Excision interosseous nerve
Anatomy: The interosseous nerve is divided into anterior and posterior sections. The anterior interosseous nerve is essentially a motor branch of the median nerve. It arises 5 cm-8 cm below the medial epicondyle, under the arch of the flexor digitorum superficialis, after passing between the two heads of the pronator teres. Its branches supply the flexor pollicis longus, the flexor digitorum profundus indicis and, about half the time, the flexor digitorum profundus majus. It then accompanies the anterior interosseous artery as they pass through and below the flexor pollicis longus and the flexor digitorum profundus to reach the pronator quadratus. Finally, it passes deep to the pronator quadratus and ends by sending articular branches to the wrist joint. None of its branches are cutaneous.
The posterior interosseous nerve travels along the posterior aspect of the forearm between the ulna and the radius. The posterior interosseous has its roots in the cervical spine (C6, C7, C8) and arises as a branch from the radial nerve.
Coding: CPT has several codes (64732-64772) relating to the excision or transection of the nerves. The origin of the nerve root must be known to reference the proper CPT code. You must also check to see whether the excision/transection is being performed for postoperative pain control. The Centers for Medicare and Medicaid Services has stated that the global surgical package includes postoperative pain management by the surgeon (see 100-04 Claims Processing Section 40). The documentation must clearly show why the nerve is being excised/transected. The recommended code for these excisions is 64772