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Chemodenervation of the eccrine glands, specifically in both axillae, is a medical procedure aimed at addressing severe focal hyperhidrosis, which is characterized by excessive and localized sweating. The eccrine glands, which are responsible for producing sweat, are distributed across most areas of the body, with common sites for this procedure including the axillary region, scalp, face, neck, and palms of the hands. The process begins with identifying the areas of excessive sweating through a diagnostic method that involves applying an iodine solution to the skin, followed by dusting the area with starch powder. After allowing 10-15 minutes for the reaction, the presence of sweat will cause the treated areas to turn dark purple, indicating the locations that require intervention. Once the reactive areas are marked, the starch-iodine compound is removed, and the skin is prepared with an antibacterial solution to minimize the risk of infection. The procedure involves the injection of reconstituted botulinum toxin type A into the dermis at intervals of 1.5-2 cm within the identified regions. This targeted approach effectively reduces the activity of the eccrine glands, thereby alleviating the symptoms of hyperhidrosis. For coding purposes, CPT® Code 64650 is specifically designated for chemodenervation of eccrine glands in both axillae, while 64653 is used for similar procedures in other areas of the body, with the latter code being reported once per day regardless of the number of areas treated.
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Chemodenervation of the eccrine glands is indicated for the treatment of severe focal hyperhidrosis, which is characterized by excessive sweating localized to specific areas of the body. The procedure is particularly beneficial for patients experiencing significant discomfort or social embarrassment due to profuse sweating in regions such as the axillae, scalp, face, neck, and palms of the hands.
The procedure for chemodenervation of the eccrine glands involves several key steps to ensure effective treatment of hyperhidrosis. First, the physician identifies the areas of excessive sweating by applying an iodine solution to the skin, which is then dusted with starch powder. This combination allows for a visual indication of sweat production, as the presence of sweat will cause the treated areas to turn dark purple after a waiting period of 10-15 minutes. Once the reactive areas are marked, the starch-iodine compound is carefully removed to prepare the skin for the next steps. The area is then cleansed with an antibacterial solution to reduce the risk of infection during the injection process. Following this preparation, reconstituted botulinum toxin type A is drawn into syringes, and the physician proceeds to inject the solution into the dermis of the previously identified regions. The injections are administered at intervals of 1.5-2 cm to ensure even distribution of the toxin and optimal results in reducing sweat production.
After the chemodenervation procedure, patients may experience some localized swelling or bruising at the injection sites, which typically resolves within a few days. It is important for patients to follow any post-procedure care instructions provided by their healthcare provider, which may include avoiding strenuous activities and excessive heat exposure for a short period. The effects of the treatment generally begin to manifest within a few days and can last for several months, depending on individual response. Patients should schedule follow-up appointments to assess the effectiveness of the treatment and determine if additional sessions are necessary.
| Short Descr | CHEMODENERV ECCRINE GLANDS | Medium Descr | CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE | Long Descr | Chemodenervation of eccrine glands; both axillae | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 156 - Injections and aspirations of muscles, tendons, bursa, joints and soft tissue |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | JZ | Zero drug amount discarded/not administered to any patient | LT | Left side (used to identify procedures performed on the left side of the body) | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | RT | Right side (used to identify procedures performed on the right side of the body) | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2006-01-01 | Added | First appearance in code book in 2006. |
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