Summary & Overview
CPT 64862: Lumbar Plexus Repair
CPT code 64862 represents surgical repair of the lumbar plexus, a targeted nerve reconstruction procedure performed to address nerve injury from trauma, lesions, infection, or other causes. This procedure is clinically significant because lumbar plexus injuries can produce major motor and sensory deficits affecting ambulation, bowel/bladder function, and quality of life; appropriate coding supports accurate clinical documentation and payer adjudication nationally.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of clinical context and coding intent for 64862, typical settings where the service occurs, and what to expect in payer coverage considerations. The publication summarizes benchmarks and common modifiers used with complex surgical nerve-repair procedures, and outlines policy and billing topics relevant to facilities and surgical specialists.
The analysis helps billing managers, surgical teams, and revenue cycle stakeholders understand how 64862 fits into the broader landscape of peripheral nerve surgery coding, the clinical rationale for use, and the administrative elements that commonly accompany lumbar plexus repair claims. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 64862 describes surgical repair of the lumbar plexus, addressing damage caused by trauma, lesions, infection, or other pathological conditions. The procedure involves identification and reconstruction of injured nerve elements within the lumbar plexus to restore or preserve neurological function.
Service type: Surgical nerve repair and reconstruction
Typical site of service: Hospital operating room or specialized surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 35–65-year-old adult presenting after blunt force trauma to the abdomen or pelvis, a penetrating injury, or iatrogenic injury during retroperitoneal surgery who has signs of lower-extremity motor weakness, sensory deficits, or radiating pain consistent with lumbar plexus involvement. Initial evaluation includes focused neurologic and vascular exam, CT or MRI to assess hematoma, fracture, or mass effect, and electromyography/nerve conduction studies when timing permits. Indications for surgical repair include identifiable nerve disruption, entrapment by scar or hematoma, or contaminated wounds requiring debridement with concurrent nerve reconstruction.
The operative workflow typically involves preoperative localization using imaging, general anesthesia, possible intraoperative neuromonitoring, exploration of the retroperitoneal space or pelvic brim, identification of injured lumbar plexus elements (e.g., femoral, obturator, lateral femoral cutaneous branches), neurolysis or primary repair with microsutures, or grafting when necessary. Postoperative care includes pain control, physical therapy, wound surveillance, and follow-up EMG to document recovery or need for further intervention.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or time is substantially greater than typical for repair of the lumbar plexus. |