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A nerve graft procedure involves the surgical repair of a damaged nerve in the head or neck using a graft taken from another nerve. This technique is employed to facilitate a tension-free repair of the injured nerve, which is crucial for restoring proper nerve function. During the procedure, the surgeon first exposes the injured nerve and assesses the extent of the damage. Any necrotic or damaged tissue is debrided to prepare the site for grafting. To evaluate nerve function, additional nerve testing and monitoring may be performed, which are reported separately. The healthy segments of the nerve, both proximal and distal to the injury, are carefully dissected to free them from surrounding tissues, allowing for accurate measurement of the required graft length. Once the appropriate length is determined, the nerve graft is harvested from a donor site, which involves exposing the donor nerve and dissecting it free from surrounding tissue. The graft is then cut at both ends to prepare it for attachment. The next step involves suturing the graft to the ends of the severed nerve. This can be accomplished through various techniques, including end-to-end anastomosis. In an epineural repair, sutures are placed in the outer layer of the nerve (epineurium) at one end of the severed nerve and the graft, followed by securing the sutures to approximate the two ends. The same technique is applied to the other end of the injured nerve. Alternatively, a perineural closure technique may be utilized, where the epineurium is retracted to expose the individual fascicles of axons. These fascicles, which are responsible for specific functions such as sensory or motor activities, are identified and sutured together. The closure process is meticulous, starting with the deeper fascicles and progressing toward the surface, ensuring that all nerve structures are properly repaired. Finally, the overlying soft tissues and skin are sutured in layers to complete the procedure. This code, 64885, is specifically used when the nerve graft is 4 cm or less in length, while 64886 is designated for grafts exceeding this length.
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The nerve graft procedure is indicated for various conditions involving nerve injury in the head or neck. These may include:
The nerve graft procedure involves several critical steps to ensure successful repair of the injured nerve. The first step is the exposure of the damaged nerve, where the surgeon carefully dissects the surrounding tissues to visualize the extent of the injury. Once the injury is assessed, any necrotic or damaged tissue is debrided to prepare the site for grafting. Following this, the surgeon may perform nerve testing and monitoring to evaluate the function of the nerve, which is reported separately from the grafting procedure. Next, the healthy proximal and distal segments of the nerve are dissected free from surrounding tissues. This dissection allows the surgeon to measure the length of the required nerve graft accurately. After determining the appropriate length, the nerve graft is harvested from a donor site. The donor nerve is exposed, and the desired length is dissected free from surrounding tissue. The graft is then divided proximally and distally, allowing it to be harvested for use in the repair. Once the graft is prepared, the surgeon sutures it to the severed ends of the injured nerve. This can be accomplished using various techniques, including end-to-end anastomosis. In an epineural repair, the surgeon places several sutures in the epineurium of one end of the severed nerve and the graft, securing the sutures to approximate the two ends. The same suturing technique is applied to the other end of the injured nerve and the graft. Alternatively, a perineural closure technique may be employed. In this method, the epineurium of the graft and the severed nerve ends are retracted to expose the individual fascicles of axons. The surgeon identifies fascicles that perform similar functions, such as sensory or motor, and approximates them through end-to-end closure. Each fascicle is sutured together with a single suture placed through the perineurium, and if rotation occurs, a second suture may be necessary to maintain alignment. The closure process is performed by suturing the deeper fascicles first and then moving toward the nerve surface until all structures are repaired. In some cases, a variation of the perineural technique may be used to repair tightly grouped fascicles with several sutures to ensure proper approximation and closure. Finally, the overlying soft tissues and skin are repaired in layers to complete the procedure.
After the nerve graft procedure, patients typically require careful monitoring and follow-up care to assess the success of the repair and the recovery of nerve function. Post-operative care may include pain management, wound care, and physical therapy to promote healing and restore function. Patients are advised to avoid activities that may strain the surgical site during the initial recovery period. The expected recovery time can vary depending on the extent of the nerve injury and the individual’s overall health. Regular follow-up appointments are essential to evaluate nerve regeneration and functional recovery, and additional interventions may be necessary if complications arise.
| Short Descr | NERVE GRAFT HEAD/NECK <4 CM | Medium Descr | NERVE GRAFT HEAD/NECK < 4 CM | Long Descr | Nerve graft (includes obtaining graft), head or neck; up to 4 cm in length | 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 | 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.
| 64901 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Nerve graft, each additional nerve; single strand (List separately in addition to code for primary procedure) | 64902 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Nerve graft, each additional nerve; multiple strands (cable) (List separately in addition to code for primary procedure) | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure 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 | 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) | SG | Ambulatory surgical center (asc) facility service | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2025-01-01 | Changed | Medium Description punctuation changed. |
| 2024-01-01 | Changed | Short and Medium Descriptions changed. |
| 2013-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Short description changed. |
| 1992-01-01 | Added | First appearance in code book in 1992. |
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