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The procedure described by CPT® Code 64865 involves the surgical suture of the facial nerve, specifically targeting the infratemporal portion. The facial nerve, known as cranial nerve VII (CN VII), is essential for facial expression and also contains fibers responsible for sensory and secretomotor functions. This procedure is a continuation of the repair process initiated in CPT® Code 64864, which focuses on the extracranial segment of the facial nerve. The infratemporal portion of the facial nerve is located deeper within the skull and is critical for the proper functioning of facial muscles. During the procedure, the surgeon exposes the affected nerve to assess the extent of the injury, which may involve debridement of damaged tissue. Intraoperative nerve function testing may be performed to evaluate nerve integrity. The repair can be executed using various techniques, including end-to-end closure, which involves approximating the two ends of the transected nerve. If necessary, a nerve graft may be utilized to ensure a tension-free connection between the nerve ends, typically using donor nerves such as the great auricular nerve or sural nerve. The meticulous approach to suturing the nerve is crucial for restoring function and minimizing complications, ensuring that the nerve is repaired effectively to facilitate recovery and restore facial movement.
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The procedure coded under CPT® 64865 is indicated for the surgical repair of the infratemporal portion of the facial nerve, which may be necessary due to various conditions that result in nerve injury. These indications include:
The procedure for CPT® 64865 involves several critical steps to ensure the effective repair of the infratemporal portion of the facial nerve:
Post-procedure care following the suture of the infratemporal facial nerve includes monitoring for signs of nerve function recovery and potential complications. Patients may require follow-up appointments to assess the healing process and the restoration of facial movement. Pain management and wound care instructions are provided to facilitate recovery. Rehabilitation may also be recommended to help restore function and improve outcomes following the surgical repair.
| Short Descr | REPAIR OF FACIAL NERVE | Medium Descr | SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT | Long Descr | Suture of facial nerve; infratemporal, with or without grafting | 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 | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | 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. | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. |
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