CPT® Code 64857

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 nature 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 repositioned to ensure that the repair can be conducted without tension. This involves dissecting the nerve from the surrounding tissues both proximal and distal to the injury site, allowing for a tension-free repair. During the repair process, multiple sutures are placed in the epineurium of each nerve end to ensure that the two ends are brought together without any tension, which is crucial for optimal healing and function. For more proximal injuries, a different approach known as perineural closure may be employed. In this technique, the epineurium of each nerve end is retracted to reveal the individual fascicles of axons. The surgeon identifies and aligns fascicles that serve similar functions, such as sensory or motor, and performs an end-to-end closure by suturing these fascicles together. A single suture is typically placed through the perineurium to secure the fascicles, and if any rotation occurs that misaligns the fascicles, a second suture may be necessary to maintain proper alignment. The closure process begins with suturing the deeper fascicles and progresses toward the surface of the nerve until all components are adequately repaired. It is important to note that for cases involving nerve transposition, a different code, 64856, should be used, while 64857 is designated for repairs conducted without nerve transposition.