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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 nature 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 repositioned to ensure that the repair can be conducted without tension. This involves dissecting the nerve from the surrounding tissues both proximal and distal to the injury site, allowing for a tension-free repair. During the repair process, multiple sutures are placed in the epineurium of each nerve end to ensure that the two ends are brought together without any tension, which is crucial for optimal healing and function. For more proximal injuries, a different approach known as perineural closure may be employed. In this technique, the epineurium of each nerve end is retracted to reveal the individual fascicles of axons. The surgeon identifies and aligns fascicles that serve similar functions, such as sensory or motor, and performs an end-to-end closure by suturing these fascicles together. A single suture is typically placed through the perineurium to secure the fascicles, and if any rotation occurs that misaligns the fascicles, a second suture may be necessary to maintain proper alignment. The closure process begins with suturing the deeper fascicles and progresses toward the surface of the nerve until all components are adequately repaired. It is important to note that for cases involving nerve transposition, a different code, 64856, should be used, while 64857 is designated for repairs conducted without nerve transposition.
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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 transection or significant injury. These may include:
The procedure for suturing a major peripheral nerve involves several critical steps, which are detailed as follows:
After the suture repair of the major peripheral nerve, the patient will require careful monitoring and post-operative care. This may include pain management, wound care, and physical therapy to promote recovery and restore function. The expected recovery time can vary based on the extent of the injury and the specific nerve involved. Patients may experience some degree of numbness or weakness initially, but with appropriate rehabilitation, many can regain function over time. Follow-up appointments are essential to assess healing and nerve function, and any complications should be addressed promptly.
| Short Descr | REPAIR ARM/LEG NERVE | Medium Descr | SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS | Long Descr | Suture of major peripheral nerve, arm or leg, except sciatic; without 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) | 2 - Payment restriction for assistants at surgery does not apply 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. | 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 | F5 | Right hand, thumb | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | 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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