# Botox Trigger Point Injections



## nbohm (Nov 13, 2014)

I have a couple scenarios where my Pain Provider is giving Botox chemodenervation/trigger point injections.  I have read some older guidance from SuperCoder and AAPC threads that indicate the chemodenervation codes 64616 (for the neck muscles) would be more appropriate than billing with the trigger point codes 20552/20553.  The 2014 Coders? Desk Reference indicates the provider uses localization by electromyographic needle or surgical incision. My provider?s documentation does not include use of an electromyographic needle or surgical incision, rather he has documented:

 ?Sterile prep and drape were employed using alcohol and landmarks obtained by palpation. Each cervical spinal muscle point was injected with 0.1cc/10 units of a solution containing Botox A. A total of 5 points were injected.?

Does anyone have any additional insight on the best code selection for these Botox trigger points?

Thank you!


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## mhstrauss (Nov 13, 2014)

nbohm said:


> I have a couple scenarios where my Pain Provider is giving Botox chemodenervation/trigger point injections.  I have read some older guidance from SuperCoder and AAPC threads that indicate the chemodenervation codes 64616 (for the neck muscles) would be more appropriate than billing with the trigger point codes 20552/20553.  The 2014 Coders? Desk Reference indicates the provider uses localization by electromyographic needle or surgical incision. My provider?s documentation does not include use of an electromyographic needle or surgical incision, rather he has documented:
> 
> ?Sterile prep and drape were employed using alcohol and landmarks obtained by palpation. Each cervical spinal muscle point was injected with 0.1cc/10 units of a solution containing Botox A. A total of 5 points were injected.?
> 
> ...



 EMG localization isn't required for Botox, but IF it is used, you can bill the additional code 95874.  If Botox is injected into the neck muscles for chemodenervation, use 64616.  If the muscles are bilateral, you can use mod. 50.


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