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ICD-9 code: 355.9 Piriformis syndrome (mononeuritis) CPT codes: 20552 Trigger point injections, 1-2 muscles 77002 Fluoroscopic guidance, non-spinal Remember to bill for the injectables (contrast, steroid) if done in an office procedure room Solution (injectable): Corticosteroids: 40-mg of Depo-Medrol or Kenalog Local anesthetics: 3-5-ml of local anesthetic (lidocaine or bupivacaine) Note: Can also be done with botulinum toxin (Botox, Myobloc, Dysport) for longer relief than steroid and local anesthetic

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Major Criteria Skin hyperextensibility, with velvety skin texture and absence of atrophic scarring Generalized joint hypermobility, with or without recurrent dislocations (most commonly shoulder and ankle) Easily bruisable skin/spontaneous ecchymoses Minor Criteria Foot deformities (broad/plump forefoot