ICD-10 Coding for Piriformis Pain(G57.00, G57.01, G57.02, M62.838)
Complete ICD-10-CM coding and documentation guide for Piriformis Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Piriformis Pain
G57.00-G57.02Primary Range
Lesion of sciatic nerve
Primary range for conditions involving sciatic nerve compression by the piriformis muscle.
Sciatica and lumbago with sciatica
Used when piriformis etiology is unconfirmed or when sciatica is present without specific piriformis involvement.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G57.00 | Lesion of sciatic nerve, unspecified side | Use when laterality is unconfirmed and sciatic nerve compression by the piriformis is documented. |
|
| G57.01 | Lesion of sciatic nerve, right side | Use when right-sided sciatic nerve compression by the piriformis is confirmed. |
|
| G57.02 | Lesion of sciatic nerve, left side | Use when left-sided sciatic nerve compression by the piriformis is confirmed. |
|
| M62.838 | Other muscle spasm | Use when muscle spasm is the dominant feature without nerve involvement. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for piriformis pain
Essential facts and insights about Piriformis Pain
Primary ICD-10-CM Codes for piriformis pain
Decision Criteria
clinical Criteria
- Sciatic nerve compression by piriformis
documentation Criteria
- Absence of spinal pathology
Applicable To
- Sciatic nerve compression by piriformis
Excludes
- Sciatica due to disc disorder
Clinical Validation Requirements
- Sciatic nerve compression documented
- Absence of spinal pathology
Code-Specific Risks
- Incorrect use when laterality is known
Coding Notes
- Ensure documentation specifies nerve compression by the piriformis.
G57.01 - Lesion of sciatic nerve, right side
Use when right-sided sciatic nerve compression by the piriformis is confirmed.
Applicable To
- Right sciatic nerve compression by piriformis
Excludes
- Sciatica due to disc disorder
Clinical Validation Requirements
- Right sciatic notch tenderness
- Pain worsens with internal rotation
Coding Notes
Ensure laterality is confirmed through documentation.
G57.02 - Lesion of sciatic nerve, left side
Use when left-sided sciatic nerve compression by the piriformis is confirmed.
Applicable To
- Left sciatic nerve compression by piriformis
Excludes
- Sciatica due to disc disorder
Clinical Validation Requirements
- Left sciatic notch tenderness
- Pain worsens with internal rotation
Coding Notes
Ensure laterality is confirmed through documentation.
M62.838 - Other muscle spasm
Use when muscle spasm is the dominant feature without nerve involvement.
Applicable To
- Piriformis muscle spasm
Excludes
- Muscle spasm due to neurological conditions
Clinical Validation Requirements
- Palpable piriformis spasm
- Relief with trigger point injection
Coding Notes
Document muscle spasm and response to treatment.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other muscle spasm
M62.838Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Piriformis Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G57.00.
Impact
Clinical: Leads to incorrect diagnosis and treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Always specify right or left side in documentation., Use imaging to confirm laterality.
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement rates., Compliance: May result in compliance issues during audits., Data Quality: Affects the accuracy of clinical data and patient records.
Mitigation Strategy
Link G57.0x to EMG/MRI findings excluding disc pathology
Impact
Reimbursement: Incorrect procedure coding can affect reimbursement., Compliance: May lead to audit discrepancies., Data Quality: Impacts the accuracy of procedural data.
Mitigation Strategy
Use 20552 + 76942 for ultrasound-guided muscle injection
Impact
Using sciatica codes instead of specific piriformis syndrome codes.
Mitigation Strategy
Ensure documentation supports the specific diagnosis of piriformis syndrome.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Piriformis Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Piriformis Pain
Use these documentation templates to ensure complete and accurate documentation for Piriformis Pain. These templates include all required elements for proper coding and billing.
Definitive Piriformis Syndrome
Specialty: OrthopedicsRequired Elements
- Patient history of gluteal pain
- Physical exam findings
- Imaging results
- EMG findings
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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