Dermatology Coding Alert

Question: I heard that CPT 2006 would offer a new code for Botox injections of sympathetic nerves in the hands and feet to treat hyperhidrosis. Is this the case and, if so, what is the proper code?


Missouri Subscriber

Answer: Unfortunately, the CPT update disappoints dermatology offices when it comes to a specific code for chemodenervation of extremities. You'll need to use unlisted-procedure code 64999 (Unlisted procedure, nervous system) for this procedure.

Why you heard otherwise: Many experts were speculating that a specific code for Botox injections in the hands and feet was on its way.

CPT 2006 does offer new codes for chemodenervation of eccrine glands: 64650 (Chemodenervation of eccrine glands; both axillae) and 64653 (... other area[s] [e.g., scalp, face, neck], per day). However, CPT 2006 stops short of the hands and feet. (See "CPT 2006 Update: Get Ready -- Next Year's Manual Shows a Lot More Skin -- Skin Grafts, That Is" in the November 2005 Dermatology Coding Alert.)

Mistake: Even though 64653 -- with its description of "other areas" -- might seem to open up the possibility for use when injecting the sympathetic nerves of the feet, you can't ignore the new parenthetical note that specifically points coders to 64999 for "chemodenervation of extremities (e.g., hands or feet)."

Remember: To help recover the substantial cost of Botox itself, remember to report HCPCS code J0585 (Botulinum toxin type A, per unit).

As with any unlisted-procedure code, your hopes for reimbursement will largely hinge on the documentation you submit with your claim.

In the case of hyperhidrosis, your biggest challenge may be justifying medical necessity for the procedure.

When selecting the ICD-9 codes, choose among 705.21 (Disorders of sweat glands; primary focal hyperhidrosis), 705.22 (... secondary focal hyperhidrosis) and 780.8 (Generalized hyperhidrosis).

Tip: Before submitting the claim, check with your carrier to determine under what diagnosis codes the chemodenervation will be covered, if at all.