0 code page views remaining today. Guest accounts are limited to 2 daily page views. Register free account to get more views.
Log in Register free account

Official Description

Suture of major peripheral nerve, arm or leg, except sciatic; including transposition

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Suture repair of a major peripheral nerve in the arm or leg, excluding the sciatic nerve, is a surgical procedure aimed at restoring the continuity of a damaged nerve. This procedure, also known as end-to-end closure, can be performed using various techniques depending on the location and severity of the nerve injury. In cases of more distal injuries, an epineural closure technique may be utilized, where the two ends of the transected nerve are carefully exposed. Prior to the actual repair, the injured nerve may be transposed to a new position to facilitate a tension-free repair. This involves dissecting the nerve from the surrounding tissues both proximal and distal to the injury site, allowing for rerouting as necessary. The repair itself involves placing several sutures in the epineurium of each nerve end, ensuring that the ends are approximated without tension. For more proximal injuries, a perineural closure technique is often employed. This method involves exposing the individual fascicles of axons by pulling back the epineurium of each nerve end. The fascicles, which are bundles of axons that perform similar functions (either sensory or motor), are identified and approximated through end-to-end closure. Sutures are then placed through the perineurium to secure the fascicles together, with additional sutures applied if any rotation occurs that misaligns the fascicles. The closure process begins with suturing the deeper fascicles first, progressing toward the nerve surface until all structures are adequately repaired. A variation of the perineural technique may involve repairing tightly grouped fascicles using multiple sutures to ensure proper approximation and closure of the entire group. This procedure is coded as 64856 when nerve transposition is involved, while 64857 is used for nerve repair without transposition.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The suture of a major peripheral nerve in the arm or leg, excluding the sciatic nerve, is indicated for various conditions that result in nerve injury. These may include:

  • Traumatic Nerve Injury - Damage to the nerve due to trauma, such as lacerations or crush injuries.
  • Peripheral Neuropathy - Conditions that lead to nerve damage, necessitating surgical intervention for repair.
  • Compression Syndromes - Situations where nerves are compressed, leading to dysfunction that may require surgical repair.
  • Post-Surgical Complications - Nerve injuries that may occur as a complication of previous surgical procedures in the arm or leg.

2. Procedure

The procedure for suturing a major peripheral nerve involves several critical steps, which are detailed as follows:

  • Step 1: Exposure of the Nerve - The first step involves making an incision to expose the two ends of the transected nerve. This is crucial for accessing the damaged area and preparing for repair.
  • Step 2: Nerve Transposition (if applicable) - If the injury is more distal, the nerve may be transposed to a new position. This involves dissecting the nerve from surrounding tissues both proximal and distal to the injury site, allowing for a tension-free repair.
  • Step 3: Epineural Closure (for distal injuries) - In cases of distal injuries, the repair is performed by placing several sutures in the epineurium of each of the two nerve ends. The sutures are strategically placed to approximate the nerve ends without creating tension.
  • Step 4: Perineural Closure (for proximal injuries) - For more proximal injuries, the epineurium of each nerve end is pulled back to expose the individual fascicles of axons. The fascicles are identified based on their function (sensory or motor) and are approximated through end-to-end closure.
  • Step 5: Suturing of Fascicles - A single suture is placed through the perineurium to secure the fascicles together. If any rotation occurs that misaligns the fascicles, a second suture may be required to maintain proper alignment.
  • Step 6: Closure of the Nerve - The closure process begins with suturing the deeper fascicles first, gradually moving toward the nerve surface until all structures are repaired. In some cases, multiple sutures may be used to repair tightly grouped fascicles.

3. Post-Procedure

After the procedure, post-operative care is essential for optimal recovery. Patients may be monitored for signs of nerve function restoration, and pain management strategies will be implemented. Rehabilitation may be necessary to regain strength and function in the affected limb. Follow-up appointments will be scheduled to assess healing and nerve recovery, ensuring that any complications are addressed promptly. It is important to provide the patient with instructions regarding activity restrictions and signs of potential complications that should prompt immediate medical attention.

Short Descr REPAIR/TRANSPOSE NERVE
Medium Descr SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS
Long Descr Suture of major peripheral nerve, arm or leg, except sciatic; including transposition
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) 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 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 2
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.

0882T New Code for 2024 Add on code MPFS Status: Carrier Priced APC N ASC N1 Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; initial nerve (List separately in addition to code for primary procedure)
64859 Addon Code MPFS Status: Active Code APC N ASC N1 Suture of each additional major peripheral nerve (List separately in addition to code for primary procedure)
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)
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
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.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
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.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GC This service has been performed in part by a resident under the direction of a teaching physician
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
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)
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
Date
Action
Notes
Pre-1990 Added Code added.
Code
Description
Code
Description
Code
Description
Code
Description
Code
Description