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The CPT® Code 64859 refers to the suture of each additional major peripheral nerve, which is reported separately in addition to the code for the primary procedure. This procedure is performed following the repair of the first major peripheral nerve in the arm or leg, where one or more additional nerves require surgical intervention. The suture repair of a nerve, commonly known as end-to-end closure, can be executed using various techniques depending on the location and nature of the nerve injury. For injuries located more distally, an epineural closure technique is typically employed, where the two ends of the transected nerve are exposed, and the injured nerve may be repositioned to facilitate a tension-free repair. The surrounding tissues are carefully dissected to allow for proper alignment of the nerve ends, which are then approximated using multiple sutures placed in the epineurium. This ensures that the nerve ends are brought together without tension, promoting optimal healing. In cases of more proximal injuries, a perineural closure technique may be utilized, which involves exposing the individual fascicles of axons by pulling back the epineurium. The fascicles, which are grouped based on their functional roles (sensory or motor), are identified and sutured together using a single suture through the perineurium, with additional sutures applied as necessary to maintain alignment. The closure process begins with the deeper fascicles and progresses toward the nerve surface, ensuring comprehensive repair of all structures involved. The code 64859 is specifically designated for each additional major peripheral nerve repair performed after the initial procedure, highlighting the complexity and specificity of nerve repair in surgical practice.
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The procedure associated with CPT® Code 64859 is indicated for the surgical repair of additional major peripheral nerves following the initial repair of a primary nerve. The specific indications for this procedure include:
The procedure for CPT® Code 64859 involves several detailed steps to ensure the successful repair of each additional major peripheral nerve. The following procedural steps are typically followed:
After the completion of the nerve repair procedure associated with CPT® Code 64859, post-procedure care is essential for optimal recovery. Patients may be monitored for signs of complications, such as infection or improper healing. Rehabilitation may be necessary to restore function, which could include physical therapy to improve strength and mobility in the affected area. Follow-up appointments will be scheduled to assess the healing process and ensure that the nerve is regenerating properly. The expected recovery time may vary depending on the extent of the nerve injury and the complexity of the repair, but close monitoring and adherence to rehabilitation protocols are crucial for achieving the best possible outcomes.
| Short Descr | NERVE SURGERY | Medium Descr | SUTURE EACH ADDITIONAL PERIPHERAL NERVE | Long Descr | Suture of each additional major peripheral nerve (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 2 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 64856 | MPFS Status: Active Code APC J1 ASC A2 Illustration for Code Suture of major peripheral nerve, arm or leg, except sciatic; including transposition | 64857 | MPFS Status: Active Code APC J1 ASC A2 Illustration for Code Suture of major peripheral nerve, arm or leg, except sciatic; without transposition | 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) |
| 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. | 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.) | 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 | 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) | 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. |