Neurology & Pain Management Coding Alert
Think 'Chemodenervation' for Botulinum Toxin Injection
Question: Our physician documented that he administered botulinum toxin trigger point injections for a patient with shoulder muscle spasticity. He performed bilateral injections to the supraspinatus suprascapular region. Do we bill 20552 for a trigger point injection, or 64646?
New Mexico Subscriber
Answer: A botulinum toxin injection equates to chemodenervation, so it would not be appropriate to report the service as a trigger point injection with a code such as 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]).
CPT® has very specific criteria for reporting chemodenervation of the trunk muscles: “Trunk muscles include the erector spinae and paraspinal muscles, rectus abdominus and obliques. All other somatic muscles are extremity muscles, head muscles or neck muscles.”
Neither the suprascapular or supraspinatus meet the CPT® criteria for trunk muscles, so it would not be appropriate to report 64646 (Chemodenervation of trunk muscle[s]; 1-5 muscle[s]) either.
Correct code: Since these muscles are of the shoulder area and not the neck, many providers consider them to be part of the upper extremity. From that standpoint, you would report the injections with 64642 (Chemodenervation of one extremity; 1- 4 muscles).
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