Pain Management Coding Alert

Question: We normally bill 64445 for a piriformis nerve block, but Tricare does not cover this code in an ASC. My doctor has asked if there is another code that would be sufficient or if 64445 the correct code. What should we use?

Georgia Subscriber

Answer: Code 64445 (Injection, anesthetic agent; sciatic nerve, single) describes a sciatic nerve injection, which you should not use to report a piriformis injection.

Here’s why: Anatomically speaking, the body does not have a piriformis nerve. That means the physician likely is performing a piriformis muscle injection, not a nerve injection. The correct choice instead for piriformis muscle injection(s) is 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]).

Another point: If your provider uses fluoroscopic guidance, you can report this in addition to the injection. Submit 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]).