CPT® Code 64818

The procedure described by CPT® Code 64818 refers to a lumbar sympathectomy, which is a surgical intervention targeting the sympathetic nervous system. The sympathetic nervous system is responsible for regulating involuntary bodily functions, including processes such as sweating, blushing, and salivation. In this procedure, the surgeon aims to destroy or excise specific sympathetic nerve fibers that are contributing to conditions such as hyperhidrosis of the feet, a condition characterized by excessive sweating. The lumbar sympathectomy is distinct from a thoracolumbar sympathectomy, which is performed at a higher level in the thoracic region and is typically indicated for conditions like malignant hypertension. During the lumbar sympathectomy, an incision is made in the lower abdomen, allowing access to the sympathetic chain. The procedure involves careful dissection to locate the sympathetic chain, which is then divided using electrocautery, a technique that simultaneously cuts and coagulates tissue to minimize bleeding. In some cases, a segment of the sympathetic chain may be removed entirely. The complete obliteration of the ganglia ensures that the sympathetic chain is severed, and any aberrant nerve bundles are also addressed to prevent future complications. The final step involves cauterizing the ends of the separated nerve bundles to inhibit regrowth, followed by the closure of the incision in layers to promote proper healing.