The repair of damaged nerves, known as neurorrhaphy, requires highly specific Current Procedural Terminology (CPT) coding that depends on the technique and materials used by the surgeon. Selecting the correct code is paramount, as a minor detail, such as the type of graft material, can completely change the code used for reporting the procedure.
Identifying the Specific CPT Code
The procedure involving the repair of a single nerve with an autogenous vein graft is reported using CPT code 64890. The full description is: Suture of nerve; requiring secondary or later repair, with autogenous vein graft (single strand) for bridging of gap up to 4 cm. This code captures the complexity of a nerve repair that cannot be closed end-to-end. The use of this code is strictly limited by the length of the nerve gap bridged, which must not exceed four centimeters.
Defining the Autogenous Vein Graft Procedure
An autogenous vein graft is utilized when a segment of the nerve has been damaged or lost, creating a gap that prevents the two nerve ends from being brought together without excessive tension. This tension would impede the nerve’s ability to regenerate, leading to a poor functional outcome. The term “autogenous” indicates that the tissue used for the graft is harvested from the patient’s own body, often a non-essential vein from the forearm or leg. The harvested vein is typically inverted and used as a biological conduit to bridge the gap between the severed nerve ends, providing a protected pathway for the regenerating nerve fibers (axons) to cross the defect. This technique is classified as a secondary or later repair because it addresses a nerve injury too significant for a primary, immediate suture repair.
Accurate Reporting and Documentation Requirements
Compliant reporting of CPT code 64890 relies on meticulous documentation within the operative report. The surgeon’s notes must explicitly confirm that an autogenous vein graft was used for the neurorrhaphy. Furthermore, the report must specify the exact length of the gap bridged, confirming it does not exceed the four-centimeter limit, and clearly document that only a single nerve was repaired.
A significant coding consideration is the concept of bundling. The harvesting of the autogenous vein graft is considered an integral component of the overall procedure described by 64890. Therefore, the graft harvest procedure should not be reported separately, as its work is included within the payment for the primary neurorrhaphy code.
When the procedure is performed, anatomical modifiers are required to indicate the side of the body treated. Modifiers such as RT (Right) or LT (Left) must be appended to CPT code 64890 to specify laterality. If this nerve repair is performed with another distinct, non-related procedure during the same operative session, Modifier 59 (Distinct Procedural Service) may be necessary. If multiple nerves require a similar repair, 64890 is reported for each nerve, which may necessitate the use of Modifier 51 (Multiple Procedures) depending on payer rules.
Coding for Alternative Nerve Repair Techniques
The selection of CPT 64890 is dependent on the material and method used, which distinguishes it from other common nerve repair codes. For a simple nerve repair where the nerve ends can be brought together and sutured directly without a graft, codes from the simple suture family, such as 64831 (Suture of digital nerve, hand or foot; one nerve), would be appropriate. These codes represent a less complex procedure that does not require bridging a nerve gap.
Synthetic or Allograft Repair
If a different type of material is used to bridge the gap, the code selection changes entirely. Nerve repair using a synthetic conduit or a non-autogenous vein graft (an allograft) is reported using CPT code 64910 (Nerve repair; with synthetic conduit or vein allograft (e.g., nerve tube), each nerve). This code accounts for materials that are not harvested from the patient.
Autogenous Conduit and Extensive Grafts
When an autogenous vein conduit is used instead of a nerve graft, the code 64911 (Nerve repair; with autogenous vein graft (includes harvest of vein graft), each nerve) is used. If the nerve gap is larger than the four-centimeter limit, or if an autologous nerve graft (a segment of the patient’s own nerve) is used instead of a vein, the repair falls into a different family of codes, such as those beginning with 64885, which are specific to more extensive nerve grafting procedures.