# HELP!! CPT 64653 and "PER DAY"



## cleecpc (Jan 7, 2009)

Can someone please help me out here??  I have a denied claim with CPT code 64653-my provider gave bilateral injections of Botox for a patient who was salivating excessively.

Does the "per day" mean you can only bill this code once per day??  Just when you think you know what you are doing, something like this pops up and blindsides you!!???

Anyone else feel like this?????????????

Thanks in advance for any help here!!


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## Anna Weaver (Jan 7, 2009)

*64653*

I'm not familiar with this at all, but here's the lay description of 64650-64653. It sounds like they do a series of injections, bilaterally, so it should only be billed once per day. See what you think. 

The physician administers a neurotoxin to the eccrine glands to reduce hyperhydrosis (excessive sweating). The skin area to be injected is identified by applying iodine to the skin followed by a light dusting with cornstarch. The resulting chemical change caused by the patient's perspiration turns the area black. Botulinum toxin type A (BTX-A, Botox®) is injected intradermally into the site with a series of injections, usually 10 to 15 injections per axilla, via a Teflon-coated 23- to 26-gauge electromyogram (EMG) needle with syringe. Since the sweat glands are between the dermis and the dermal fat tissue, the injections must be precise. BTX-A must be injected deep enough to reach the nerve endings but not so deep as to go into the fat. Report 64650 for eccrine glands of both axillae. Report 64653 for eccrine glands of other body areas.


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## cleecpc (Jan 7, 2009)

Thanks for the help Anna.   I had read this too, but I am still hoping for a more definitive answer.  I have been coding and billing for over 25 years and I never have run across "per day"!!


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