2025 CPT code 64820
(Active) Effective Date: N/A Surgery - Excision Procedures on the Sympathetic Nerves Surgery Feed
Sympathectomy of digital arteries, performed with magnification, for each digit.
Modifiers may be applicable to indicate specific circumstances, such as increased procedural services (modifier 22), multiple procedures (modifier 51), or procedures performed on the left or right side (modifiers LT, RT), or specific digits. Finger and toe modifiers (e.g. F1-F9, FA, T1-T9, TA) may be applied to specify which digit(s) the procedure was performed on. Modifier 59 may be used to indicate a distinct procedural service when performing 64820 on the same day as other procedures, if appropriate.
Medical necessity for 64820 must be established by documenting the patient's condition, failed conservative treatments, and the expected improvement in pain, blood flow, or ulcer healing.
The physician is responsible for preparing the patient, providing anesthesia, making the incisions, carefully dissecting and excising the adventitial tissue containing the sympathetic nerves while preserving the digital arteries and their branches, closing the incisions, and providing post-operative care.
In simple words: This procedure helps improve blood flow and reduce pain in the fingers by removing the nerves around the arteries in each affected finger. It's done with a magnifying glass or microscope to protect the arteries.
This procedure involves the surgical removal or destruction of the sympathetic nerve fibers around the digital arteries of the fingers.It is performed under magnification (e.g., loupe magnification, operating microscope) to enhance precision. The surgeon makes an incision in the distal palm and dissects along the digital arteries to expose the adventitial tissue containing the sympathetic nerves.The adventitial tissue is carefully stripped and excised, taking care not to damage the digital arteries and their smaller branches. The procedure is performed on each affected digit to relieve pain or improve blood flow in conditions such as Raynaud's syndrome or digital ischemia.
Example 1: A patient with Raynaud's syndrome experiences severe pain and discoloration in their fingers due to vasospasm.Digital artery sympathectomy (64820) is performed on the affected digits to alleviate symptoms., A patient with digital ischemia secondary to scleroderma has painful ulcers on their fingertips.Digital artery sympathectomy (64820) is performed to improve blood flow to the affected digits and promote healing., A patient has persistent pain and limited function in their fingers following a crush injury. Digital artery sympathectomy (64820) is performed to relieve the pain and improve function by restoring blood supply.
Documentation should include the diagnosis necessitating the procedure (e.g., Raynaud's syndrome, digital ischemia), the affected digits, the use of magnification, the surgical technique employed, any intraoperative findings, and post-operative instructions.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- Payment Status: Active
- Specialties:Plastic Surgery, Hand Surgery, Vascular Surgery
- Place of Service:Ambulatory Surgical Center (ASC), Hospital Outpatient Department, Physician's Office