# 64640 vs. 64650--Help!



## lshannon (Apr 8, 2014)

My derm has been providing axillae botox injections for hyperhidrosis.  She insists on coding as 64640.  The documentation states: "botox for hyperhydrosis underarms", and there is a scribbled picture of 2 underarms, and the notation of how many cc of botox were injected under each arm (yes, she is still using paper charts--don't ask!).  I have repeatedly requested that she code these as 64650, but she states that the coding expert at the AAD conferences is telling the doctors that 64640 is fine for this.  She is getting paid for 64640, and will get paid less for 64650 if that's what she bills.

Can someone please help me understand if she would ever bill 64640 vs 64650 for axillae hyperhidrosis?  I explained to her that because 64650 is a code specific to axillae hyperhidrosis, that is what should be used.  

And finally, because she injects up to 400 units of botox per visit, has anyone ever submitted either 64640 or 64650 with modifier 22 and received additional payment? 

Thanks in advance!


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## CatchTheWind (Apr 8, 2014)

You are right: 64650 is the code.  Coding rules require you to code to the highest specificity, and not only is 64650 more specific, but also 64640 is found in the "intercostal, facet joint, plantar, and pudential nerves" section; I'm no anatomy maven, but I can't imagine how any of those nerves could be found in the axillae!

We have never used modifier 22, so I can't help you there - sorry!


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## lshannon (Apr 8, 2014)

Thank you!

Can you tell me your source from which you quoted the nerves referred to by 64640?  My CPT book just shows 64640 under Somatic nerves and 64650 under Sympathetic nerves.  And I am definitely not an anatomy maven!

Thanks again.


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## CatchTheWind (Apr 8, 2014)

I have an "enhanced" CPT book from Optum called "Current Procedural Coding Expert: CPT codes with Medicare essentials enhanced for accuracy"

64640 is in a section entitled: Chemical Denervation Intercostal, Facet Joint, Plantar, and Pudendal Nerve(s), found on page 222.


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