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Sympathectomy of the ulnar artery, designated by CPT® Code 64822, is a surgical procedure aimed at improving blood flow to the fingers by severing the sympathetic nerve connections associated with the ulnar artery. This procedure is particularly beneficial for patients suffering from severe ischemia, which can occur due to conditions such as Raynaud's syndrome, scleroderma, or other vascular diseases. The sympathetic nervous system plays a crucial role in regulating blood flow, and by interrupting these nerve connections, the procedure can alleviate symptoms associated with poor circulation in the digits. The technique involves careful dissection and manipulation of the ulnar artery, often utilizing an operating microscope to enhance precision and minimize damage to surrounding tissues. This procedure is part of a broader category of sympathectomies that may also include interventions on the digital arteries and the superficial palmar arch, each tailored to the specific vascular needs of the patient.
© Copyright 2025 Coding Ahead. All rights reserved.
The sympathectomy of the ulnar artery is indicated for patients experiencing severe ischemia, which may manifest as pain, numbness, or color changes in the fingers. This procedure is particularly relevant for individuals diagnosed with:
The procedure for ulnar artery sympathectomy involves several critical steps to ensure effective surgical intervention. First, the patient is positioned appropriately, and the surgical area is prepared and draped in a sterile manner. The surgeon then makes an incision at the wrist to expose the ulnar artery. This incision may vary in length but typically ranges from 1 to 4 cm, depending on the specific anatomy and the extent of the procedure required. An operating microscope is utilized to enhance visibility and precision during the dissection. Once the ulnar artery is adequately exposed, the surgeon carefully identifies the sympathetic nerve connections adjacent to the artery. These nerve connections are then meticulously divided to interrupt the sympathetic supply to the artery. Following this, the adventitia, or outer layer, of the ulnar artery is stripped away along a segment of the artery to further facilitate improved blood flow. After completing these steps, the surgeon closes the incision in layers, ensuring proper healing and minimizing the risk of complications.
Post-procedure care for patients undergoing ulnar artery sympathectomy typically involves monitoring for any immediate complications, such as bleeding or infection at the surgical site. Patients may be advised to keep the affected area elevated to reduce swelling and promote healing. Pain management is also an essential aspect of post-operative care, and patients may be prescribed analgesics as needed. Follow-up appointments are crucial to assess the success of the procedure, monitor blood flow to the digits, and evaluate the resolution of ischemic symptoms. Patients should be educated on signs of potential complications, such as changes in sensation or color in the fingers, and instructed to report any concerning symptoms promptly.
| Short Descr | SYMPATHECTOMY ULNAR ARTERY | Medium Descr | SYMPATHECTOMY ULNAR ARTERY | Long Descr | Sympathectomy; ulnar artery | 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) | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
| 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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. | 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.) | F2 | Left hand, third digit | F7 | Right hand, third 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 |
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| 2025-01-01 | Changed | Short Description changed. |
| 2002-01-01 | Added | First appearance in code book in 2002. |