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Botox treatment record template 2026

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Your documentation should include a diagram that shows the sites of injection on each side of the face. This is required by many payers and will help to audit-proof your documentation. (Tip: For functional treatments, dont use a diagram that is labeled cosmetic.) Units injected and discarded.
64612 Chemodenervation of muscle(s) innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm) 64615 Chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (e.g., for chronic migraine)
The 2cm rule refers to avoiding injecting within 2cm of the orbital rim (eye socket). This helps prevent complications like eyelid drooping. However, experienced injectors may adjust this based on individual anatomy.

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1:18 2:13 And push in the full. 25 C pcs gently rotate and invert the bottle. But dont vigorously agitate itMoreAnd push in the full. 25 C pcs gently rotate and invert the bottle. But dont vigorously agitate it the is now reconstituted. And ready for use.
Documentation Requirements: documentation of the medical necessity for this treatment. a covered diagnosis; dosage(s), site(s) and frequency(ies) of injection; documentation of the medical necessity for associated electromyography when used; and. description of the effectiveness of this treatment.

botox treatment record template

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