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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.
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:
The procedure for suturing a major peripheral nerve involves several critical steps, which are detailed as follows:
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 |
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| Pre-1990 | Added | Code added. |