Trigger finger injection cpt

Moving the needle and your finger helps break apart the tissue that's blocking the smooth motion of the tendon. Using ultrasound guidance during the procedure can improve results. Surgery. Working through a small incision near the base of your affected finger, a surgeon can cut open the narrowed section of tendon sheath. Request an appointment.

No more than 3 Trigger point injection sessions in a rolling 12 months will be considered reasonable and necessary, regardless of the code billed. CPT 20552 limits to 1 or 2 muscles and 20553 is 3 or more muscles. The number of injections into the muscle group are not billed separately.Red toes can be a symptom of Raynaud’s disease, according to Mayo Clinic. In some cases, when the disease is triggered and the body warms up, toes or fingers may turn red, throb or...Jan 22, 2016. #6. You can bill for the drugs used for the trigger point injections. However, it varies by carrier if they will pay them. It doesn't hurt to bill it and receive your denials so you can substantiate who pays and who doesn't. You may need to create a "zero charge" bill for these drugs if you match your inventory.Instructional video on how to perform an intra-articular injection for the treatment of trigger finger.Journal: JBJS JOPASubspecialty: Hand & WristThis Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35010, Trigger Point Injections. Please refer to the LCD for reasonable and necessary requirements. Coding Guidance. Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if ...Trigger finger 3 mL 25 gauge, 0.5 to 1 mL of 1% lidocaine or 0.5 mL Celestone Soluspan or ... †—A hemostat is needed to immobilize the needle when performing injection following aspiration ...

A study released today finds that big earthquakes around the world have triggered separate quakes in the US where wastewater resulting from natural gas production is injected under...Correct Coding: 99213-25, 20552 Diagnosis: M79.70. There continues to be a lot of confusion on proper coding for trigger-point injections. Two CPT4 codes can be used: 20552—Injection(s); single or multiple trigger point(s), one or two muscle(s); and; 20553—Injection(s); single or multiple trigger point(s), three or more muscle(s).Article Text. The following billing and coding guidance is to be used with its associated Local Coverage Determination. Injection therapies for Morton's neuroma do not involve the structures described by CPT code 20550 and 20551 or direct injection into other peripheral nerves but rather the focal injection of tissue surrounding a specific focus of inflammation on the foot.CPT Code 20552, General Surgical Procedures on the Musculoskeletal System, General Introduction or Removal Procedures on the Musculoskeletal System - ... Trigger point injection, or TPI, is a medical procedure that involves injecting an anesthetic or corticosteroid substance to relieve a trigger point, which is a painful area or knot in a ...Jan 17, 2024 · Here are ⁤some tips to help you navigate trigger finger release CPT coding with confidence: 1. Familiarize yourself with the ⁣relevant ‍CPT codes: CPT codes 26055, 64721, and 26341 are commonly⁢ used for trigger finger release‍ procedures. Understanding the specifics of each code and when to apply them is crucial for accurate coding. Do them as follows: Using the opposite hand, grasp the affected finger just below the crease nearest to the end of your finger. Bend just the tip of your finger five times. Move your hand to just below the middle knuckle of the finger, holding your large knuckle straight. Bend the middle knuckle five times.

Tendons, Ligaments, and Muscle Injections. Tendon sheath or Ligament (e.g., iliolumbar Ligament, trigger finger):CPT 20550; Tendon origin/insertion: CPT 20551; Trigger point injection (1 or 2 muscles):CPT 20552; Trigger point injection (3 or more muscles):CPT 20553; Sacroiliac joint (SIJ) without fluoroscopy (billed as a trigger point injection ...Injuries from electrical outlets can injure, maim, or even kill you. Find out exactly what could happen if you stick your finger in an outlet. Advertisement Many people, parents in...A trigger finger is a very common and treatable problem. It can occur in both fingers and the thumbs, which have tendons that help them to bend. The flexor tendons that bend the fingers have a lining on the outside. This lining is called tenosynovium. The tendon and lining are covered by a series of thick, soft tissue called pulleys.Swollen middle finger joints can be attributed to a condition known as trigger finger, which is a type of tendonitis that has developed in the tendons that allow the fingers to ben...

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Webbing of the fingers or toes is called syndactyly. It refers to the connection of 2 or more fingers or toes. Most of the time, the areas are connected only by skin. In rare cases...Oct 1, 2015 · Coverage Guidance. This policy addresses the injection of chemical substances, such as local anesthetics, steroids, sclerosing agents and/or neurolytic agents into ganglion cysts, tendon sheaths, tendon origins/insertions, ligaments or near nerves of the feet (e.g., Morton's neuroma) to affect therapy for a pathological condition. Which CPT code is used 20550 or 20551 for a trigger finger /A1 pulley injection? Answer: CPT code 20550 defines an injection to a single tendon sheath, or …Trigger Finger (trigger thumb when involving the thumb) is the inhibition of smooth tendon gliding due to mechanical impingement at the level of the A1 pulley that causes progressive pain, clicking, catching, and locking of the digit. Diagnosis is made by physical examination with presence of active triggering and tenderness at the A1 pulley.Final word from Sportdoctorlondon about trigger finger steroid injection. A trigger finger is a common condition causing pain and clicking at the base of a finger or thumb. Simple treatments such as rest, physiotherapy, and anti-inflammatory cream help. In some cases, an ultrasound-guided trigger finger injection is very effective, and more ...Article Text. The following billing and coding guidance is to be used with its associated Local Coverage Determination. Injection therapies for Morton's neuroma do not involve the structures described by CPT code 20550 and 20551 or direct injection into other peripheral nerves but rather the focal injection of tissue surrounding a specific focus of inflammation on the foot.

No more than 3 Trigger point injection sessions in a rolling 12 months will be considered reasonable and necessary, regardless of the code billed. CPT 20552 limits to 1 or 2 muscles and 20553 is 3 or more muscles. The number of injections into the muscle group are not billed separately. The code includes all injections made into the muscle ...No more than 3 Trigger point injection sessions in a rolling 12 months will be considered reasonable and necessary, regardless of the code billed. CPT 20552 limits to 1 or 2 muscles and 20553 is 3 or more muscles. The number of injections into the muscle group are not billed separately.The finger will be numb for an hour. Sometimes the triggering increases due to the volume of fluid but this rapidly resolves. For further information, refer to Hand Injections – General. Tips for the administration of injections for the treatment of Trigger Fingers. Palpate the flexor sheath and mark the line with your thumb nail.The injection is given after aspiration is negative for blood. The solution is typically a 3-cc mixture of a 2:1 ratio of anesthetic and corticosteroid respectively. Post procedure the injection area is cleansed and a bandage is applied to the site. Example of Intra-service Work Associated With Code 20551 The affected tendon(s) is identified ...Price: $3,025. CPT Code: 26055. Trigger finger, trigger thumb, or trigger digit, is a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. A disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level ...Nov 1, 2013 ... RheumTutor•44K views · 2:40 · Go to channel · TRIGGER FINGER STEROID INJECTION/ DR PRADEEP BALA. Dr. Pradeep Bala•31K views · 1:09:04 &m...Description. This document addresses trigger point injections. Trigger points are small, circumscribed, hyperirritable foci in muscles, often found within a firm or taut band of skeletal muscle. Frequently affected sites include the trapezius, supraspinatus, infraspinatus, teres major, lumbar paraspinals, gluteus and pectoralis muscles.20551 is for trigger points into various muscles, just one or 2. More than 2 muscles injected is 20552. Both of these codes can be billed only a single time per encounter. If your physician is injecting tendons, the code would be 20550 Injection (s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia") For the knee, this …I have a physician that did a in injection for trigger finger on both the right and left hands. The patient was also treated for other problems during the office visit. All was paid except the 2nd injection. This is how it was billed 99213/25 20550/RT-F7 20550/59-LT This was not paid j1040*2Therefore when the internist injects three different muscles you can only report one code 20553. Before CPT introduced 20552-20553 in 2002 internal medicine coders could use modifier -59 to report 20550 (Injection; tendon sheath ligament or ganglion cyst) multiple times for trigger point injections in different sites. Created Date.CPT code: Description: Price: 99203: New Patient Consultation – Low Complexity: $150: ... Trigger Finger Injection: $75: 20551: Tendon Origin/Insertion Injection: $85: 20526: Carpal Tunnel Injection: ... Trigger finger release local anesthetic: $1500: 25111: Ganglion cyst excision: $1750: 25000: DeQuervain tendonitis release:Learn how to bill and code trigger point injections for myofascial pain relief by physical therapists and pain management professionals. Find out the CPT codes, modifiers, units, and ICD-10-CM codes for this procedure.

6. Best answers. 0. Feb 8, 2011. #4. 20550 says "injection (s) of a single tendon sheath...) the coding tips in the coding companion state that if more than one tendon is injected in the same incounter, each injection should be reported separately. You can bill 20550 more than once during the same encounter.

Sep 13, 2013 · 20551 is for trigger points into various muscles, just one or 2. More than 2 muscles injected is 20552. Both of these codes can be billed only a single time per encounter. If your physician is injecting tendons, the code would be 20550 Injection (s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia") For the knee, this would ... No more than 3 Trigger point injection sessions in a rolling 12 months will be considered reasonable and necessary, regardless of the code billed. CPT 20552 limits to 1 or 2 muscles and 20553 is 3 or more muscles. The number of injections into the muscle group are not billed separately. ... Pain in right finger(s) M79.645 Pain in left finger(s ...Trigger finger, or stenosing tenosynovitis, occurs when the flexor tendons cannot pass through the A-1 pulley smoothly. ... For procedures associated with this Diagnostic Guide the CPT Codes are provided above. Reference materials for these codes is provided below. ... Corticosteriod injections help trigger fingers 60% of the time with a 60% ...20552- injection- Single or Multiple Trigger points for 1- 2 muscles. 20553- injection- Single or Multiple Trigger points for =<3 muscles. Here are some medical procedure codes related to injections, tendon sheaths, ligaments, trigger points, and ganglion cysts: Injection into tendon sheath, ligament, trigger points, or ganglion cyst (CPT code ...Jul 10, 2010 · Procedure code and description. 20550 Injection (s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia’’) 20551 Injection (s); single tendon origin/insertion. 20600 – Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance – average fee payment – $50 – $60. Aspiration and Injection CPT Codes. Puncture aspiration of abscess, hematoma, bulla, or cyst (10160) Injection, therapeutic; carpal tunnel (20526) Injection, therapeutic; single tendon origin or insertion (20551) Arthrocentesis, aspiration and/or injection; small joint, bursa or ganglion cyst eg, fingers, toes) (20600) Arthrocentesis ...www.MPSurgery.comwww.hand411.comHere is a good little video on how to inject a trigger finger with steroid in the clinic.Oct 3, 2018 · Article Guidance. This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33912, Injection of Trigger Points. Please refer to the LCD for reasonable and necessary requirements. Coding Guidelines. Trigger finger, right middle finger M65.332 Trigger finger, left middle finger M65.341 Trigger finger, right ring finger ... Billing and Coding: Trigger Point Injections (TPI). 10/01/2023 R13 Based on the annual ICD-10 code update, ICD-10 code D48.1 has been deleted from Group 2. 03/19/2023 R12 The article has been revised to remove all ...Oct 1, 2002 · The diagnosis is usually 727.05 (Other tenosynovitis of hand and wrist) or 727.03 (Trigger finger [acquired]). Florida Subscriber Answer: The diagnoses you offered indicate that the orthopedist is probably injecting the tendon sheath or ligament, which would point to 20550* ( Injection; tendon sheath, ligament, ganglion cyst ).

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Trigger finger causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger. The condition is also known as ...There are two CPT ® codes for Trigger point injections: 20552-Injection (s); single or multiple trigger point (s), 1 or 2 muscle (s) 20553-Injection (s); single or multiple trigger point (s), 3 or more muscles. Local anesthesia is included in these services. However, imaging guidance can be billed in addition to the injection if necessary ...Trigger finger release CPT code 26055 can be reported for stenosing tenosynovitis by incising the tendon sheath at the finger’s base. Trigger finger issue comes to the limelight when a finger stays in a stiff bent position for some time due to swollen tendon or inflammation, narrowing of A1 pulley, or formation of nodules among...Swollen middle finger joints can be attributed to a condition known as trigger finger, which is a type of tendonitis that has developed in the tendons that allow the fingers to ben...CPT codes for procedures where 76942 and 76998 are covered if selection criteria are met: ... Median nerve block, Trigger finger injection/trigger finger release without hydro dissection, clavi-pectoral fascial plane block, iliotibial (IT) band injection, percutaneous bursectomy of the pretibial tubercle bursa, scar tissue injection, ...You'll need to use the correct modifier for each finger. 20551-F7 (right hand, middle finger) 20551-F3 (left hand, ring finger)Wiki - Percutaneous trigger finger release | Medical Billing and Coding Forum - AAPC. If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in …Change the syringe, inject 10-20 mg of steroid. Apply pressure for 5 minutes then a light dressing. Advise the patient to be cautious with use of the finger until normal sensation returns. Expect some discomfort for a day or two. Placing the needle at the base of the finger flexion crease often easier than placing it right at the A1 pulley in ...Moving the needle and your finger helps break apart the tissue that's blocking the smooth motion of the tendon. Using ultrasound guidance during the procedure can improve results. Surgery. Working through a small incision near the base of your affected finger, a surgeon can cut open the narrowed section of tendon sheath. Request an appointment.High-quality evidence supports the use of corticosteroid injections for adhesive capsulitis, de Quervain tenosynovitis, and trigger finger. 13 – 17 In a systematic review and network meta ...Trigger finger, also known as stenosing tenosynovitis, is a condition in which one or more of your fingers gets stuck in a bent position or straightens with a snap, like a trigger being pulled and released. Trigger finger affects the tendons in your fingers, which control movement. When straightening and bending your finger normally, the ... ….

Conclusions: Trigger finger injections with triamcinolone demonstrate a higher rate of additional injections when compared with dexamethasone and methylprednisolone. Patients who underwent methylprednisolone injection had surgical release performed earlier and more frequently than the other 2 groups. The choice of corticosteroid significantly ...Best answers. 0. Mar 17, 2016. #1. My physician did bilateral trigger finger injections on the rt and lt 3rd digit and rt and lt 4th digits. He bill 20550-50 X1 unit. 20550 has an MUE of …The search was conducted using Current Procedural Terminology (CPT) codes 20550 (injection; tendon sheath, ligament), 20551 (injection; tendon origin/insertion), or 20600 (arthrocentesis, aspiration, or injection) and International Classification of Diseases, Ninth Revision (ICD-9) codes 727.03 (trigger finger) or 727.05 (tenosynovitis; hand ... 20605 is injection into a joint or bursa. 20552 is what you would want if it is a trigger point injection into 1 or 2 muscles. If 3 or more you would code 20553. Remember that it goes by number of mus... [ Read More ] Coding: 20550-LT Injection (s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia)-Left side. J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg x 4 units. Because this is follow-up visit with no new patient complaint or complications, you may not report a significant separately identifiable E/M service.Wiki - Percutaneous trigger finger release | Medical Billing and Coding Forum - AAPC. If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in …Carpal tunnel syndrome and trigger finger (TF) frequently present concomitantly; some studies suggest that carpal tunnel release (CTR) is a risk factor for the ...Before injection of the first carpometacarpal joint, 3.0 to 5.0 mL of 1.0 percent lidocaine (Xylocaine) may be injected around this nerve with a pre-frozen 30-gauge needle, 2 with caution not to ... Trigger finger injection cpt, Coding Trigger point injections are reported with the following CPT codes: • 20552: Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) • 20553: Injection(s); single or multiple trigger point(s), 3 or more muscles . Imaging guidance for the injection would be reported with one of the following codes, depending on, Trigger Finger Release. Comments. TECHNIQUE STEPS 0 % 0. 0 Preoperative Patient Care A. Intermediate Evaluation and Management. 1. Obtain focused history and performs focused exam . check range of motion check radial and ulnar pulses ..., Price: $3,025. CPT Code: 26055. Trigger finger, trigger thumb, or trigger digit, is a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. A disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level ..., Learn more about CPT® code 96372 for injection of drug or substance under skin or into muscle., © 1995-2024 by the American Academy of Orthopaedic Surgeons. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without ..., To ask other uestions. Pease cal 1 4 000 eect Option three times. A trigger finger injection is an injection of a mixture of local anesthetic and corticosteroid into the tendon sheath of the affected finger to help relieve the symptoms of stenosing tenosynovitis, otherwise known as trigger finger. Duration Less than 30 minutes How is it performed?, Trigger finger, or stenosing tenosynovitis, is when a finger remains in a bent position. It is painful to open or close the finger. A swollen tendon or formation of knots or nodules in …, Do them as follows: Using the opposite hand, grasp the affected finger just below the crease nearest to the end of your finger. Bend just the tip of your finger five times. Move your hand to just below the middle knuckle of the finger, holding your large knuckle straight. Bend the middle knuckle five times., The trigger point injection CPT codes are 20552 and 20553, also called a dry beedling procedure. CPT 20552 narrates injection (s) administration in a single or multiple trigger point (s) for either 1 or 2 muscles. The CPT 20553 narrates as the injection (s) is administered for single or multiple trigger point (s) for either three or more muscles. , Price: $3,025. CPT Code: 26055. Trigger finger, trigger thumb, or trigger digit, is a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. A disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level ..., Jan 10, 2024 ... Although a trigger finger injection uses a low dose of cortisone, possible side effects include a cortisone flare, infection, thinning of the ..., We billed Medicare the following: 99212 (25), 20600 (F3) and J1030- patient DX: trigger finger,swelling of limb & pain in finger. Medicare is denying both 99212 (25) & 20600 (F3) as inclusive and only paid on drug J1030? SHOULD the admin. CPT be corrected to 20552 for trigger point injection rather than injection of small joint/finger.toe 20600?, No more than 3 Trigger point injection sessions in a rolling 12 months will be considered reasonable and necessary, regardless of the code billed. CPT 20552 limits to 1 or 2 muscles and 20553 is 3 or more muscles. The number of injections into the muscle group are not billed separately. The code includes all injections made into the muscle ..., No more than 3 Trigger point injection sessions in a rolling 12 months will be considered reasonable and necessary, regardless of the code billed. CPT 20552 limits to 1 or 2 muscles and 20553 is 3 or more muscles. The number of injections into the muscle group are not billed separately. The code includes all injections made into the muscle., , Quartz is a guide to the new global economy for people in business who are excited by change. We cover business, economics, markets, finance, technology, science, design, and fashi..., Sonographically guided tendon sheath injections are more accurate than blind injections: implications for trigger finger treatment. J Ultrasound Med. 2011 Feb. 30 (2):197-203. [QxMD MEDLINE Link]. Jianmongkol S, Kosuwon W, Thammaroj T. Intra-tendon sheath injection for trigger finger: the randomized controlled trial. Hand Surg. 2007. 12 (2):79-82., There are two CPT ® codes for Trigger point injections: 20552-Injection (s); single or multiple trigger point (s), 1 or 2 muscle (s) 20553-Injection (s); single or multiple trigger point (s), 3 or more muscles. Local anesthesia is included in these services. However, imaging guidance can be billed in addition to the injection if necessary ..., Trigger finger (also called stenosing tenosynovitis) is a condition where it’s hard to fully bend or straighten one or more of your fingers. When a finger gets stuck in the bent po..., A trigger finger is a very common and treatable problem. It can occur in both fingers and the thumbs, which have tendons that help them to bend. The flexor tendons that bend the fingers have a lining on the outside. This lining is called tenosynovium. The tendon and lining are covered by a series of thick, soft tissue called pulleys., Jul 28, 2022 · Injection of the flexor tendon in the hand is most commonly performed for the treatment of stenosing tenosynovitis. Stenosing tenosynovitis, also known as trigger finger, involves a size mismatch between a thickened or stenotic first annular (A1) pulley in the hand and the flexor tendon trying to glide through the pulley. , Do not code the injections or how may injections are done on a single muscle, code the muscle (s). 20552 and 20553 are used to report single or multiple injections on 1-3 or more muscles. 20552 - 1 or 2 muscle (s) 20553 - 3 or more muscles. Modifier 50 - Bilateral. Bilateral surgical indicator 50 may apply as well, so be sure to code accordingly., The trigger point injection CPT codes are 20552 and 20553, also called a dry beedling procedure. CPT 20552 narrates injection (s) administration in a single or multiple trigger point (s) for either 1 or 2 muscles. The CPT 20553 narrates as the injection (s) is administered for single or multiple trigger point (s) for either three or more muscles., Sep 15, 2005 · M65.30 Trigger finger, unspecified finger M65.311 – M65.359 Trigger finger M65.4 Radial styloid tenosynovitis [de Quervain] M65.80 Other synovitis and tenosynovitis, unspecified site M65.811 – M65.9 Other synovitis and tenosynovitis M65.841 – M65.849 Other synovitis and tenosynovitis, hand , Oct 3, 2018 · Article Guidance. This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33912, Injection of Trigger Points. Please refer to the LCD for reasonable and necessary requirements. Coding Guidelines. , Oct 3, 2018 · Article Guidance. This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33912, Injection of Trigger Points. Please refer to the LCD for reasonable and necessary requirements. Coding Guidelines. , Aspiration and Injection CPT Codes. Puncture aspiration of abscess, hematoma, bulla, or cyst (10160) Injection, therapeutic; carpal tunnel (20526) Injection, therapeutic; single tendon origin or insertion (20551) Arthrocentesis, aspiration and/or injection; small joint, bursa or ganglion cyst eg, fingers, toes) (20600) Arthrocentesis ..., No more than 3 Trigger point injection sessions in a rolling 12 months will be considered reasonable and necessary, regardless of the code billed. CPT 20552 limits to 1 or 2 muscles and 20553 is 3 or more muscles. The number of injections into the muscle group are not billed separately. The code includes all injections made into the muscle., Trigger finger (727.03) Ganglion of tendon sheath (727.42) Contracture of joint, hand/fingers (718.44) Loc prim osteoarthritis, hand (715.14) Pain in joint, hand (719.44) CPT Codes Injection, tendon sheath, ligament, trigger points or ganglion cyst (20550) Aspiration or injection ganglion cyst (20612) , Trigger finger injections involve a corticosteroid medication into the tendon sheath to reduce inflammation and alleviate symptoms. The article provides information …, No more than 3 Trigger point injection sessions in a rolling 12 months will be considered reasonable and necessary, regardless of the code billed. CPT 20552 limits to 1 or 2 muscles and 20553 is 3 or more muscles. The number of injections into the muscle group are not billed separately., 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) 20553 Injection(s); single or multiple trigger point(s), 3 or more muscles Injections for plantar fasciitis are addressed by 20550 and ICD-10-CM M72.2. , No more than 3 Trigger point injection sessions in a rolling 12 months will be considered reasonable and necessary, regardless of the code billed. CPT 20552 limits to 1 or 2 muscles and 20553 is 3 or more muscles. The number of injections into the muscle group are not billed separately. The code includes all injections made into the muscle.