CPT® Code 64804

The cervicothoracic sympathectomy, identified by CPT® Code 64804, is a surgical procedure that targets the sympathetic nervous system, which is responsible for regulating involuntary bodily functions such as sweating, blushing, and salivation. This procedure involves the destruction or excision of sympathetic nerve fibers located in the cervicothoracic region. The primary goal of a cervicothoracic sympathectomy is to alleviate conditions that are influenced by sympathetic nerve activity. During the procedure, an incision is made in either the neck or chest, allowing access to the cervical or cervicothoracic sympathetic chain. The surgical approach may require the deflation of the lung to enhance visibility of the thoracic structures, facilitating the precise identification and division of the sympathetic chain. The procedure can involve the use of electrocautery to cut and coagulate the sympathetic chain, or alternatively, a segment of the chain may be excised. Complete obliteration of the ganglia is performed to ensure that the sympathetic chain is fully severed. The specific level at which the sympathetic chain is transected is determined by the underlying condition being treated, with different levels targeted for various indications such as hyperhidrosis, thoracic outlet syndrome, reflex sympathetic dystrophy, and chronic pancreatic pain. Following the completion of the transection, the lungs are re-expanded, a chest tube is inserted, and the incision is subsequently closed, marking the conclusion of the procedure.