Neurology & Pain Management Coding Alert

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


West Virginia Subscriber

Answer: Unfortunately, the CPT update disappoints neurology 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.

Reason: Even though 64653 (Chemodenervation of eccrine glands; other area[s] [e.g., scalp, face, neck], per day) 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).-

Many experts were speculating that a specific code for Botox injections in the hands and feet was on its way. And while CPT 2006 does offer new codes for chemodenervation of eccrine glands in both axillae (64650) and other areas like the face and scalp (64653), it stops short of the hands and 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).

As with any unlisted-procedure code, your hopes for reimbursement will largely hinge on the documentation you submit with your claim. For hyperhidrosis, your biggest challenge will likely be justifying medical necessity for the procedure. When selecting your 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 your claim, check with your carrier to determine which diagnosis codes it covers for chemodenervation.