How To Use CPT Code 64804

CPT 64804 describes a surgical procedure that involves the removal or destruction of a portion of the cervicothoracic nerve, which is part of the cervical and thoracic sympathetic nerve chains. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 64804?

CPT 64804 is a code used to describe a surgical procedure that aims to relieve pain or increase blood flow in a patient with narrowed blood vessels. The procedure involves the removal or destruction of a portion of the cervicothoracic nerve, which is part of the cervical and thoracic sympathetic nerve chains. This code is used when the procedure is performed unilaterally. If the procedure is performed bilaterally, modifier 50 should be appended to the code.

2. Official Description

The official description of CPT code 64804 is: ‘Sympathectomy, cervicothoracic (For bilateral procedure, report 64804 with modifier 50)’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the neck or chest, depending on the approach used.
3. The provider locates and identifies the sympathetic nerve chain, a vertical, thick, cord-like structure.
4. The provider carefully elevates and exposes the chain.
5. The provider identifies the cervicothoracic ganglion, also known as a stellate ganglion.
6. The provider resects the chain, being careful to avoid surrounding structures.
7. The provider divides the nerve connections to the ganglion as she dissects the chain.
8. The provider closes the incised tissue and skin incision to complete the procedure.

4. Qualifying circumstances

CPT 64804 is performed on patients who experience pain or have narrowed blood vessels that require intervention. The procedure is typically performed by a qualified healthcare professional who is experienced in performing sympathetic nerve surgeries. It is important to note that this procedure is performed unilaterally, and if performed bilaterally, modifier 50 should be appended to the code.

5. When to use CPT code 64804

CPT code 64804 should be used when a provider performs a sympathectomy on the cervicothoracic nerve to relieve pain or increase blood flow in a patient with narrowed blood vessels. It is important to ensure that the procedure is performed unilaterally and that modifier 50 is appended if performed bilaterally.

6. Documentation requirements

To support a claim for CPT 64804, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the sympathectomy
• Details of the procedure performed, including the approach used
• Whether the procedure was performed unilaterally or bilaterally (if bilateral, modifier 50 should be appended)
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 64804, ensure that the procedure is performed unilaterally. If the procedure is performed bilaterally, modifier 50 should be appended to the code. It is important to follow the specific guidelines provided by the payer regarding documentation and billing for this procedure.

8. Historical information

CPT 64804 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient with chronic pain undergoes a sympathectomy on the cervicothoracic nerve to alleviate their symptoms.
2. A patient with narrowed blood vessels undergoes a sympathectomy on the cervicothoracic nerve to improve blood flow.
3. A healthcare provider performs a unilateral sympathectomy on the cervicothoracic nerve to relieve pain in a patient with a specific diagnosis.
4. A patient with a history of narrowed blood vessels undergoes a bilateral sympathectomy on the cervicothoracic nerve to address their condition.
5. A provider performs a sympathectomy on the cervicothoracic nerve as part of a larger surgical procedure to address a patient’s medical condition.