Medicare Benefits Schedule - Item 35006

CERVICAL OR UPPER THORACIC SYMPATHECTOMY, where operation is a reoperation for previous incomplete sympathectomy by any surgical approach

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $1,342.25 Benefit: 75% = $1,006.70

(See para TN.8.295 of explanatory notes to this Category)

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Appropriate Use Guidance

Hyperhidrosis

Sympathectomy can be a valuable treatment for a limited number of patients with hyperhidrosis who have tried and failed to respond to non-surgical intervention. Non-surgical options include but are not limited to:

• Topical aluminium chloride hexahydrate or aluminium chloral hydrate (antiperspirants)
• Botulinum toxin A injection of the sweat glands
• Iontophoresis
• Topical anticholinergic creams, gels and sprays, or prescription underarm wipes
• Oral anticholinergics for e.g. propantheline bromide, glycopyrrolate, oxybutynin, and methantheline bromide
• Laser therapy to the affected area
• Microwave therapy to the affected area

It would be expected that a patient with treatment resistant hyperhidrosis would be under the care of a Dermatologist and the decision to undertake surgical sympathectomy would involve the patient’s general practitioner, dermatologist and the treating surgeon.

Refractory Cardiac Arrhythmias

Sympathectomy may be performed on patients as an adjunct to lifelong optimal medical therapy for refractory cardiac arrhythmias including, but not limited to:

• Congenital long QT syndrome
• Extreme non-congenital prolonged QT syndrome
• Catecholaminergic polymorphic ventricular tachycardia (CPVT)

 Vascular Indications

Sympathectomy may be performed on patients as an adjunct to lifelong optimal medical therapy for the management of treatment resistant (but not limited to):

• small vessel vasospastic pathology related to:

          - Raynaud’s disease

          - Scleroderma

          - Acrocyanosis

          - Livedo reticularis

• Upper limb ischaemia pain (e.g. thromboangiitis obliterans)
• Chronic regional pain syndrome

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