© Copyright 2025 American Medical Association. All rights reserved.
A nerve graft procedure involves the surgical repair of a damaged nerve in the head or neck using a graft that is longer than 4 cm. This technique is employed to facilitate a tension-free repair of the injured nerve, which is crucial for restoring nerve function. The process begins with the exposure of the injured nerve, allowing the surgeon to assess the extent of the damage. Any necrotic or damaged tissue is carefully debrided to prepare the site for grafting. To evaluate the function of the nerve, additional nerve testing and monitoring may be performed, which can provide valuable information regarding the nerve's condition.
Once the injury is assessed, the healthy segments of the nerve, both proximal and distal to the injury, are meticulously dissected free from surrounding tissues. The length of the required nerve graft is then determined based on the gap that needs to be bridged. The graft is harvested from a donor nerve, which is also exposed and dissected free of surrounding tissue to obtain the desired length. After the graft is harvested, it is sutured to the ends of the severed nerve. The surgical technique for this anastomosis can vary, with options including epineural and perineural repairs. In an epineural repair, sutures are placed in the outer layer of the nerve (epineurium) to secure the graft to the nerve ends. Alternatively, a perineural closure involves identifying and suturing individual fascicles of axons, which are the functional units of the nerve. This meticulous approach ensures that the nerve is repaired in a way that maximizes the chances of restoring its function. Finally, the overlying soft tissues and skin are repaired in layers to complete the procedure.
© Copyright 2025 Coding Ahead. All rights reserved.
The nerve graft procedure is indicated for patients who have sustained nerve injuries in the head or neck region that require surgical intervention to restore function. The following conditions may warrant this procedure:
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, which allows the surgeon to evaluate the extent of the injury. Following this, any necrotic or damaged tissue is debrided to prepare the site for grafting. Next, nerve testing and monitoring may be performed to assess the function of the nerve, providing essential information for the surgical approach.
Post-procedure care is essential for optimal recovery following a nerve graft. Patients are typically monitored for signs of complications, such as infection or improper healing. Pain management strategies may be implemented to ensure patient comfort during the recovery phase. Rehabilitation may be necessary to restore function and strength to the affected area, and patients may be advised on specific exercises to promote nerve healing. Follow-up appointments are crucial to assess the success of the graft and to monitor nerve function over time.
| 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; more than 4 cm 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 | 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) | 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). | 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. | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | 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) | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Changed | Short Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 1992-01-01 | Added | First appearance in code book in 1992. |
Get instant expert-level medical coding assistance.