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The brachial plexus is a complex network of nerves that originates from the spinal cord and is responsible for controlling both movement and sensation in the upper extremities, including the shoulders, arms, and hands. In contrast, the lumbar plexus, also known as the lumbosacral plexus, governs similar functions in the lower extremities, such as the hips, legs, and feet. Suture repair of the brachial plexus is typically indicated in cases of traumatic injuries, particularly those caused by sharp objects that penetrate the nerve tissue. During the procedure, the site of injury is surgically exposed and thoroughly explored to assess the extent of the damage. This exploration may involve debridement, which is the removal of damaged or necrotic tissue to promote healing. Intraoperative nerve function testing and monitoring may be performed as necessary to evaluate nerve integrity and function during the repair process. The actual repair of severed nerves can be accomplished using various techniques, including end-to-end closure, which is a common method for re-establishing continuity in the nerve pathway. The procedure involves careful dissection of the injured nerves from surrounding tissues, both proximal and distal to the injury site, to facilitate proper alignment and suturing of the nerve ends. The suture repair can be performed using an epineural technique, where sutures are placed in the outer layer of the nerve (the epineurium) to approximate the nerve ends without applying tension. Alternatively, a perineural closure technique may be employed, which involves exposing the individual fascicles of axons within the nerve and suturing them together based on their functional grouping. This meticulous approach ensures that the nerve's functional capabilities are preserved as much as possible. Each severed nerve in the brachial plexus is repaired individually, and the choice of technique may vary based on the specific nature of the injury and the surgeon's preference.
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The suture of the brachial plexus is indicated for specific types of nerve injuries that may result from various traumatic events. The following conditions warrant this surgical intervention:
The procedure for suturing the brachial plexus involves several critical steps to ensure effective repair of the damaged nerves. Each step is designed to facilitate optimal healing and restore nerve function:
After the suture repair of the brachial plexus, patients typically require careful monitoring and follow-up care to ensure proper healing and recovery. Post-procedure care may include pain management, physical therapy, and rehabilitation to restore function and strength in the affected upper extremity. Patients are advised to follow their surgeon's instructions regarding activity restrictions and any signs of complications that should be reported. The expected recovery time can vary based on the severity of the injury and the success of the repair, with ongoing assessments to evaluate nerve function and overall progress.
| Short Descr | REPAIR OF ARM NERVES | Medium Descr | SUTURE BRACHIAL PLEXUS | Long Descr | Suture of; brachial plexus | 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). | 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. | 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). | 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) |
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| Pre-1990 | Added | Code added. |
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