Proper billing and coding are essential to document the diagnosis of hyperhidrosis and to assure proper reimbursement for treatment. Providers should become familiar with the payment policies of local health plans to streamline the preauthorization process that is often needed for many treatments commonly used for hyperhidrosis. Having a preprinted letter of medical necessity and patient intake forms that record the necessary historical information about the disease, previous treatments, and other pertinent information will help increase the speed of the office flow. This article presents algorithms for treatment of the various forms of primary focal hyperhidrosis.
Key points
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Treatments for hyperhidrosis lead to a great improvement in patient quality of life.
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Proper billing and coding are needed to document diagnosis and treatment and assure proper reimbursement.
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Providers may buy and bill botulinum toxin or prescribe it as a drug for any individual patient.
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Algorithms for treating various forms of hyperhidrosis can help clinicians decide on the best treatments.
Is hyperhidrosis a cosmetic condition for which patients should pay out of pocket for treatment or is it a true medical disease that should be considered necessary to treat and therefore covered by health insurance? How this question is answered by the provider will largely determine how treatments are incorporated into a busy clinical practice.
For providers who choose to treat hyperhidrosis as a cosmetic condition, the provider need not bother with insurance precertification, determination of medical necessity, or billing. Whether the patient is getting iontophoresis, botulinum toxin injections, local surgery, or treatment with a device such as the miraDry microwave system (Miramar Labs, Inc., Santa Clara, CA, USA), the provider simply collects a cash payment from the patient, often before the procedure is performed.
By considering hyperhidrosis a true disease that is medically necessary to treat, the financial barrier to care is lessened and far more people with the condition are able to receive treatment. Expensive treatments such as botulinum toxin injections or miraDry procedures are inaccessible for many patients if out-of-pocket payment is required. Some high-deductible health plans also present an obstacle to care if these deductibles have not been met already, which is often the case for an otherwise healthy young person with low health care expenses—the primary demographic of patients with hyperhidrosis. Curiously, the medical necessity of one of the most expensive and most invasive treatments, endoscopic thoracic sympathectomy, is seldom questioned by insurance payers and is usually covered.
If the full range of hyperhidrosis treatments is made available, including topical and systemic therapies, iontophoresis, botulinum toxin injections, miraDry microwave procedures, and local surgery, the provider should get to know the coverage policies of the major health plans in the local service area. Some plans will require a stepwise ladder of treatments; usually failure of or intolerance to topical and oral systemic therapies is required before other treatments, such as iontophoresis or botulinum toxin injections, will be considered for coverage. Treatment with the miraDry microwave device is uniformly not covered by insurance.
Contacting a medical director of the major health plans in a provider’s local service area may be helpful to ascertain whether the health plan uses any particular criteria to determine medical necessity or follows guidelines for clinical decision making regarding coverage of treatments for hyperhidrosis. One example of an ill-conceived criterion of medical necessity is the requirement that a patient exhibit signs of maceration or infection before axillary hyperhidrosis is considered medically necessary to treat, when in fact maceration and infection are seldom seen in uncomplicated primary focal axillary hyperhidrosis. If a health plan does not have criteria for determining the medical necessity for treatment of hyperhidrosis, providers can offer to help develop them. Health plans pay attention to published literature, especially that which is peer-reviewed and presents good science. Published treatment algorithms, such as those developed by the International Hyperhidrosis Society (see Figs. 2–7 ), may be a helpful resource when developing a carrier’s precertification process.
Related posts:
Incidence and Prevalence of Hyperhidrosis
Impact of Hyperhidrosis on Quality of Life and its Assessment
Special Considerations for Children with Hyperhidrosis
Botulinum Neurotoxin Treatment of Palmar and Plantar Hyperhidrosis
Botulinum Toxin for Hyperhidrosis of Areas Other than the Axillae and Palms/Soles
Oral Medications
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