Reference no: EM133243549

Question: The 25-year-old patient is seen in the dermatologist's office upon the advice of the family practice physician with the complaint of excessive sweating in particular areas of her body, such as her underarms, soles of her feet, and the palms of her hands. The patient notes that the excessive sweating started when she was a young teenager. She describes this condition as very embarrassing and difficult to manage because nearly every day, she has to take extra clothing with her in order to change her blouse at work. The physician takes a complete history and cannot find any medical condition that might be causing this problem. The physical examination confirms, however, excessive moisture under the arms and on her hands and feet. The physician is certain the patient suffers from primary focal hyperhidrosis. Her primary care physician had given her a prescription for a certain antiperspirant designed for this condition. The patient had tried the antiperspirant but found it to be ineffective as well as irritating to her underarm skin. The dermatologist recommends injections of botulinum toxin at the sites where excessive sweating is occurring. The drug promptly freezes the nerve that would normally stimulate the sweat gland. He had used this therapy for other patients, who were pleased with the results. The patient immediately wants the procedure. The physician injects the subcutaneous tissue of both axillae with the "botox" under sterile technique. The patient is to return in four weeks to report on the results, or sooner if problems are detected.

The physician states that if the patient has a positive response, the injections will need to be repeated every six to nine months. While there is no requirement that ICD-10-PCS procedures are coded on outpatient code the injection of botulinum toxin for coding practice.