Anesthesia Coding Alert

Question: Our physician has started giving Botox injections for myofascial pain syndrome. How should we report multiple injections?

Utah Subscriber

Answer: Choose the appropriate code based on your provider's documentation of the actual procedure and injection site as follows:

• 64612-- Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm)

• 64613 -- ... neck muscle(s) (e.g., for spasmodic torticollis, spasmodic dysphonia)

• 64614-- ... extremity(s) and/or trunk muscle(s) (e.g., for dystonia, cerebral palsy, multiple sclerosis). CPT does not include separate codes for multiple injections in this series. The descriptors apply to single or multiple muscles, so you don't need to include any additional codes.

Preauthorize: Using Botox for chemodenervation of a muscle is an off-label use of the drug. Most (if not all) third-party payers will not cover the injections for myofascial pain, so get preauthorization from your payer and have the patient sign an advance beneficiary notice if possible.