Hyperhidrosis is characterized by excessive sweating that is not normally related to heat or other physical exercises. Also known as polyhidrosis or sudorrhea, the condition can affect just one specific area or the whole body. It can be localized to a particular anatomical area or may be diffuse (involving much of the skin). People, as part of the condition, sweat so much that it soaks through the clothes or drips off the hands. The sweating can occur in unusual situations like in cooler weather or without any trigger at all. It can also be caused by other medical conditions like menopause or hyperthyroidism. Most commonly affecting the feet, face and armpits, hyperhidrosis may be present from birth or may develop at a later stage in life. However, most cases of excessive sweating tend to start during a person’s teenage years. It is estimated that about 4.8 percent of Americans have hyperhidrosis, but this figure may be underreported. Besides disrupting normal daily activities, excessive sweating can cause social anxiety and embarrassment. In most cases, people don’t seek proper treatment as they don’t really realize that they suffer from a treatable medical condition. Treatment modalities for this condition generally begin with prescription-strength antiperspirants followed by other medications and therapies. In severe cases, physicians may advise surgery either to remove the sweat glands or to disconnect the nerves responsible for the overproduction of sweat. When it comes to reporting the causes, symptoms and diagnoses of excessive sweat disorder, dermatologists can depend on the services of a reliable medical billing company. A reputable company will have skilled medical coding service providers who are knowledgeable in the codes and other related guidelines, and can easily manage the coding and claim submission processes.

Types and Causes of Hyperhidrosis

Sweating is the body’s natural mechanism to cool itself. The nervous system automatically triggers the sweat glands when the body temperature increases. In addition, sweating also occurs due to certain other conditions, such as warm weather, physical activity, nervousness, stress, and feelings of fear or anger. The underlying causes associated with the condition depend on the specific type of hyperhidrosis.

There are two types of hyperhidrosis which may occur either due to an underlying health condition, or have no apparent causes.

  • Primary Idiopathic Hyperhidrosis – This condition usually starts in childhood. With this type, the nerves responsible for signaling your sweat glands become overactive, even when they do not get triggered by physical activity or a rise in temperature. There is no medical cause for this type and in most cases are localized and have a hereditary component, with 30 to 50 percent of people with this type having a family history of excessive sweating. The condition usually affects the palms and soles and in some cases the face.
  • Secondary Hyperhidrosis – A less common type, the person with this condition sweats too much because of an underlying health condition, such as obesity, gout, menopause, a tumor, thyroid problems, diabetes mellitus, hyperthyroidism (overactive thyroid gland), nervous system disorders, heart attack and infections. In some cases, use of certain medications can also cause heavy sweating. With this type, a person may sweat all over the body, or in just one area. In fact, a person may also sweat while he/she is sleeping.

Symptoms of Hyperhidrosis

Excessive sweating that disrupts normal activities is one of the common symptoms associated with the condition. The sweating experienced by people with hyperhidrosis far exceeds the normal sweating and becomes embarrassing, causing severe discomfort and anxiety. In fact, episodes of excessive sweating occur at least once in a week for no clear reason. Other related signs and symptoms include –

  • Sweat that occurs on both sides of your body in roughly the same amount
  • Worrying about having stained clothing
  • Socially withdrawn (causing depression)
  • Noticeable sweating that soaks through clothing
  • Irritating and painful skin problems (like fungal or bacterial infections)
  • Clammy or wet soles of the feet
  • Clammy or wet palms of the hands

How Is Hyperhidrosis Diagnosed and Treated?

Even though excessive sweating is a serious symptom associated with the condition, it can also be a symptom of other, serious conditions. In such cases, patients need to consult a physician if they experience symptoms like – sweating and weight loss, prolonged and unexplained sweating, sweating (that mainly occurs during sleep) and sweating accompanied by fever, chest pain, shortness of breath, and rapid heartbeat.

Diagnosis of the condition begins with a detailed patient evaluation by the physician wherein they will ask questions about the patterns of sweating – which parts of the body are affected, how often sweating episodes occur, and whether sweating occurs during sleep. Dermatologists may recommend conducting blood and urine tests to check whether the condition is caused due to any other underlying conditions, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia). They may recommend other tests like – iodine-starch test, skin conductance and a thermoregulatory sweat test.

There are several treatment options for excessive sweating. If any underlying medical condition is known to cause the problem, it is important to treat that specific condition first. On the other hand, if no clear causes are identified related to the condition, the treatment modalities mainly focus on controlling excessive sweating. In some cases, a combination of treatment options may be used. Common treatment options include – specialized antiperspirant (containing aluminum chloride), Iontophoresis, Anticholinergic drugs, Nerve-blocking medications, Antidepressants and Botox (botulinum toxin) injections. In severe cases, if a person suffers excessive sweating in the armpits, surgery may be an option. Surgical options include – sweat gland removal, microwave therapy (delivering microwave energy to destroy sweat glands) and endoscopic thoracic sympathectomy (severing the nerves that carry messages to the sweat glands).

All diagnostic tests and other procedures performed need to be documented using the correct medical codes. Medical billing and coding services provided by leading medical billing companies can help physicians use the correct codes for their billing process. Medical codes for coding hyperhidrosis include –

ICD-10 Codes

  • L74.5 – Focal hyperhidrosis
  • L74.51 – Primary focal hyperhidrosis
    • L74.510 – Primary focal hyperhidrosis, axilla
    • L74.511 – Primary focal hyperhidrosis, face
    • L74.512 – Primary focal hyperhidrosis, palms
    • L74.513 – Primary focal hyperhidrosis, soles
    • L74.519 – Primary focal hyperhidrosis, unspecified
  • L74.52 – Secondary focal hyperhidrosis
  • R61 – Generalized hyperhidrosis

CPT Codes

  • 15876-15879 – Suction assisted lipectomy [includes codes 15876, 15877, 15878, 15879]
  • 17999 – Unlisted procedure, skin, mucous membrane and subcutaneous tissue [when specified as laser or microwave destruction or resection of subcutaneous sweat glands]
  • 32664 – Thoracoscopy, surgical; with thoracic sympathectomy
  • 64520 -Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)
  • 64650 – Chemodenervation of eccrine glands; both axillae
  • 64653 – Other area(s) (e.g., scalp, face, neck), per day
  • 64802 – 64823 – Excision sympathetic nerves
  • 64999 – Unlisted procedure, nervous system [when specified as endoscopic lumbar sympathectomy]
  • 97033 – Application of a modality to one or more areas; iontophoresis, each 15 minutes

HCPCS Codes

  • E1399 – Durable medical equipment, miscellaneous [when specified as iontophoresis device for home use]
  • J0585 -Botulinum toxin type A, per unit
  • J0587 – Botulinum toxin type B, per 100 units

As hyperhidrosis is a treatable condition, developing a clear treatment plan can help manage the symptoms in a better manner. Treatments for the condition may depend on the underlying condition causing sweating. If the sweating is a side effect of a medication, it is important to talk to your dermatologist as he can help switch medications or lower the dosage. In addition, making alterations in daily activity and lifestyle like using antiperspirants and armpit shields, using loose clothing, choosing shoes and socks made of natural materials, regular bathing and airing the feet may help improve the intensity of symptoms.

Dermatology medical billing and coding can be challenging. For correct and timely billing and claims submission, dermatology practices can rely on medical billing and coding companies that provide the services of AAPC-certified coding specialists for all billing and coding tasks.