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Chemodenervation of eccrine glands refers to a medical procedure aimed at reducing excessive sweating, known as hyperhidrosis, which occurs in specific localized areas of the body. The eccrine glands, which are responsible for producing sweat, are distributed across most regions of the skin. This procedure is particularly indicated for patients suffering from severe focal hyperhidrosis, where the sweating is not generalized but concentrated in specific areas such as the scalp, face, neck, and palms. The process begins with the identification of the affected areas, which is typically done using an iodine solution followed by starch powder. This method allows for the visualization of sweat production, as the areas that sweat will turn dark purple after a short waiting period. Once the areas are marked, the skin is prepared with an antibacterial solution to minimize the risk of infection. The treatment involves the injection of reconstituted botulinum toxin type A into the dermis at intervals of 1.5 to 2 centimeters across the identified regions. It is important to note that CPT® Code 64653 is specifically used for chemodenervation of eccrine glands in areas other than the axillae, and this code can be reported only once per day, regardless of the number of areas treated during that day.
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The procedure of chemodenervation of 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 common sites for this procedure include:
The procedure for chemodenervation of eccrine glands involves several key steps to ensure effective treatment of hyperhidrosis. First, the affected areas are identified using a diagnostic method that involves painting the skin with an iodine solution. This is followed by dusting the area with starch powder, which reacts with the sweat to create a visible indication of the sweating regions. After allowing 10 to 15 minutes for the reaction to occur, the areas that have turned dark purple are marked for treatment. Once the areas are identified, the skin is prepared for the procedure by applying an antibacterial solution to reduce the risk of infection. The next step involves the preparation of the botulinum toxin type A, which is reconstituted and drawn into syringes. The clinician then injects the toxin into the dermis of the marked areas at intervals of 1.5 to 2 centimeters. This precise injection technique is crucial for achieving optimal results in reducing excessive sweating.
After the chemodenervation procedure, patients may experience some localized swelling or discomfort 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 can take several days to manifest, and patients should be informed that the results may vary. Regular follow-up appointments may be necessary to assess the effectiveness of the treatment and determine if additional sessions are required. As CPT® Code 64653 is reported once per day, it is essential for healthcare providers to document the procedure accurately and ensure compliance with coding guidelines.
| Short Descr | CHEMODENERV ECCRINE GLANDS | Medium Descr | CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY | Long Descr | Chemodenervation of eccrine glands; other area(s) (eg, scalp, face, neck), per day | 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. | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SA | Nurse practitioner rendering service in collaboration with a physician |
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| 2013-01-01 | Changed | Guideline information changed. |
| 2006-01-01 | Added | - |
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