© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 64818 refers to a lumbar sympathectomy, which is a surgical intervention targeting the sympathetic nervous system. The sympathetic nervous system is responsible for regulating involuntary bodily functions, including processes such as sweating, blushing, and salivation. In this procedure, the surgeon aims to destroy or excise specific sympathetic nerve fibers that are contributing to conditions such as hyperhidrosis of the feet, a condition characterized by excessive sweating. The lumbar sympathectomy is distinct from a thoracolumbar sympathectomy, which is performed at a higher level in the thoracic region and is typically indicated for conditions like malignant hypertension. During the lumbar sympathectomy, an incision is made in the lower abdomen, allowing access to the sympathetic chain. The procedure involves careful dissection to locate the sympathetic chain, which is then divided using electrocautery, a technique that simultaneously cuts and coagulates tissue to minimize bleeding. In some cases, a segment of the sympathetic chain may be removed entirely. The complete obliteration of the ganglia ensures that the sympathetic chain is severed, and any aberrant nerve bundles are also addressed to prevent future complications. The final step involves cauterizing the ends of the separated nerve bundles to inhibit regrowth, followed by the closure of the incision in layers to promote proper healing.
© Copyright 2025 Coding Ahead. All rights reserved.
The lumbar sympathectomy, as described by CPT® Code 64818, is primarily indicated for the treatment of hyperhidrosis of the feet. This condition is characterized by excessive sweating that can lead to significant discomfort and social embarrassment for affected individuals. The procedure may be considered when conservative treatments have failed to provide adequate relief from symptoms.
The lumbar sympathectomy procedure involves several critical steps to ensure effective treatment. Initially, the surgeon makes an incision in the lower abdomen, which provides access to the sympathetic nerve structures. Following the incision, careful dissection of the surrounding tissues is performed to expose the sympathetic chain. Once located, the sympathetic chain is divided using electrocautery, a method that allows for simultaneous cutting and coagulation of the tissue, thereby minimizing blood loss during the procedure. In some instances, the surgeon may opt to remove a segment of the sympathetic chain entirely to achieve the desired therapeutic effect. The procedure continues with the complete obliteration of the ganglia, ensuring that the sympathetic chain is thoroughly severed. Additional dissection may be necessary to identify and sever any aberrant nerve bundles that could contribute to ongoing symptoms. After the sympathetic nerve bundles are separated, the ends are cauterized to prevent any potential regrowth of nerve fibers. Finally, the incision is meticulously closed in layers to promote optimal healing and recovery.
After the lumbar sympathectomy, patients can expect a recovery period that may vary based on individual circumstances and the extent of the procedure. Post-operative care typically includes monitoring for any complications, managing pain, and ensuring proper wound healing. Patients may be advised to limit physical activity for a specified duration to facilitate recovery. Follow-up appointments are essential to assess the surgical site and evaluate the effectiveness of the procedure in alleviating symptoms of hyperhidrosis. Any concerns regarding unusual symptoms or complications should be promptly addressed with the healthcare provider.
| Short Descr | SYMPATHECTOMY LUMBAR | Medium Descr | SYMPATHECTOMY LUMBAR | Long Descr | Sympathectomy, lumbar | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
| 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). | 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2025-01-01 | Changed | Short Description changed. |
| Pre-1990 | Added | Code added. |