CPT® Code 64856

Suture repair of a major peripheral nerve in the arm or leg, excluding the sciatic nerve, is a surgical procedure aimed at restoring the continuity of a damaged nerve. This procedure, also known as end-to-end closure, can be performed using various techniques depending on the location and severity of the nerve injury. In cases of more distal injuries, an epineural closure technique may be utilized, where the two ends of the transected nerve are carefully exposed. Prior to the actual repair, the injured nerve may be transposed to a new position to facilitate a tension-free repair. This involves dissecting the nerve from the surrounding tissues both proximal and distal to the injury site, allowing for rerouting as necessary. The repair itself involves placing several sutures in the epineurium of each nerve end, ensuring that the ends are approximated without tension. For more proximal injuries, a perineural closure technique is often employed. This method involves exposing the individual fascicles of axons by pulling back the epineurium of each nerve end. The fascicles, which are bundles of axons that perform similar functions (either sensory or motor), are identified and approximated through end-to-end closure. Sutures are then placed through the perineurium to secure the fascicles together, with additional sutures applied if any rotation occurs that misaligns the fascicles. The closure process begins with suturing the deeper fascicles first, progressing toward the nerve surface until all structures are adequately repaired. A variation of the perineural technique may involve repairing tightly grouped fascicles using multiple sutures to ensure proper approximation and closure of the entire group. This procedure is coded as 64856 when nerve transposition is involved, while 64857 is used for nerve repair without transposition.