Anesthesia Coding Alert

Question: Our pain management specialist administered Botox injections to a patient's hands and feet for persistent hyperhidrosis. Can we use chemodenervation code CPT 64653 to report these injections?

Wyoming Subscriber

Answer: Unfortunately, CPT still doesn't have a specific code for chemodenervation of hands or feet. Per the CPT parenthetic note, "For chemodenervation of extremities (e.g., hands or feet), use 64999," pain management providers coding for Botox injections to hands and feet will need to use unlisted-procedure code 64999 (Unlisted procedure, nervous system).

Here's why: You might think that 64653 (Chemodenervation of eccrine glands; other area[s] [e.g., scalp, face, neck], per day) sounds like the best option, but you need to remember the "Instructions for Use of the CPT Codebook" states, "Do not select a CPT code that merely approximates the service provided. If no such specific code exists, then report the service using the appropriate unlisted-procedure or service code."

Always remember: You will report HCPCS code J0585 (Botulinum toxin type A, per unit) with your claim in order to help recover the substantial cost of Botox itself.

Document it: Your hopes for reimbursement hinge largely on the documentation you submit with the claim, just like any unlisted-procedure code.

Carriers often look to medical necessity and treatment effectiveness in processing unlisted-procedure codes. Your provider's documentation should include the severity and duration of the patient's symptoms, along with descriptions and effectiveness of any of the more conservative treatments your physician has already tried.

Be sure to check with your carrier before submitting the claim so you'll be aware of the specific guidelines.

-- Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; Marvel J. Hammer, RN, CPC, CS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver; and Kelly Dennis, MBA, CPC, ACS-AP, with Perfect Office Solutions of Leesburg, Fla.