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The procedure described by CPT® Code 64890 involves the surgical repair of a nerve in the hand or foot using a single strand nerve graft. This technique is employed to facilitate a tension-free repair of an 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. If necessary, any damaged tissue is carefully removed through a process known as debridement. To evaluate the function of the nerve, additional nerve testing and monitoring may be performed, which are reported separately. The surgeon then utilizes microscopic visualization to meticulously dissect the healthy proximal and distal segments of the nerve, freeing them from surrounding tissue to prepare for the grafting process. The length of the required nerve graft is determined at this stage. A single strand nerve graft is harvested from a donor site, where the donor nerve is exposed and the desired length is dissected free. After the graft is divided at both ends, it is carefully sutured end-to-end to the severed ends of the injured nerve. Finally, the overlying soft tissues and skin are repaired in layers to complete the procedure. This code is specifically used when the length of the single strand nerve graft is 4 cm or less, while a different code, CPT® 64891, is applicable for grafts exceeding this length.
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The procedure associated with CPT® Code 64890 is indicated for the repair of a nerve in the hand or foot that has sustained injury. The following conditions may warrant the use of this nerve grafting technique:
The procedure begins with the surgical exposure of the injured nerve, allowing the surgeon to evaluate the extent of the nerve damage. This assessment is critical for determining the appropriate course of action. If there is any damaged tissue surrounding the nerve, it is debrided to ensure a clean area for repair. Following this, the surgeon may perform nerve testing and monitoring, which are separately reportable, to assess the function of the nerve and guide the repair process.
After the completion of the nerve grafting procedure, post-operative care is essential for optimal recovery. Patients may be monitored for any signs of complications, such as infection or improper healing. Pain management strategies will be implemented to ensure patient comfort. Rehabilitation may be necessary to restore function and strength in the affected hand or foot, and this may include physical therapy. Follow-up appointments will be scheduled to assess the healing process and the effectiveness of the nerve repair. It is important for patients to adhere to post-operative instructions provided by their healthcare provider to facilitate a successful recovery.
| Short Descr | NRV GRF 1STRND HND/FOOT <4CM | Medium Descr | NERVE GRAFT 1 STRAND HAND/FOOT <4 CM | Long Descr | Nerve graft (includes obtaining graft), single strand, hand or foot; up to 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) | 0 - Co-surgeons not permitted for this procedure. | 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 | 2 | 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) | 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. | 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.) | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F1 | Left hand, second digit | F2 | Left hand, third digit | F3 | Left hand, fourth digit | F7 | Right hand, third digit | F8 | Right hand, fourth digit | FA | Left hand, thumb | 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 | T5 | Right foot, great toe | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2024-01-01 | Changed | Short and Medium Descriptions changed. |
| 2013-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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