Ask Dr. Z

Would you recommend billing a pectoralis minor Botox injection(s) as a trigger point injection (20552-20553)? These are being done at the same time as scalene Botox injections for TOS (64616). Is it appropriate to add a -59 modifier to the trigger point injection?

"This patient is a 35-year-old male with right upper extremity thoracic outlet syndrome. The skin over the right anterior scalene was prepared and draped using sterile technique. Under ultrasound guidance, a 1.5 inch 25 gauge needle was advanced into the right anterior scalene muscle belly under ultrasound guidance. The right scalene muscle was then injected with 50 U of Botox. The skin over the right pectoralis minor muscle was prepared and draped using sterile technique. Under ultrasound guidance, a 1.5 inch 25 gauge needle was advanced into the right pec minor muscle belly under ultrasound guidance. The right pec minor muscle was then injected with 50 U of Botox."