Anesthesia Coding Alert

Question: Can we use new chemodenervation code 64653 for Botox injections to the patient's hands and feet?


West Virginia Subscriber


Answer: Unfortunately, CPT disappoints pain management providers with its lack of a specific code for chemodenervation of an extremity. You'll need to use unlisted-procedure code 64999 (Unlisted procedure, nervous system) for Botox injections to hands and feet.

The reason: Although 64653 (Chemodenervation of eccrine glands; other area[s] [e.g., scalp, face, neck], per day) might seem like a viable option when your provider injects sympathetic nerves of the feet, you can't ignore the new parenthetical note that points you to 64999 for "chemodenervation of extremities (e.g., hands or feet)."

Don't forget: To help recover the substantial cost of Botox itself, remember to report HCPCS code J0585 (Botulinum toxin type A, per unit) with your claim. 

Document it: As with any unlisted-procedure code, your hopes for reimbursement hinge largely on the documentation you submit with the claim. Carriers usually accept diagnosis 705.21 (Primary focal hyperhidrosis) along with documentation of the symptoms' length and duration and descriptions of the more conservative treatments your physician has already tried. Check with your carrier before submitting the claim so you'll know its specific guidelines.