01X20Z2
Transfer Phrenic Nerve to Phrenic Nerve with No Device, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 1 Peripheral Nervous System |
| Operation | X Transfer |
| Body Part | 2 Phrenic Nerve |
| Approach | 0 Open |
| Device | Z No Device |
| Qualifier | 2 Phrenic Nerve |
Operation Definition
Moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part
Procedure Overview
Transfer procedures on the peripheral nervous system move a nerve, still attached to its original blood and nerve supply at one end, to a new location so it can take over the function of a different, nonworking nerve. Nerve transfers are used after severe injuries, such as brachial plexus avulsions, when the original nerve supplying a muscle is damaged beyond repair but a healthy, less critical nerve nearby can be redirected to reinnervate that muscle instead. A common example is transferring a branch of the spinal accessory nerve to the suprascapular nerve to restore shoulder function after a brachial plexus injury.
Because the donor nerve is not cut free entirely but repositioned to connect with a different target, these procedures differ from a graft, which uses a separate, disconnected piece of tissue to bridge a gap. Transfer is chosen specifically when restoring the original damaged nerve directly is not feasible.
Anatomy & Axis Detail
Phrenic Nerve
Phrenic nerve transfer uses this nerve, which normally carries the sole motor supply to the diaphragm from cervical roots C3 through C5, as either a donor or recipient in reinnervation surgery for conditions like brachial plexus injury or, less commonly, to restore diaphragmatic function using another nerve source. Because the phrenic nerve runs along the anterior scalene muscle into the thorax and its loss causes hemidiaphragm paralysis, surgeons must weigh the respiratory consequence of harvesting it as a donor against the functional gain at the recipient site, often reserving this technique for cases with an already compromised plexus and limited alternatives. When the phrenic nerve itself is the recipient, a healthy donor nerve is coapted to restore diaphragmatic excitation. Documentation should clarify the direction of transfer and the specific segment involved given the respiratory stakes.
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.
Qualifier: Phrenic Nerve
The Phrenic Nerve, arising chiefly from cervical roots C3 through C5, provides the sole motor supply to the diaphragm and is essential to spontaneous breathing. As a qualifier it identifies this specific nerve as the procedure's target, distinguishing it from the broader cervical nerve qualifier from which it originates and from other neck structures involved in similar procedures.
Coding & Documentation
The operative note needs to name both the donor nerve being moved and the recipient nerve or muscle it is being connected to, since the body part value coded reflects the nerve being transferred, not the target. A frequent coding error is mistaking a nerve transfer for a nerve graft repair; the distinguishing detail is whether the donor nerve retains its native blood supply and proximal attachment (Transfer) or is a free segment used to bridge a gap in a different nerve (Repair or Replacement). Coders should also check whether the transferred nerve is being coapted directly to the recipient nerve or routed through a graft, which can mean an additional code is warranted.