Wiki Botox of pelvic floor muscles - CPT code help

[Miko24]

I am unsure on what cpt to use for Botox of pelvic floor muscles - 52287 is for the bladder and I read that 64614 is usually not reimbursed.

Any help is appreciated.

thank you

 

[csperoni]

1) Never base your coding on whether or not something will be reimbursed. Coding is based on the documentation of the service provided. Using incorrect coding to receive payment is at best a gray area and at worst, possible fraud.
2) 64614 was deleted in 2014 and replaced with 64642-64647
Now off my soapbox to answer your question. Look at trigger point injection codes 20552-20553. Botox injections into the pelvic floor muscles typically are best described by these codes. Your clinician should be documenting which muscles were injected. Keep in mind it's the number of muscles injected, not the number of injections to differentiate between 20552 and 20553. My personal clinical knowledge is not particularly extensive, but per my clinicians, the pelvic floor muscles are not considered part of the trunk muscles. This article lists the trunk muscles, and the pelvic floor muscles is not among them. If you really want to delve into pelvic floor anatomy, you can try this pubmed article.
Melanie Witt (@nielynco) wrote an article about coding for pelvic pain treatment a few years back I have referenced more than once. https://www.mdedge.com/obgyn/articl...siderations-investigating-chronic-pelvic-pain

 

[natashalage]

Thank you very much, Christine, for your comprehensive response with great sources to learn from. I will definitely keep the article on anatomy of pelvic muscles and Thank you to our Melanie aka Ms.Nielynco for writing the article on injections. We, new coders, learn So Much from your postings with great rationals! Many of us are silent students and observers, but we do greatly appreciate your expertise in OBGYN specialty and sharing your knowledge with us. And I must mentioned Cmama12 as well! Thank you.

 

[ruhidas.sarkar@medkpo.com]

as per below instruction of AHA article
Pelvic Floor Injections

AHA Coding Clinic for HCPCS, Second Quarter 2021, Volume 21, Number 2, Page 9
QUESTION 8

A patient with pelvic floor pain and pelvic floor muscle high-tone dysfunction was administered bilateral botulinum injections in the pelvic floor muscles. A bilateral pudendal block was given under finger guidance into the Alcock’s canal. With a finger in the vagina to confirm location and depth of the injection, botulinum was injected into two locations in each obturator internus muscle bilaterally, followed by an injection into one location in each of the pubococcygeus, ileococcygeus, coccygeus and puborectalis muscles bilaterally. The provider has documented the injections as trigger point injections. However, when injecting a toxin such as botulinum, is it more appropriate to assign a code for chemodenervation from CPT code range 64642-64647? If so, would it be appropriate to assign CPT code 64646, Chemodenervation of trunk muscle(s); 1-5 muscle(s), to capture injections into the pelvic floor muscles?



ANSWER

Assign CPT code 20553, Injection(s); single or multiple trigger point(s), 3 or more muscles, for the injection of botulinum into the pelvic floor muscles as the provider has specifically documented the procedure as trigger point injections. A trigger point injection targets the muscle to alleviate pain. Although botulinum is a toxin utilized in chemodenervation, it can be used for trigger point injections when the target is the muscle. In addition, report the number of units of botulinum administered with HCPCS Level II code J0585, Injection, onabotulinumtoxinA, 1 unit.





Coding advice contained in this issue is effective with procedures/services provided after May 26, 2021, unless otherwise noted.

 

[suec]

What if the physician is stating the botox injection into the pelvic muscles are not trigger poiny injections. Would you use 64646 instead of 20552. I find the last paragraph in the October 2021 confusing.

 

[nielynco]

In my opinion, an injection of Botox into the pelvic muscles can be considered a type of trigger point injection, as it targets painful knots and muscle spasms in that area. Is he just not mention the word "trigger point" or has he informed you it is not a trigger point he is injecting into. If he is simple doing an IM injection into a muscle, I would be looking at the IM injection code instead. But in my experience, all the Botox I have seen injected has been in the muscle to relieve the pain in the knots or the area of spasm and when that is the procedure, the trigger point injection codes are always reported.

 

[suec]

Thank you for responding.They are injecting into the muscles but the physician is telling us it is not a trigger point injections because they are injecting Botox. The physician uses CPT code 64646. Facility coders use CPT 20552 and claim is rejected by the payor. HCPCS code J0585 needs to be used with CPT 64646. If we code the chart with CPT 20552, HCPCS code J0585 rejects. If use CPT 64646, HCPCS J0585 clears but CPT 20552 rejects because pelvic muscles are not trunk muscles. In a pickle.

 

[nielynco]

Thank you for responding.They are injecting into the muscles but the physician is telling us it is not a trigger point injections because they are injecting Botox. The physician uses CPT code 64646. Facility coders use CPT 20552 and claim is rejected by the payor. HCPCS code J0585 needs to be used with CPT 64646. If we code the chart with CPT 20552, HCPCS code J0585 rejects. If use CPT 64646, HCPCS J0585 clears but CPT 20552 rejects because pelvic muscles are not trunk muscles. In a pickle.

For sure. But both you and the facility must match codes or you will get denials. I would bring up this issue with the provider and the facility biller. As I indicated, I think 20552/20553 code options are the most correct. The vignette submitted to CPT for the chemodenervation codes was a patient with multiple sclerosis and the trunk muscles do not correlate to the pelvic floor muscles (https://www.kenhub.com/en/library/anatomy/muscles-of-the-trunk). Compare that to an explanation of the pelvic floor muscles (https://my.clevelandclinic.org/health/body/22729-pelvic-floor-muscles). But this may also be a great question to ask ACOG to weigh in on.