01XG4ZD
Transfer Tibial Nerve to Femoral Nerve with No Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 1 Peripheral Nervous System |
| Operation | X Transfer |
| Body Part | G Tibial Nerve |
| Approach | 4 Percutaneous Endoscopic |
| Device | Z No Device |
| Qualifier | D Femoral 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
Tibial Nerve
Tibial nerve transfer involves the larger terminal branch of the sciatic nerve, which runs through the popliteal fossa and posterior compartment of the leg to supply the calf muscles responsible for plantarflexion and sensation to the sole of the foot. Transfer procedures at this level are used to restore function after peroneal nerve injury, where a branch of the tibial nerve supplying a redundant or less critical muscle, such as one head of gastrocnemius, is redirected to reinnervate the anterior compartment and restore foot dorsiflexion, correcting foot drop. The relatively short distance between donor and recipient sites in the leg favors better recovery than more proximal transfers. Precise identification of the donor branch is necessary to avoid compromising the tibial nerve's contribution to normal gait push-off.
Approach: Percutaneous Endoscopic
Percutaneous Endoscopic combines a puncture through skin or mucous membrane with insertion of an endoscope to visualize the procedure internally, as in laparoscopic cholecystectomy. It is distinguished from plain Percutaneous by the presence of scope-guided visualization, and from Via Natural or Artificial Opening Endoscopic by its route being a new puncture rather than an existing orifice or stoma.
Qualifier: Femoral Nerve
The Femoral Nerve arises from the lumbar plexus and supplies the anterior thigh muscles, including the quadriceps responsible for knee extension, along with sensation to the anteromedial thigh and leg. As a qualifier it distinguishes this nerve from the sciatic nerve, which governs the posterior thigh and leg, and from other lumbar plexus branches.
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.