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The procedure described by CPT® Code 64858 refers to the suture repair of the sciatic nerve, which is a critical nerve in the human body responsible for motor and sensory functions in the lower limb. This surgical intervention, also known as end-to-end closure, is performed when the sciatic nerve has been transected or injured. The repair can be executed using various techniques depending on the location and severity of the injury. For injuries that are more distal, an epineural closure technique is typically employed, where the two ends of the damaged nerve are carefully exposed. In this method, the injured nerve may be repositioned to ensure a tension-free repair. The surgeon meticulously dissects the nerve from the surrounding tissues both proximal and distal to the injury site, allowing for proper alignment during the suturing process. In contrast, for more proximal injuries, a perineural closure technique is utilized. This involves exposing the epineurium of the nerve ends and pulling it back to reveal the individual fascicles, which are bundles of axons that perform specific functions, such as sensory or motor activities. The surgeon identifies and aligns these fascicles for end-to-end closure, ensuring that they are sutured together effectively. The suturing process is performed in a manner that prioritizes the deeper fascicles first, gradually moving towards the surface of the nerve until all structures are securely repaired. This meticulous approach is essential for restoring the nerve's functionality and promoting optimal healing. After the nerve repair is completed, the surrounding soft tissues and skin are closed in layers to facilitate recovery and protect the surgical site.
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The suture of the sciatic nerve, as described by CPT® Code 64858, is indicated for specific conditions and injuries that compromise the integrity of the nerve. These indications include:
The procedure for suturing the sciatic nerve involves several critical steps, which are detailed as follows:
Following the suture repair of the sciatic nerve, post-procedure care is critical for ensuring proper recovery. Patients may be monitored for signs of nerve function restoration, which can include improvements in sensation and motor function in the lower limb. Pain management strategies will be implemented to address any discomfort following the surgery. Rehabilitation may be recommended to facilitate recovery and restore function, which could include physical therapy focused on strengthening and mobility exercises. Additionally, patients should be advised on wound care to prevent infection and ensure proper healing of the surgical site. Regular follow-up appointments will be necessary to assess the healing process and the effectiveness of the nerve repair.
| Short Descr | REPAIR SCIATIC NERVE | Medium Descr | SUTURE SCIATIC NERVE | Long Descr | Suture of sciatic 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) | 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) | P1G - Major procedure - 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) |
| 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). | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) | 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. |
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