Jenina3295
New
Hello,
I am new to ortho coding. I am trying to find the cpt codes for nerve transfers.
I came up with:
Spinal accessory nerve to suprascapular transfer 64713
Right partial radial to axillary nerve transfer 64999
I cannot find a code to compare the unlisted code to.
I would appreciate all the help. Here is the op-report. Thank you
The patient was identified in the preoperative holding area. We reviewed the operative indications, operative plan and recovery. The right shoulder was marked as the operative site and confirmed with the patient. He was then brought to the operating room. He was placed in the prone position. All bony prominences were well padded. Preoperative antibiotics were given per standard protocol. The right shoulder girdle and upper extremity was then prepped and draped in the normal sterile fashion.
A timeout was performed per standard protocol, identifying the patient, the procedure and the operative site. All personnel were in agreement and there were no discrepancies identified.
A transverse incision was made over the superior aspect of the scapula, beginning medial to the superior angle and eventually extending over the acromion. The incision was taken through skin, subcutaneous tissue and fascia down to the trapezius muscle. The fibers of the trapezius were split transversely to identify the spinal accessory nerve. Once we identified the nerve, we used a nerve stimulator to confirm its identity and its function. We carried our dissection laterally to identify the suprascapular nerve. We had difficulty identifying the suprascapular nerve. Proximally, we identified a section of the nerve, proximal to the notch, that appeared damaged. We carried our dissection distally to the acromion and the spinoglenoid notch. Unfortunately, the nerve was not identified in the notch despite wide exposure, suggesting that perhaps the nerve was avulsed distally, with the spinoglenoid notch serving as a second tethering point.
*
We decided at this point to revisit the suprascapular nerve at a later time and instead to continue with the partial radial nerve to axillary transfer. The incision was extended longitudinally over the posterior aspect of the arm. The incision was taken through the skin, subcutaneous tissue and fascia down to the triceps. The radial nerve was identified in the triangular space. We identified its branches, and used a nerve stimulator to evaluate the function of each branch. We selected the branch that provided only elbow extension as our donor nerve; another branch that provided wrist extension was preserved. We then carried our dissection proximally to the quadrangular space to identify the axillary nerve. We isolated the anterior motor branch. The donor radial nerve was divided as distal as possible, and the axillary nerve was divided as proximal as possible. The microscope was then brought into the operating field. The nerve ends were prepared and coapted under the microscope using 8-0 Nylon sutures. The repair was reinforced with fibrin glue (Eviseal).
*
We turned our attention back to the suprascapular nerve. Again, we found that the proximal portion of the nerve appeared unhealthy, and distally it was absent from the spinoglenoid notch. As such, a spinal accessory to suprascapular nerve transfer would be nonfunctional, and we abandoned this second nerve transfer, deciding it was best to preserve trapezius function as it was one of the few stabilizing muscles remaining around his shoulder.
I am new to ortho coding. I am trying to find the cpt codes for nerve transfers.
I came up with:
Spinal accessory nerve to suprascapular transfer 64713
Right partial radial to axillary nerve transfer 64999
I cannot find a code to compare the unlisted code to.
I would appreciate all the help. Here is the op-report. Thank you
The patient was identified in the preoperative holding area. We reviewed the operative indications, operative plan and recovery. The right shoulder was marked as the operative site and confirmed with the patient. He was then brought to the operating room. He was placed in the prone position. All bony prominences were well padded. Preoperative antibiotics were given per standard protocol. The right shoulder girdle and upper extremity was then prepped and draped in the normal sterile fashion.
A timeout was performed per standard protocol, identifying the patient, the procedure and the operative site. All personnel were in agreement and there were no discrepancies identified.
A transverse incision was made over the superior aspect of the scapula, beginning medial to the superior angle and eventually extending over the acromion. The incision was taken through skin, subcutaneous tissue and fascia down to the trapezius muscle. The fibers of the trapezius were split transversely to identify the spinal accessory nerve. Once we identified the nerve, we used a nerve stimulator to confirm its identity and its function. We carried our dissection laterally to identify the suprascapular nerve. We had difficulty identifying the suprascapular nerve. Proximally, we identified a section of the nerve, proximal to the notch, that appeared damaged. We carried our dissection distally to the acromion and the spinoglenoid notch. Unfortunately, the nerve was not identified in the notch despite wide exposure, suggesting that perhaps the nerve was avulsed distally, with the spinoglenoid notch serving as a second tethering point.
*
We decided at this point to revisit the suprascapular nerve at a later time and instead to continue with the partial radial nerve to axillary transfer. The incision was extended longitudinally over the posterior aspect of the arm. The incision was taken through the skin, subcutaneous tissue and fascia down to the triceps. The radial nerve was identified in the triangular space. We identified its branches, and used a nerve stimulator to evaluate the function of each branch. We selected the branch that provided only elbow extension as our donor nerve; another branch that provided wrist extension was preserved. We then carried our dissection proximally to the quadrangular space to identify the axillary nerve. We isolated the anterior motor branch. The donor radial nerve was divided as distal as possible, and the axillary nerve was divided as proximal as possible. The microscope was then brought into the operating field. The nerve ends were prepared and coapted under the microscope using 8-0 Nylon sutures. The repair was reinforced with fibrin glue (Eviseal).
*
We turned our attention back to the suprascapular nerve. Again, we found that the proximal portion of the nerve appeared unhealthy, and distally it was absent from the spinoglenoid notch. As such, a spinal accessory to suprascapular nerve transfer would be nonfunctional, and we abandoned this second nerve transfer, deciding it was best to preserve trapezius function as it was one of the few stabilizing muscles remaining around his shoulder.