CPT® Code 64859

Add-On Code

The CPT® Code 64859 refers to the suture of each additional major peripheral nerve, which is reported separately in addition to the code for the primary procedure. This procedure is performed following the repair of the first major peripheral nerve in the arm or leg, where one or more additional nerves require surgical intervention. The suture repair of a nerve, commonly known as end-to-end closure, can be executed using various techniques depending on the location and nature of the nerve injury. For injuries located more distally, an epineural closure technique is typically employed, where the two ends of the transected nerve are exposed, and the injured nerve may be repositioned to facilitate a tension-free repair. The surrounding tissues are carefully dissected to allow for proper alignment of the nerve ends, which are then approximated using multiple sutures placed in the epineurium. This ensures that the nerve ends are brought together without tension, promoting optimal healing. In cases of more proximal injuries, a perineural closure technique may be utilized, which involves exposing the individual fascicles of axons by pulling back the epineurium. The fascicles, which are grouped based on their functional roles (sensory or motor), are identified and sutured together using a single suture through the perineurium, with additional sutures applied as necessary to maintain alignment. The closure process begins with the deeper fascicles and progresses toward the nerve surface, ensuring comprehensive repair of all structures involved. The code 64859 is specifically designated for each additional major peripheral nerve repair performed after the initial procedure, highlighting the complexity and specificity of nerve repair in surgical practice.