⚕️ICD-10 CM 64822 - Suture of digital nerve, hand or foot; 1 nerve

Code Description

ICD-10 CM 64822 represents Suture of digital nerve, hand or foot; 1 nerve. This surgical procedure involves the microsurgical repair of a single digital nerve in either the hand or foot through direct suture of the severed nerve ends. This procedure is typically performed to restore sensory function following traumatic nerve injury.^{AMA CPT}

Clinical Overview

Digital nerve injuries commonly occur from lacerations, crush injuries, or penetrating trauma to the fingers or toes. When a digital nerve is severed, patients experience loss of sensation (anesthesia) in the distribution of that nerve. Surgical repair involves identifying the nerve ends, trimming damaged tissue, and suturing the epineurium (outer nerve sheath) under magnification. Optimal timing for repair is typically within 72 hours of injury, though delayed repairs are possible. Recovery of sensation may take months and is often incomplete.^ASSH

Coding Hierarchy (Code Tree)

This code exists within the following hierarchy in the CPT structure:

Section: Surgery
- Subsection: Nervous System
  - Section: Somatic Nerves
    - Subsection: Repair, Suture
      - Category: Nerves of Hand or Foot
        
        Code: Suture of digital nerve, hand or foot; 1 nerve (64822)

Official Coding Guidelines & Notes

Includes

This code includes procedures specified as:

Primary repair of one digital nerve
Direct end-to-end neurorrhaphy of digital nerve
Epineurial suture of single digital nerve in hand or foot^{AMA CPT}

Bundling & Component Services

Note: Certain services are bundled into 64822 and should not be reported separately.

Microscope Use: If operating microscope is used and not inherent, 69990 may be reported separately if allowed by payer.^NCCI
Local Anesthesia: Included in the surgical package.
Simple Debridement: Minor wound preparation is included.
Postoperative Care: Routine follow-up care is included in the global period.^{CMS MPFS}

Excludes

Note: Do not use 64822 for these conditions/procedures.

Multiple Nerves: If 2 or more digital nerves are repaired, use 64823 (Suture of 2 digital nerves, hand or foot).
Nerve Graft: If a nerve graft is required to bridge the gap, use 64824 or 64825.
Nerve Transposition: If nerve is transposed, use appropriate transposition codes.
Upper Arm/Forearm Nerves: Nerves of the upper arm or forearm have separate codes (64821, 64827).
Neuroplasty: If only nerve decompression is performed without suture, use neuroplasty codes (64702-64704).^{AMA CPT}

Coding Tips

Laterality: Always document and code the specific digit and laterality (right vs. left).
Number of Nerves: Count each digital nerve repaired separately. Use 64823 for 2 nerves, or 64822 with modifier -51 for multiple single nerve repairs at different sites (check payer policy).
Nerve Gap: If there is a gap requiring graft, do not use 64822; use nerve graft codes.
Diagnosis Link: Link to the appropriate injury code from Chapter 19 (Injury, poisoning and certain other consequences of external causes).^{Coding Clinic}
Global Period: This code typically has a 90-day global period; routine postoperative care is bundled.^{CMS MPFS}

Reimbursement & Risk Adjustment

HCC (Hierarchical Condition Category)

Status: N/A
Reason: HCC models apply to ICD-10-CM diagnosis codes, not CPT procedure codes. However, the diagnosis driving this procedure (e.g., S64.00XA) may be HCC eligible.^{CMS Risk Adjustment}

wRVU (Work Relative Value Unit)

Value: Yes (Variable)
Reason: 64822 is assigned a wRVU under the Medicare Physician Fee Schedule (MPFS). The exact value varies annually and by facility vs. non-facility setting.^{CMS MPFS}
Impact: Determines physician reimbursement relative to other services. Typically carries moderate wRVU due to microsurgical complexity.

Assistant Surgeon Payable

Status: Yes
Reason: This code typically allows for an assistant surgeon (modifiers -80, -81, -82) if medically necessary and permitted by payer policy, given the microsurgical nature of the procedure.^{CMS MPFS}

MS-DRG Applicability: No (Inpatient Facility)
Reason: Inpatient hospital reimbursement uses ICD-10-PCS for procedure coding, not CPT. CPT is used for physician billing.
APC Applicability: Yes (Outpatient Facility)
Impact: For outpatient hospital reimbursement, this code maps to an Ambulatory Payment Classification (APC) under OPPS. It typically falls under Neurosurgery/Peripheral Nerve Procedures.^{CMS OPPS}

Coding Examples

Example 1: Single Digital Nerve Laceration

Scenario: A patient sustains a glass laceration to the right index finger with complete transection of the radial digital nerve. Surgeon performs primary neurorrhaphy.

Primary Procedure: 64822 (Suture of digital nerve, hand or foot; 1 nerve)
Diagnosis: S64.00XA (Injury of unspecified digital nerve of right hand, initial encounter)
Diagnosis: S61.210A (Laceration without foreign body of right index finger with damage to nail, initial encounter)
Note: Specify the exact digit and nerve in documentation.^{Coding Clinic}

Example 2: Multiple Digital Nerve Repairs

Scenario: Patient has lacerations to two adjacent fingers with digital nerve injuries to both.

Primary Procedure: 64823 (Suture of digital nerve, hand or foot; 2 nerves)
Diagnosis: S64.00XA (Injury of unspecified digital nerve of right hand, initial encounter)
Diagnosis: S64.01XA (Injury of digital nerve of right index finger, initial encounter)
Note: Use 64823 for 2 nerves rather than 2 units of 64822.^{AMA CPT}

Example 3: Nerve Repair with Microscope

Scenario: Surgeon performs digital nerve repair using operating microscope for enhanced visualization.

Primary Procedure: 64822 (Suture of digital nerve, hand or foot; 1 nerve)
Add-on Procedure: 69990 (Microsurgical techniques, requiring use of operating microscope)
Diagnosis: S64.02XA (Injury of digital nerve of right middle finger, initial encounter)
Note: Verify payer allows 69990 with 64822; some consider microscope inherent.^NCCI

Example 4: Delayed Repair with Graft

Scenario: Patient presents 3 weeks after injury with nerve gap requiring sural nerve graft.

Primary Procedure: 64824 (Suture of digital nerve, hand or foot; requiring graft, 1 nerve)
Diagnosis: S64.00XD (Injury of unspecified digital nerve of right hand, subsequent encounter)
Note: Do not use 64822 when graft is required.^{AMA CPT}

Common modifiers applicable to 64822:

-50: Bilateral Procedure (if same nerve repaired on both hands/feet during same session).
-51: Multiple Procedures (if multiple distinct nerve repairs performed).
-59: Distinct Procedural Service (if performed with other procedures at different sites).
-76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional.
-77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional.
-78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period.
-79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period.
-80: Assistant Surgeon.
-81: Minimum Assistant Surgeon.
-82: Assistant Surgeon (when qualified resident surgeon not available).
-RT: Right Side.
-LT: Left Side.^{AMA CPT}

Sources

^{AMA CPT} American Medical Association, CPT Professional Edition. ^ASSH American Society for Surgery of the Hand, Nerve Injury and Repair Resources. ^NCCI CMS National Correct Coding Initiative Policy Manual. ^{Coding Clinic} AHA Coding Clinic for CPT. ^{CMS Risk Adjustment} CMS Medicare Advantage Risk Adjustment Data Processing System. ^{CMS MPFS} CMS Medicare Physician Fee Schedule. ^{CMS OPPS} CMS Outpatient Prospective Payment System.

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64822