Summary & Overview
CPT 64858: Repair of Sciatic Nerve
CPT code 64858 denotes surgical repair of the sciatic nerve, a specialized operative intervention to restore continuity or function after traumatic injury, lesions, infection, or related causes. This code is important nationally because sciatic nerve injuries can produce significant morbidity — including pain, motor deficits, and loss of function — and surgical repair decisions affect patient outcomes and resource use. Key payers covered in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find clinical context for when sciatic nerve repair is billed, an overview of expected sites of service and service type, and payer coverage considerations. The publication outlines benchmarks and utilization patterns where available, summarizes relevant policy elements affecting payment and medical necessity determinations, and highlights coding and billing considerations specific to operative peripheral nerve repair. The material is intended for billing professionals, surgical teams, and policy analysts seeking a concise reference on CPT code 64858 within a national payer landscape. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 64858 describes repair of the sciatic nerve, addressing damage caused by trauma, lesions, infection, or other conditions. The procedure involves surgical restoration of continuity or function of the sciatic nerve when structural injury has occurred.
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Service type: Surgical nerve repair
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Typical site of service: Hospital operating room or specialized surgical center
Clinical & Coding Specifications
Clinical Context
A 36-year-old male construction worker presents with severe left lower-extremity pain, paresthesia, and weakness after a high-velocity crush injury to the posterior thigh. Imaging and physical exam localize a transection of the sciatic nerve in the mid-thigh with loss of ankle dorsiflexion and plantarflexion strength and absent Achilles reflex. The patient is scheduled for operative exploration and primary repair of the sciatic nerve under general anesthesia.
Preoperative workflow includes focused neurologic and vascular assessment, informed consent discussing risks of persistent deficit, and receipt of pre-op imaging (MRI or ultrasound) to localize the lesion. Intraoperative steps include exposure of the nerve, debridement of nonviable nerve ends, tension-free end-to-end repair or interposition nerve grafting if necessary, and layered wound closure. Postoperative workflow includes pain control, immobilization as indicated, outpatient physical therapy, serial neurologic exams, and documentation of motor and sensory status for follow-up billing and disability assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and complexity substantially exceed typical for 64858 (document justification). |