Ask Dr. Z

Which CPT code would you assign for a procedure documented as "Botox trigger point injections in the puborectalis, pubococcygeus, iliococcygeus, coccygeus, and obturator internus muscles"? Some coders recommended 20553 for trigger point injection [three or more muscle(s)]. Other coders suggested 64646 [chemodenervation of trunk muscle(s); 1-5 muscle(s)]. A third group prefers to assign 64999 (unlisted procedure, nervous system).

I would like to know your opinion on which code to use. My other question is, are these muscles that were injected classified under trunk muscles, as the pelvis anatomically is the lower part of the trunk?