How To Use CPT Code 64865

CPT 64865 describes the procedure for suture of the facial nerve in the infratemporal region, with or without grafting. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 64865?

CPT 64865 can be used to describe the surgical procedure performed to repair and potentially graft the facial nerve in the infratemporal region. This procedure is typically done when the facial nerve has been damaged or severed due to trauma or the presence of a facial nerve tumor. The goal of this procedure is to restore sensory and/or motor functions of the facial nerve.

2. Official Description

The official description of CPT code 64865 is: ‘Suture of facial nerve; infratemporal, with or without grafting.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider accesses the injured facial nerve through an open wound or by making an incision in the temple area.
3. The provider identifies the specific nerve involved and carefully mobilizes the nerve ends, taking care not to disturb the blood supply.
4. If possible, the provider trims the nerve ends to expose healthy tissue, ensuring that the size of the two nerve ends align closely.
5. The provider sutures the healthy nerve ends together without creating tension.
6. If the nerve segment cannot be rejoined due to tumor resection or excessive nerve damage, the provider may graft the nerve using a cable graft or inter-positional graft.
7. To obtain the nerve graft, the provider makes an incision over the donor nerve, such as the sural nerve from the back of the calf or the great auricular nerve from the side of the neck.
8. The provider identifies and frees a segment of the donor nerve, removes the necessary length, and repairs the donor nerve by suturing the transected nerve ends together.
9. The provider then sutures the donor nerve graft to the ends of the transected facial nerve, ensuring adequate soft tissue coverage to protect the graft.
10. The provider checks for any obstructions or compression of the graft to ensure proper innervation.
11. Finally, the provider closes the wound or incision.

4. Qualifying circumstances

CPT 64865 is performed when the facial nerve in the infratemporal region requires repair and potentially grafting. This procedure is typically indicated for patients who have experienced facial nerve damage or severing due to trauma or the presence of a facial nerve tumor.

5. When to use CPT code 64865

CPT code 64865 should be used when the provider performs the suture of the facial nerve in the infratemporal region, with or without grafting. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 64865, the provider must document the following information:

• Patient’s diagnosis and the need for facial nerve repair
• Details of the procedure, including whether grafting was performed
• Specific location of the facial nerve repair (infratemporal region)
• Any additional details or complications encountered during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 64865, ensure that the procedure performed matches the description of the code. It is important to accurately document the details of the procedure to support the use of this code. There are no specific guidelines regarding reporting CPT 64865 with other codes.

8. Historical information

CPT 64865 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 undergoes a suture of the facial nerve in the infratemporal region to repair nerve damage caused by a traumatic injury.
2. A provider performs a suture of the facial nerve in the infratemporal region with grafting to restore facial nerve function in a patient with a facial nerve tumor.
3. A patient undergoes a suture of the facial nerve in the infratemporal region to repair nerve damage resulting from a surgical procedure.
4. A provider performs a suture of the facial nerve in the infratemporal region without grafting to restore facial nerve function in a patient with facial paralysis.
5. A patient undergoes a suture of the facial nerve in the infratemporal region with grafting using the sural nerve to repair nerve damage caused by a traumatic injury.
6. A provider performs a suture of the facial nerve in the infratemporal region without grafting to restore facial nerve function in a patient with Bell’s palsy.
7. A patient undergoes a suture of the facial nerve in the infratemporal region with grafting using the great auricular nerve to repair nerve damage resulting from a surgical procedure.
8. A provider performs a suture of the facial nerve in the infratemporal region without grafting to restore facial nerve function in a patient with a congenital facial nerve anomaly.
9. A patient undergoes a suture of the facial nerve in the infratemporal region with grafting to repair nerve damage caused by a facial trauma.
10. A provider performs a suture of the facial nerve in the infratemporal region without grafting to restore facial nerve function in a patient with a facial nerve infection.