© Copyright 2025 American Medical Association. All rights reserved.
Sympathectomy of the digital arteries, as described by CPT® Code 64820, is a surgical procedure aimed at improving blood flow to the fingers by targeting the sympathetic nerve connections associated with the digital arteries. This procedure is particularly relevant for patients suffering from severe ischemia, which can occur due to conditions such as Raynaud's syndrome, scleroderma, or other vascular diseases that impair blood circulation to the digits. The procedure involves making a zigzag incision at the base of the finger, which is then extended into the palm. The surgeon utilizes an operating microscope to enhance visibility and precision during the operation. The common digital artery is carefully separated from the adjacent digital nerve, and the adventitia, or outer layer of the artery, is stripped away, starting from the superficial palmar arch and continuing distally along the artery. This dissection effectively severs the sympathetic connections, which can alleviate symptoms associated with poor blood flow. After the completion of the procedure, the incisions are meticulously closed in layers to promote optimal healing. It is important to note that CPT® Code 64820 is reported for each digit on which the sympathectomy is performed, allowing for accurate coding and billing for the surgical intervention.
© Copyright 2025 Coding Ahead. All rights reserved.
Sympathectomy of the digital arteries is indicated for the following conditions:
The procedure for digital artery sympathectomy involves several key steps:
Post-procedure care for patients who have undergone digital artery sympathectomy typically includes monitoring for any signs of complications, such as infection or excessive bleeding. Patients may be advised to keep the surgical site clean and dry, and to follow specific instructions regarding activity restrictions to promote healing. Pain management may be necessary, and follow-up appointments will be scheduled to assess recovery and the effectiveness of the procedure in improving blood flow to the digits. It is essential for patients to report any unusual symptoms or concerns to their healthcare provider during the recovery period.
| Short Descr | SYMPATHECTOMY DIGITAL ARTERY | Medium Descr | SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT | Long Descr | Sympathectomy; digital arteries, each digit | 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) | 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 4 | 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). | 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. | 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. | 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.) | 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.) | F1 | Left hand, second digit | F2 | Left hand, third digit | F3 | Left hand, fourth digit | F4 | Left hand, fifth digit | F6 | Right hand, second digit | F7 | Right hand, third digit | F8 | Right hand, fourth digit | F9 | Right hand, fifth digit | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) | 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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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2002-01-01 | Changed | Code description changed. |
| 1995-01-01 | Added | First appearance in code book in 1995. |