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Official Description

Suture of posterior tibial nerve

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 64840 involves the suture repair of the posterior tibial nerve, which is a critical nerve in the lower leg responsible for sensory and motor functions in the foot and ankle. This surgical intervention is often necessary when the nerve has been transected or injured, leading to loss of function or sensation. The repair can be performed using various techniques depending on the location and severity of the injury. For distal injuries, an epineural closure technique is typically employed, where the outer layer of the nerve, known as the epineurium, is sutured to bring the two ends of the nerve together without applying tension. In cases of more proximal injuries, a perineural closure technique may be utilized, which involves exposing the individual fascicles of axons within the nerve. This method allows for a more precise alignment of the nerve fibers that are responsible for specific functions, ensuring that sensory and motor fascicles are properly approximated and sutured together. The goal of this procedure is to restore the continuity of the nerve, promote healing, and ultimately regain function in the affected areas.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The suture of the posterior tibial nerve, as described by CPT® Code 64840, is indicated for specific conditions related to nerve injury. These include:

  • Traumatic Nerve Injury - This procedure is performed when the posterior tibial nerve has been severed or significantly damaged due to trauma, such as lacerations or crush injuries.
  • Neuropathy - In cases where neuropathy has led to significant functional impairment, surgical intervention may be necessary to repair the nerve and restore function.
  • Post-Surgical Complications - If the posterior tibial nerve is inadvertently injured during surgical procedures in the lower leg or foot, repair may be required to address the resulting nerve damage.

2. Procedure

The procedure for suturing the posterior tibial nerve involves several critical steps, which are detailed as follows:

  • Step 1: Exposure of the Nerve - The surgical site is prepared, and an incision is made to access the posterior tibial nerve. The nerve is carefully exposed to allow for a clear view of the injury site.
  • Step 2: Identification of Nerve Ends - Once the nerve is exposed, the two ends of the transected nerve are identified. This is crucial for determining the appropriate technique for repair based on the location of the injury.
  • Step 3: Epineural Closure for Distal Injuries - For injuries located more distally, an epineural closure technique is performed. The epineurium of each nerve end is sutured together using several sutures, ensuring that the nerve ends are approximated without tension.
  • Step 4: Perineural Closure for Proximal Injuries - In cases of proximal injuries, a perineural closure technique is utilized. The epineurium is retracted to expose the individual fascicles of axons. Fascicles are identified based on their function (sensory or motor) and are approximated using end-to-end closure.
  • Step 5: Suturing of Fascicles - Each fascicle is sutured together with a single suture placed through the perineurium. If any rotation occurs, a second suture may be necessary to realign the fascicles properly.
  • Step 6: Layered Closure - The closure is performed by suturing the deeper fascicles first, gradually moving toward the nerve surface until all structures are repaired. This layered approach ensures that the nerve is securely closed and promotes optimal healing.
  • Step 7: Final Inspection and Closure - After the suturing is complete, the surgical site is inspected for any complications, and the incision is closed in layers to promote healing.

3. Post-Procedure

After the suture of the posterior tibial nerve, patients typically require careful monitoring and follow-up care. Post-procedure care may include pain management, physical therapy to regain function, and regular assessments to ensure proper healing of the nerve. Patients are advised to avoid activities that may strain the surgical site during the initial recovery period. The expected recovery time can vary based on the extent of the injury and the surgical technique used, but rehabilitation is crucial for restoring nerve function and minimizing complications.

Short Descr REPAIR OF LEG NERVE
Medium Descr SUTURE POSTERIOR TIBIAL NERVE
Long Descr Suture of posterior tibial nerve
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) 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 Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5E - Ambulatory procedures - other
MUE 1
CCS Clinical Classification 9 - Other OR therapeutic nervous system procedures

This is a primary code that can be used with these additional add-on codes.

64872 Addon Code MPFS Status: Active Code APC N ASC N1 Illustration for Code Suture of nerve; requiring secondary or delayed suture (List separately in addition to code for primary neurorrhaphy)
64874 Addon Code MPFS Status: Active Code APC N ASC N1 Illustration for Code Suture of nerve; requiring extensive mobilization, or transposition of nerve (List separately in addition to code for nerve suture)
64876 Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Suture of nerve; requiring shortening of bone of extremity (List separately in addition to code for nerve suture)
69990 Addon Code MPFS Status: Restricted APC N ASC N1 PUB 100 CPT Assistant Article 1Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)
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.
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
KX Requirements specified in the medical policy have been met
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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