nEMG Guided Injection Botulinum Toxin - intramuscular injection with botulinum toxin into peripheral muscle for treatment of focal spasticity secondary to an upper motor neuron disorder. Maximum one botulinum treatment of one or more muscles per patient every 10 weeks. G597 - Injection into first muscle per day; G598 - each additional muscle same day as G597 when G597 is payable in full (maximum 8 per day) G599 - with electromyographic (EMG) guidance of injection into one or more muscles when G597 is payable in full (maximum 1 per day); E543 - use of disposable EMG hypodermic electrode outside hospital when G599 is payable in full (maximum 1 per patient per day) Chemodenervation injection of individual peripheral motor nerve using phenol, ethyl alcohol or similar non-anesthetic chemical agents for reduction of focal spasticity, and may include electromyography (EMG) guidance of injection(s): G485 - first major nerve and/or its branches ;G486 - each additional major nerve and/or its branches same day; Repeat or additional procedure within 30 days of previous chemodenervation injection; G487 - first major nerve and/or its branches; G488- each additional major nerve and/or its branches same day

OHIP Bulletin- 4397a (last modified '07)

There are three procedures for Myoguide; one for the EMG, one for stimulation location,  and one for the injection. For a limited study of the muscles of one extremity or of axial muscles the CPT code is 95870. If the injection is of local anesthetic and/or steroid the CPT codes are 20552 for injections of one or two muscle, and 20553 for injections of three or more muscles. If the injection is of a chemical neurolytic agent such as botulinum toxin, or phenoxybenzamine, the CPT code is 64613 for injection of cervical spine muscles and 64614 for injection of extremity or trunk muscles. Eye muscles use 92265. Codes 64612–64614 involve chemodenervation of muscles innervated by the facial nerve, neck muscles and extremity(s) and/or trunk muscles, respectively. These services may involve injections of single muscle groups or multiple muscle groups.

To account for the EMG guidance use the CPT code listed below in addition to the CPT code for the injection. +95874 >>Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)

To account for the guidance using electrical stimulation use the CPT code listed below in addition to the CPT code for the injection. +95873 >>Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)

In addition to coding for the procedure, physicians should also code for the drug itself. Supply codes for the two types of botulinum toxin currently in clinical use: J0585 Botulinum toxin type A, per unit J0587 Botulinum toxin type B, per 100 units.

Billing is based on the CPT 2008 Standard Edition, American Medical Association – Neurology and Neuromuscular Procedures.

This information is only for review. The individual provider will need to determine what the proper billing procedure is for these codes in his or her locality for the specific payer to whom a claim is submitted. We cannot advise billing strategies or make allegations that any of these codes continue to be valid.