Summary & Overview
CPT 69745: Suture of Facial Nerve at Geniculate Ganglion
CPT code 69745 represents surgical repair (suture) of the facial nerve at the level of the geniculate ganglion in the middle ear, with or without nerve grafting or decompression. This microsurgical otologic procedure is clinically significant because it addresses facial nerve disruption that can cause functional and aesthetic deficits; accurate coding ensures appropriate classification of complex cranial nerve surgery for national billing and quality monitoring. Key national payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise clinical and billing context for CPT code 69745, including typical service setting and procedure scope. The publication outlines common payer coverage considerations and benchmarking focal points (where available) and summarizes policy-relevant issues that affect payment and documentation for complex facial nerve procedures. The report also provides operational guidance on where to look for additional policy details and what aspects of the procedure—such as use of operating microscope, grafting, or decompression—are most likely to influence coding complexity. Data not available in the input is noted where applicable; the narrative focuses on national implications rather than state-specific rules.
Billing Code Overview
CPT code 69745 describes suture of the facial nerve performed in the region of the geniculate ganglion within the middle ear. The procedure may be done with or without a nerve graft or nerve decompression and falls under the Surgery/Operating Microscope section of the CPT manual.
Service type: Surgical repair of cranial nerve (facial nerve) via operating microscope
Typical site of service: Hospital operating room or ambulatory surgery center, performed in the middle ear
Clinical & Coding Specifications
Clinical Context
A 45-year-old adult presents with acute onset facial paralysis and conductive hearing loss after temporal bone trauma with suspected injury to the facial nerve within the middle ear at the geniculate ganglion. Imaging (CT temporal bone and MRI) demonstrates possible nerve transection or compression at the geniculate region. The patient is taken to the operating room for exploration under an operating microscope with planned repair. Intraoperative nerve stimulation and monitoring are used. The surgeon performs microsurgical exposure of the middle ear, identifies the injured facial nerve at the geniculate ganglion, and performs primary microsurgical suture repair of the facial nerve. If a segmental defect is present, the surgeon may perform a nerve graft using a sural nerve graft. Hemostasis is achieved, tympanomeatal flap and ossicular chain are inspected, and the middle ear is closed. Postoperative care includes facial nerve function assessment, audiology evaluation, wound care, and scheduled follow-up with otolaryngology and physical therapy for facial reanimation as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for 69745, documented with rationale for increased complexity. |