ICD-10 Coding for Piriformis Syndrome(G57.01, G57.02, M62.85)
Complete ICD-10-CM coding and documentation guide for Piriformis Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Piriformis Syndrome
G57.0-G57.9Primary Range
Mononeuropathies of lower limb
Includes codes for piriformis syndrome with sciatic nerve involvement.
Other specified disorders of muscle
Includes codes for piriformis muscle disorder without sciatic nerve 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 |
|---|---|---|---|
| G57.01 | Lesion of sciatic nerve, right lower limb | Use when right-sided piriformis syndrome with sciatic nerve compression is confirmed. |
|
| G57.02 | Lesion of sciatic nerve, left lower limb | Use when left-sided piriformis syndrome with sciatic nerve compression is confirmed. |
|
| M62.85 | Muscle spasm | Use when piriformis muscle disorder is present without sciatic 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 syndrome
Essential facts and insights about Piriformis Syndrome
Primary ICD-10-CM Codes for piriformis syndrom
Decision Criteria
clinical Criteria
- Presence of right-sided buttock pain with sciatic nerve compression
Applicable To
- Right-sided piriformis syndrome with sciatic nerve compression
Excludes
- Sciatica without piriformis involvement
Clinical Validation Requirements
- Right-sided deep buttock pain radiating to posterior thigh
- Positive Pace/Freiberg signs
- MRI excludes lumbar pathology
Code-Specific Risks
- Confusion with sciatica without piriformis involvement
Coding Notes
- Ensure laterality is documented.
G57.02 - Lesion of sciatic nerve, left lower limb
Use when left-sided piriformis syndrome with sciatic nerve compression is confirmed.
Applicable To
- Left-sided piriformis syndrome with sciatic nerve compression
Excludes
- Sciatica without piriformis involvement
Clinical Validation Requirements
- Left piriformis tenderness on palpation
- Pain exacerbated by prolonged sitting
- Resolved with trigger point injection
Coding Notes
Ensure laterality is documented.
M62.85 - Muscle spasm
Use when piriformis muscle disorder is present without sciatic nerve involvement.
Applicable To
- Piriformis muscle disorder without sciatica
Excludes
- Sciatica with piriformis syndrome
Clinical Validation Requirements
- Piriformis spasm confirmed on EMG
- No radicular symptoms or neurological deficits
Coding Notes
Document absence of sciatica.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Myalgia
M79.1Differential 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 Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G57.01.
Impact
Clinical: Impacts treatment accuracy., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document side of involvement.
Impact
Reimbursement: Incorrect billing may lead to denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on treatment provided.
Mitigation Strategy
Use 20552 + 76942 for muscle injection
Impact
Reimbursement: Incorrect DRG assignment., Compliance: Potential audit risk., Data Quality: Misrepresentation of clinical condition.
Mitigation Strategy
Use M62.85 for isolated piriformis disorder
Impact
Using M54.3 without documented sciatica.
Mitigation Strategy
Ensure documentation supports sciatica diagnosis.
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 Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Piriformis Syndrome
Use these documentation templates to ensure complete and accurate documentation for Piriformis Syndrome. These templates include all required elements for proper coding and billing.
Piriformis Syndrome with Sciatic Nerve Involvement
Specialty: OrthopedicsRequired Elements
- Laterality
- Physical exam findings
- Imaging results
- Injection details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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