A patient suffering from idiopathic dystonia is seen today and receives the following Botulinum injections: three muscle injections in both upper extremities and seven injections in six paraspinal muscles.
How are these injections reported according to the CPT® guidelines?
7 injections such as Botox
B 646-50, 65643-50 , 64647 this likely reflects a convention where 50 is used to emphasize bilateral treatment of the upper extremities 64643 is a additional code making 50 neede
You cannot denote a bilateral procedure with the modifier 50 when there is a lack of specificity in the code, also with that thinking they would not provide in the book a code for "each additional extremity" which is much more simplified for billing/coding purposes. Also you would not add the modifier to both codes because now it has become redundant and you are noting that there have been 6 shots in each arm for a total of 12 since you are modifying that each code happened bilaterally.
One extremity, one additional extremity (1-4 muscle(s)), then one in the trunk muscle but for 6 or more. Modifiers would be redundant and misleading, by process of deduction it is a fairly simple situation where the complication of the other answers means way more shots than were actually administered.