01RD0JZ
Replacement Femoral Nerve to No Qualifier with Synthetic Substitute, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 1 Peripheral Nervous System |
| Operation | R Replacement |
| Body Part | D Femoral Nerve |
| Approach | 0 Open |
| Device | J Synthetic Substitute |
| Qualifier | Z No Qualifier |
Operation Definition
Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part
Procedure Overview
This family covers replacing a segment of damaged peripheral nerve with graft material or a synthetic conduit that physically takes the place of the missing nerve tissue, used when the ends of an injured nerve cannot be brought together without excessive tension. Rather than suturing torn ends directly, the surgeon bridges the gap using a nerve autograft harvested from elsewhere in the patient's body, a nerve allograft from a donor, or a manufactured nerve conduit.
This approach is chosen when trauma, tumor resection, or a prior failed repair has left a defect too large for direct reconnection, since forcing damaged nerve ends together under tension typically worsens the chance of meaningful recovery. The graft or conduit serves as a scaffold that the patient's own regenerating nerve fibers grow through over time.
Candidates for this procedure usually have a documented nerve gap measured during surgery, and the choice between autograft, allograft, or conduit depends on the gap length, the nerve involved, and the surgeon's assessment of expected regeneration.
Anatomy & Axis Detail
Femoral Nerve
The femoral nerve descends beneath the inguinal ligament to innervate the quadriceps and anterior thigh sensation, and it can be transected during pelvic trauma, hip surgery, retroperitoneal tumor resection, or iatrogenic injury from femoral vascular access. Replacement is performed when a nerve segment cannot be reapproximated directly, using a sural or other donor autograft, allograft, or conduit to span the defect and restore a pathway for axonal regeneration, which is essential for regaining knee extension and preventing buckling gait. The nerve's proximity to the femoral artery and vein in the femoral triangle requires meticulous dissection to protect these vessels during graft placement. Because quadriceps weakness from femoral nerve loss is functionally significant, timely reconstruction is emphasized, and documentation should note the graft source and the inguinal or pelvic segment reconstructed.
Approach: Open
Open approach means the surgeon cuts through skin, mucous membrane, or other tissue layers to physically expose the target site to view before performing the procedure. It gives direct visualization and hands-on access, distinguishing it from Percutaneous approaches where instruments pass through a small puncture without exposing the site. Open is typical for procedures needing wide access, such as most laparotomies.
Device: Synthetic Substitute
Synthetic Substitute designates a device made from manufactured, non-biologic material, such as mesh or prosthetic components, used to replace or augment a body part. It is distinguished from the two tissue substitute categories by its artificial composition, which carries different considerations for integration and long-term durability than biologic grafts.
Coding & Documentation
Coding requires the operative note to specify the type of graft or conduit material used and confirm that it was placed to bridge a nerve gap rather than to reinforce or wrap an otherwise intact nerve. The donor nerve, if an autograft was harvested, may be documented as a separate procedure at the harvest site.
A frequent error is coding Replacement when the material was actually laid over or around an intact nerve for support, which is more consistent with Supplement rather than Replacement. Another common mistake is overlooking the harvest-site procedure when an autograft is used, since that donor nerve excision is typically reportable in addition to the graft placement itself.