How To Use CPT Code 64891

CPT 64891 describes the procedure of nerve grafting in the hand or foot, specifically when the graft is longer than 4 cm. 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 64891?

CPT 64891 can be used to describe the procedure of nerve grafting in the hand or foot when the graft is longer than 4 cm. This code is used when a healthy nerve segment is used to replace a damaged portion of a nerve, restoring sensory and/or motor functions that have been affected by injury or trauma.

2. Official Description

The official description of CPT code 64891 is: ‘Nerve graft (includes obtaining graft), single strand, hand or foot; more than 4 cm length.’

3. Procedure

1. The provider begins by appropriately prepping and anesthetizing the patient.
2. A healthy nerve graft is harvested, typically from the sural nerve in the leg, by making an incision just behind the ankle bone and extending it as needed.
3. A segment of the sural nerve that is longer than 4 cm is identified and freed.
4. The provider removes the necessary segment and places it on moist gauze.
5. The donor nerve is repaired by joining the ends of the sural nerve and suturing them together.
6. The leg incision is then closed.
7. The location over the damaged nerve is incised, and the damaged portion of the nerve is resected and removed.
8. The donor nerve graft is then sutured to the ends of the transected nerve, ensuring enough soft tissue surrounds the graft to protect it from external trauma.
9. The provider checks for any obstruction or compression of the graft to ensure proper innervation is not impaired.
10. Finally, the wound is closed.

4. Qualifying circumstances

Patients who may require CPT 64891 are those with damaged or severed nerves in the hand or foot due to injury or trauma. The procedure is performed to restore sensory and/or motor functions. The provider must use a nerve graft that is longer than 4 cm in length, typically obtained from the sural nerve in the leg.

5. When to use CPT code 64891

CPT code 64891 should be used when a nerve graft longer than 4 cm is used to replace a damaged portion of a nerve in the hand or foot. It is important to ensure that the length of the graft meets the criteria specified in the code description.

6. Documentation requirements

To support a claim for CPT 64891, the provider must document the following information:

• Patient’s diagnosis and the need for nerve grafting
• Details of the procedure, including the specific nerve graft used and its length
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 64891, ensure that the procedure meets the criteria specified in the code description. It is important to accurately document the length of the nerve graft used. Additionally, consider any specific billing guidelines provided by the payer or relevant coding guidelines.

8. Historical information

CPT 64891 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 nerve grafting in their hand to restore sensory function after a traumatic injury.
2. A provider performs nerve grafting in the foot to restore motor function following a surgical procedure.
3. A patient with a severed nerve in their hand undergoes nerve grafting to regain both sensory and motor functions.
4. A provider performs nerve grafting in the foot to restore sensation after a severe burn injury.
5. A patient with a damaged nerve in their hand undergoes nerve grafting to improve their ability to grasp and manipulate objects.
6. A provider performs nerve grafting in the foot to restore balance and coordination in a patient with a neurological disorder.
7. A patient with a severed nerve in their hand undergoes nerve grafting to regain fine motor skills.
8. A provider performs nerve grafting in the foot to restore sensation and improve walking ability in a patient with peripheral neuropathy.
9. A patient with a damaged nerve in their hand undergoes nerve grafting to improve their ability to feel and differentiate temperatures.
10. A provider performs nerve grafting in the foot to restore motor function in a patient with a nerve injury caused by repetitive stress.