01X40Z4
Transfer Ulnar Nerve to Ulnar 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 | 4 Ulnar Nerve |
| Approach | 0 Open |
| Device | Z No Device |
| Qualifier | 4 Ulnar 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: 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: Ulnar Nerve
The Ulnar Nerve runs along the medial forearm and hand, supplying most intrinsic hand muscles and sensation to the little finger and part of the ring finger; it is the nerve responsible for the "funny bone" sensation at the elbow. As a qualifier it distinguishes this nerve from the median and radial nerves, its companions in the upper extremity, when specifying the target of a procedure.
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.