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Anesthesia Coding Alert

Reader Questions:

Study Opinions for Botox for Hyperhidrosis

Published on Tue May 17, 2005

Question: How should I code a Botox injection for hyperhidrosis? Should I resort to an unlisted-procedure code, or will carriers accept something else?


Maryland Subscriber
Answer: Your best bet is to check with the carrier before filing the claim. Some payers accept 64640 (Destruction by neurolytic agent; other peripheral nerve or branch), but other payers only accept 64999 (Unlisted procedure, nervous system).
The American Academy of Dermatology says to report 17999 (Unlisted procedure, skin, mucous membrane and subcutaneous tissue) because the physician is not really chemodenervating a muscle in hyperhidrosis - but most carriers won't accept this.

Some coders opt to report 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) for the injections, and 64450 (Injection, anesthetic agent; other peripheral nerve or branch) if the physician administers a block along with the Botox material. Other coders recommend choosing a somatic nerve destruction code based on the injection site (64600-64640).

The therapy is new, so always check with the carrier for preapproval before performing the procedure.  
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