified), 728.3 (other specific muscle disorders) or 355.0 (lesion of sciatic nerve). Some carriers such as Medicare have specific ICD-9 codes that they warrant as showing medical necessity. These codes are driven by the patient complaint/history and cover a wide range, so check with your local carrier.