Anesthesia Coding Alert

Question: Can we bill more than one unit for chemodenervation of the eccrine glands (other than the axillae)? Our pain management specialist sometimes treats the patient's hands and feet on the same date.


Wisconsin Subscriber

  
Answer: Both of the codes for chemodenervation of eccrine glands are limited to one unit of service per date of service. Note the code description for 64650 (Chemodenervation of eccrine glands; both axillae) includes both axillae. Likewise, the use of the terms "area(s)" and "per day" in the description for 64653 (... other areas [e.g., scalp, face, neck], per day) shows you can report the code only once per date of service.

Using these codes for chemodenervation of the eccrine glands in the hands or feet, however, would not be compliant coding. The parenthetical note in CPT directs you to report 64999 (Unlisted procedure, nervous system) for chemodenervation of extremities (hands or feet).

Using "unlisted-procedure" codes is usually your last resort as a coder, but it's a better option than reporting a code with an inaccurate descriptor. You report unlisted-procedure codes with only one service unit because these codes do not include descriptor language that specifies a particular service or associated value for the service. 

Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.; and Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.