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Internal neurolysis, as described by CPT® Code 64727, is a surgical procedure aimed at addressing issues such as scarring and swelling that occur within the outer nerve sheath. This procedure is typically performed in conjunction with a neuroplasty, which involves the incision of the outer nerve sheath using an operating microscope to enhance visualization of the nerve structure. The primary goal of internal neurolysis is to alleviate nerve compression and improve blood flow to the affected nerve. During the procedure, the surgeon inspects the nerve for any signs of swelling. If swelling is present, simply opening the outer sheath can relieve the pressure on the nerve. In cases where scar tissue is identified within the outer sheath, the surgeon meticulously dissects this tissue to restore normal function. It is important to note that the outer sheath is intentionally left open following the procedure to facilitate healing and further reduce the risk of nerve compression.
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The procedure of internal neurolysis (CPT® Code 64727) is indicated for specific conditions related to nerve dysfunction. These include:
The internal neurolysis procedure involves several critical steps, which are detailed as follows:
Following the internal neurolysis procedure, patients are typically monitored for any immediate complications. Post-procedure care may include pain management and instructions for activity restrictions to promote healing. Patients are advised on signs of infection or complications to watch for as they recover. Follow-up appointments are essential to assess the healing process and the effectiveness of the procedure in relieving symptoms associated with nerve compression.
| Short Descr | INTERNAL NERVE REVISION | Medium Descr | INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE | Long Descr | Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 2 | CCS Clinical Classification | 6 - Decompression peripheral nerve |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 64702 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Neuroplasty; digital, 1 or both, same digit | 64704 | MPFS Status: Active Code APC J1 ASC A2 Neuroplasty; nerve of hand or foot | 64708 | MPFS Status: Active Code APC J1 ASC G2 Neuroplasty, major peripheral nerve, arm or leg, open; other than specified | 64712 | MPFS Status: Active Code APC J1 ASC G2 Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve | 64713 | MPFS Status: Active Code APC J1 ASC G2 Neuroplasty, major peripheral nerve, arm or leg, open; brachial plexus | 64714 | MPFS Status: Active Code APC J1 ASC G2 CPT Assistant Article Illustration for Code Neuroplasty, major peripheral nerve, arm or leg, open; lumbar plexus | 64716 | MPFS Status: Active Code APC J1 ASC A2 Neuroplasty and/or transposition; cranial nerve (specify) | 64718 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Neuroplasty and/or transposition; ulnar nerve at elbow | 64719 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Neuroplasty and/or transposition; ulnar nerve at wrist | 64721 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Neuroplasty and/or transposition; median nerve at carpal tunnel | 64722 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Decompression; unspecified nerve(s) (specify) | 64726 | MPFS Status: Active Code APC J1 ASC A2 CPT Assistant Article Decompression; plantar digital nerve | CCCCC | 1 |
| RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F1 | Left hand, second digit | F2 | Left hand, third digit | FA | Left hand, thumb | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | SG | Ambulatory surgical center (asc) facility service | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| Pre-1990 | Added | Code added. |
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