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Piriformis injection code

Mike Posted Mon 18th of May, 2015 15:13:39 PM

what is the best code for piriformis injection CPT 20552 cannot be done in a ASC, but this injection the doctor wants it done in a ASC. 64445 better code??

SuperCoder Answered Tue 19th of May, 2015 00:58:47 AM

Yes, you can bill CPT 20552 in ASC. ASC payment indicator P3 is applicable on this code which states "Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs". You can only bill CPT code 64445, if the injection was given in or around sciatic nerve, but not in the muscle. Also, injections of trigger points; and injections of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels are payable in the following places of service: office (11), home (12), assisted living facility (13), group home/foster care setting (14), temporary lodging (16) urgent care facility (20), inpatient hospital (21), outpatient hospital (22), emergency room (23), ambulatory surgical center (ASC) (24), skilled nursing facility (31), nursing facility (32), custodial care facility (33), independent clinic (49), comprehensive inpatient rehab facility (61), comprehensive outpatient rehab facility (62), end stage renal disease treatment facility (65) and state or local public health clinic (71). Local anesthetics are not separately reimbursed and should not be billed.

Mike Posted Wed 20th of May, 2015 10:59:21 AM

Is 20552 really the best code for a Piriformis injection? This injection is more complicated than a trigger point and modifiers on 20552 don't work to receive extra payment.

SuperCoder Answered Thu 21st of May, 2015 01:09:29 AM

If the provider indicates that he injected into the piriformis muscle, you should use 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]). If the provider indicates that he injected the sciatic nerve, look at 64445 (Injection, anesthetic agent; sciatic nerve, single).

Piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve and causes pain in the buttock and may cause pain along the back of the leg and into the foot (similar to sciatica pain).

The piriformis muscle is a small muscle located deep in the buttock (underneath the gluteus maximus muscle). Piriformis syndrome can develop when the piriformis muscle becomes tight or spasms and places pressure on the sciatic nerve that runs beneath it.

Use accordingly.

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