CPT® Code 88362

1. Indications

The nerve teasing preparation procedure is indicated for a variety of conditions that affect peripheral nerves. These include:

• Demyelinating diseases - Conditions that result in the loss of the myelin sheath surrounding nerve fibers, leading to impaired nerve function.
• Peripheral nerve vasculitis - Inflammation of the blood vessels supplying the peripheral nerves, which can lead to nerve damage.
• Inflammatory demyelinating polyneuropathies - A group of disorders characterized by inflammation and demyelination of peripheral nerves.
• Leprous neuropathy - Nerve damage caused by the infection with Mycobacterium leprae, leading to sensory and motor deficits.
• Amyloid neuropathy - Nerve damage due to the deposition of amyloid proteins, which can disrupt normal nerve function.
• Hereditary neuropathies - Genetic conditions that lead to peripheral nerve damage, often affecting the myelin sheath.
• Sarcoid neuropathies - Nerve damage associated with sarcoidosis, an inflammatory disease that can affect multiple organs, including the nervous system.

2. Procedure

The nerve teasing preparation involves several detailed procedural steps to ensure accurate pathological evaluation. These steps include:

• Step 1: Biopsy Collection - A segment of peripheral nerve is obtained through a separately reportable biopsy procedure. This may involve the sural nerve, superficial peroneal sensory nerve, or other peripheral nerves, depending on the clinical indication.
• Step 2: Staining and Suspension - The collected nerve segment is stained to enhance visibility under a microscope. It is then suspended in glycerin, which helps preserve the nerve fibers during the preparation process.
• Step 3: Slide Preparation - The stained nerve is placed on a glass slide that has an adhesive surface. This allows the nerve fibers to adhere to the slide for further manipulation.
• Step 4: Fiber Separation - Using fine forceps and a stereomicroscope, the technician carefully separates the nerve into small bundles of fibers. This step requires precision to avoid damaging the delicate nerve structures.
• Step 5: Isolation of Single Fibers - Individual nerve fibers are isolated in a proximodistal orientation, which is crucial for the subsequent evaluation of the fibers' characteristics.
• Step 6: Drying and Mounting - After the fibers are isolated, the slide is allowed to dry. Once dry, it is mounted with a glycerin-gelatin cover, which protects the fibers and preserves them for examination.

3. Post-Procedure

After the nerve teasing preparation is completed, the slide can be viewed under a microscope, allowing pathologists to document their findings through photographs of the fibers. The expected outcome is a detailed evaluation of the distribution of myelinated fibers, the lengths of these fibers, the staining of Schwann cells, and any abnormalities present in the myelin and axons. This information is critical for diagnosing various neuropathies and guiding further clinical management. There are no specific post-procedure care instructions mentioned, but it is essential to handle the prepared slides with care to maintain the integrity of the nerve fibers for accurate analysis.