My surgeons are starting to perform AIN to Ulnar nerve transfer more often and we are trying to determine the most appropriate coding. 64905 states a first stage nerve transfer, however we are not doing staged work, we are doing a permanent transfer. 64718 includes transposition but does it include fully anastomosing the two nerves together? 64856/7 is being considered since the nerves are being sutured together, but these feels more like a traumatic nerve injury repair. See below for an example of the a surgery report.
Attention was now directed to the nerve transfer. I extended the existing incision in curvilinear fashion up the forearm, traced out the ulnar neurovascular bundled proximally. The flexors were identified, lysed from the surrounding tissues and retracted in a radial direction to expose the pronator quadratus. Neurovascular bundle entering the PQ was identified. This was protected with blunt instrument as the overlying muscle was freed away with the bipolar forceps. The anterior interosseous nerve was now divided at its branch point and transposed in the direction of the ulnar nerve. Here, we identified the deep motor branch distally, traced that back under careful loupe magnification proximally to a point where the anterior interosseous nerve could be brought up in a supercharged fashion into that motor branch under absolutely no tension. The sidewall of the motor branch was incised. The anterior interosseous nerve was transposed and was secured with an epineurium to epineurium repair with a total of four 9-0 nylon sutures under magnified vision. The nerve was now allowed to re-drape as were the flexor muscles.
This particular surgery was done at the time of a cubital tunnel release, but we are doing them on their own. Any help with coding would be greatly appreciated.
Thank you,
Autumn
Attention was now directed to the nerve transfer. I extended the existing incision in curvilinear fashion up the forearm, traced out the ulnar neurovascular bundled proximally. The flexors were identified, lysed from the surrounding tissues and retracted in a radial direction to expose the pronator quadratus. Neurovascular bundle entering the PQ was identified. This was protected with blunt instrument as the overlying muscle was freed away with the bipolar forceps. The anterior interosseous nerve was now divided at its branch point and transposed in the direction of the ulnar nerve. Here, we identified the deep motor branch distally, traced that back under careful loupe magnification proximally to a point where the anterior interosseous nerve could be brought up in a supercharged fashion into that motor branch under absolutely no tension. The sidewall of the motor branch was incised. The anterior interosseous nerve was transposed and was secured with an epineurium to epineurium repair with a total of four 9-0 nylon sutures under magnified vision. The nerve was now allowed to re-drape as were the flexor muscles.
This particular surgery was done at the time of a cubital tunnel release, but we are doing them on their own. Any help with coding would be greatly appreciated.
Thank you,
Autumn