Neurosurgery Coding Alert

Question: Are all nerve pedicle transfers considered Oberlin procedures? Georgia Subscriber Answer: Not all nerve pedicle transfers are considered Oberlin procedures. Sometimes, a nerve pedicle transfer is done to restore axon growth, rather than to "bypass" an injured or avulsed nerve. The physician conducts these nerve pedicle transfers in two stages, the first of which is similar to the Oberlin procedure (although it can occur at different sites). In the second stage, the neurosurgeon re-opens the incision and reverses the process (after reinervation is complete) by removing the donor nerve from the recipient and reanastomosing it to its distal end, as the distal end of the recipient nerve is reanastomosed to its proximal end. Coding: When the neurosurgeon performs a nerve pedicle transfer to restore axon growth, you should: - report 64905 (Nerve pedicle transfer; first stage) and +64727 (Internal neurolysis, requiring use of operating microscope [List separately in addition to code for neuroplasty] [Neuroplasty includes external neurolysis]) for the first stage of the procedure - report 64907 ( ... second stage) for the second stage pedicle transfer - attach modifier 58 (Staged or related procedure or service by the same physician during the postoperatve period) to 64907 if the physician performs it during the global period of the first stage - report +64727 for the second stage--- if the surgeon conducts an internal neurolysis via microscope during the session.