Hidradenitis is combination of two Greek words i.e. Hidros and adenos. In simple word sweat gland. Some authors also use the term "apocrinitis" rather than hidradenitis due to the fact that this disease appears to primarily affect the apocrine glands, Hidradenitis suppurativa (HS) poses a difficult problem for both the physician and the patient as a very little progress has been made in nonsurgical treatment in over 100 years.
In 1833, Purkinje discovered sweat glands in human skin. In 1839, the first clinical description of HS, as a distinct disease, was made by Velpeau. Robin, in 1845, described the structure and location of the apocrine glands and as a result of Robin's work, Verneuil, in 1854, related hidradenitis to the apocrine glands.
Hidradenitis Suppurativa is a painful, chronic inflammation of the sweat gland bearing skin areas. People with Hidradenitis Suppurativa Excision may develop a condition, where they get recurring boils under the arms and in the groin. These boils are so persistent, that they begin to cause scarring. The boils can drain which can stain clothing and cause a foul odor which can be socially embarrassing for the patient.
Hidradenitis Suppurativa Excision CPT Code
Hidradenitis suppurativa is an embarrassing condition where recurring painful boils occur under the arms, breasts and in the groin eventually causing scarring. Hidradenitis suppurativa can be treated with antibiotics and there is promising new treatments with tumor necrosis factor-alpha medications. Surgical intervention is sometimes required once scarring occurs.
The infection produces very painful nodules and cysts which recur over and over. Eventually the infections cause small tunnels to form under the skin called sinus tracts. The sinus tracts, once formed, can also be prone to infection. The infections often drain soiling clothing and producing a sometimes foul odor.
When this problem become persistent and large areas are involved then antibiotic treatment and drainage is not effective. In such cases, an extensive surgery may be an option. Surgical procedures range from simple drainage, to limited removal of affected areas, to wide excision of all the sweat gland-bearing skin.
When large amounts of skin are removed, the area may be allowed to heal on its own or a skin graft may be applied. This extensive approach is only rarely necessary. In order to determine the appropriate code, coder needs detailed information about the procedure performed. Usually severity of hidradenitis suppurativa is classified in following three stages:
· Abscess formation (single or multiple) without sinus tracts and cicatrization/scarring is characterized as stage I.
· Recurrent abscesses with sinus tracts and scarring, single or multiple widely separated lesions is referred as stage II.
· Diffuse or almost diffuse involvement or multiple interconnected sinus tracts and abscesses is termed as stage III.
Following are some commonly recommended treatments but some other may also used:
· Chemical Peels and/or Exfoliation
· Intralesional Injections
· Laser Therapy
· Oral Medications
· Photodynamic Therapy (PDT)
· Surgical Removal
CPT Codes for Hidradenitis Suppurativa Excision
11450 Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair
11451 Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repair
11462 Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair
11463 Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repair
96567 Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions.
Covered HCPCS Codes
J7308 Aminolevulinic acid HCI for topical administration, 20%, single unit dosage form (354 mg)
J7309 Methyl aminolevulinate (MAL) for topical administration, 16.8%, 1 gram
Covered ICD-9-CM Diagnosis Codes
ICD-9-CM Procedure Code
86.3 Other local excision or destruction of lesion or tissue of skin and subcutaneous tissue
99.83 Other phototherapy