# Myobloc and Knee injection for lateral retinacular nerve



## Melissa Harris CPC (May 6, 2014)

Hello,

Can anyone point me in the direction how to code a knee injection of the lateral retinacular nerve with Myobloc??  

Melissa Harris, CPC


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## dwaldman (May 6, 2014)

64642  Chemodenervation of one extremity; 1-4 muscle(s)  

64643  Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)  

64644  Chemodenervation of one extremity; 5 or more muscles  

64645  Chemodenervation of one extremity; each additional extremity, 5 or more muscles (List separately in addition to code for primary procedure)  

 Myobloc appears to be from what saw on the internet: botulinium toxin type b 
below is the HCPCS code reported.
J0587 (Botulinum toxin type B, per 100 units). 

The above chemdenervation code for the myobloc injection could be reported such based on the number of muscles and extermities. The nerve block CPT 64450 is a column 2 code and bundled with these code and modifier is not allowed to separately report.

I am not familiar with Myobloc but tried to respond after reviewing what I could find on the internet.


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## Melissa Harris CPC (May 7, 2014)

Thank you for looking!!  

My confusion is with those two codes, the 64642 for a muscle/one extremity or 64450 - 

 It is a nerve so I am assuming 64450 is the correct code??  Or is it a chemodenervation because it is a botulinium toxin ?  

I appreciate your help!


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## mhstrauss (May 7, 2014)

Melissa Harris said:


> Thank you for looking!!
> 
> My confusion is with those two codes, the 64642 for a muscle/one extremity or 64450 -
> 
> ...





The description for the 644xx codeset (which 64450 is a part of) states "injection of anesthetic agent", which Myobloc is not.  I'd be leaning more towards the Chemodenervation sets as listed by the previous responder, depending on how your provider documented.  We use all of the toxins here in my clinic, and I've never seen it used to block a nerve...but I guess it is possible ??   Is (s)he maybe injecting the muscles innervated by the retinacular nerve?  Can you post the procedure note?

Sorry, one other possible code...64640--Chemodenervation of Other Peripheral Nerve or Branch. If your provider is truly injecting at the nerve, not muscle, I think that's probably a better choice.


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## Melissa Harris CPC (May 7, 2014)

My problem is the note was so vague and just said knee injection with Myobloc.  When I asked him to be more specific he said that it was the nerve that was injected.   I was leaning towards the chemodenervation codes myself but the patient had this in the past and we used the 64450.  (I just started here at the beginning of the year).   I am going to speak with the physician when he returns from vacation again and see if it is for the muscle.   

Thank you so much for your assistance!  


Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management


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