CPT® Code 64837

Add-On Code

1. Indications

The procedure associated with CPT® Code 64837 is indicated for the repair of additional nerves in the hand or foot that have been transected or injured. This may occur due to various conditions, including traumatic injuries, lacerations, or surgical complications that necessitate nerve repair. The need for additional nerve suturing arises when multiple nerves are affected, requiring separate attention beyond the primary nerve repair procedure.

• Traumatic Injuries Injuries resulting from accidents or falls that cause nerve damage in the hand or foot.
• Lacerations Cuts or tears that sever nerves, often requiring surgical intervention for repair.
• Surgical Complications Nerve damage that may occur during surgical procedures in the hand or foot, necessitating additional repair.

2. Procedure

The procedure for suturing additional nerves in the hand or foot involves several critical steps to ensure proper repair and functionality of the nerves. Each step is essential for achieving optimal outcomes in nerve regeneration and recovery.

• Step 1: Exposure of Nerve Ends The first step involves making an incision to access the transected nerve. The surgeon carefully dissects the surrounding tissue to expose the two ends of the nerve that require suturing. This exposure is crucial for the subsequent steps of the repair process.
• Step 2: Selection of Suturing Technique Depending on the location of the injury, the surgeon will choose between an epineural closure for distal injuries or a perineural closure for proximal injuries. This decision is based on the specific characteristics of the nerve injury and the desired outcome.
• Step 3: Suturing the Nerve Ends For epineural closure, the surgeon places sutures in the epineurium of each nerve end, ensuring that the ends are approximated without tension. In the case of perineural closure, the epineurium is retracted to expose the fascicles, which are then aligned and sutured together, often requiring multiple sutures to maintain proper alignment.
• Step 4: Closure of the Surgical Site After the nerve ends are sutured, the surgeon will carefully close the incision site, ensuring that all layers of tissue are properly aligned and sutured to promote healing. This step is vital for minimizing complications and supporting recovery.

3. Post-Procedure

Post-procedure care following the suturing of additional nerves in the hand or foot is critical for successful recovery. Patients are typically monitored for signs of infection, proper healing, and nerve function. Pain management may be necessary, and physical therapy is often recommended to restore mobility and function in the affected area. Follow-up appointments are essential to assess the healing process and to ensure that the nerves are regenerating appropriately. Patients may also receive instructions on wound care and activity restrictions to promote optimal recovery.