01X44Z5
Transfer Ulnar Nerve to Median 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 | 4 Ulnar Nerve |
| Approach | 4 Percutaneous Endoscopic |
| Device | Z No Device |
| Qualifier | 5 Median 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
Ulnar Nerve
Ulnar nerve transfer, often called the Oberlin procedure when a fascicle of this nerve is used as the donor, involves rerouting a portion of the ulnar nerve's redundant motor fascicles at the level of the forearm to reinnervate the biceps branch of the musculocutaneous nerve after upper brachial plexus injury. The ulnar nerve carries distinct fascicular groups serving different forearm and hand muscles, which allows a surgeon to sacrifice a small motor fascicle supplying flexor carpi ulnaris without significant functional loss while preserving the nerve's larger sensory and motor contributions to hand intrinsics. Precise intraoperative fascicle identification, sometimes with electrical stimulation, is essential to select fibers that will not compromise ulnar-innervated grip and pinch. This body part is coded for the segment used as donor tissue in the transfer.
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: Median Nerve
The Median Nerve travels through the carpal tunnel to supply thumb-side hand muscles and sensation to the thumb and adjacent fingers, and is the nerve most often affected in carpal tunnel syndrome. As a qualifier it distinguishes this nerve from the ulnar nerve, its medial-hand counterpart, and the radial nerve, which serves the dorsal forearm and hand instead.
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.