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Official Description

Nerve pedicle transfer; second stage

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

A nerve pedicle transfer is a surgical procedure that involves the transfer of a nerve along with a muscle pedicle, which includes the motor endplate of the nerve. This procedure is typically performed in two stages. In the first stage, represented by CPT® Code 64905, the surgeon develops and transfers the nerve pedicle to a designated donor site. The process begins with making an incision over the injured nerve, followed by the elevation of skin, fascial, or muscle flaps as necessary to expose the injured nerve and its branches. The incision may be extended, or a second incision may be created at the site where the nerve pedicle will be harvested. Utilizing microscopic visualization, the surgeon carefully dissects the donor nerve and its motor endplate from the surrounding tissues, along with the associated muscle tissue. A tunnel is then created from the donor site to the injured nerve, allowing the nerve pedicle to be pulled through this tunnel to the injury site. Once in position, the nerve pedicle is secured to the injury site with sutures. In the second stage, denoted by CPT® Code 64907, after the nerve axons have regenerated and normal nerve function has been restored, the nerve pedicle is severed at its original site. This staged approach allows for the restoration of nerve function while ensuring that the nerve pedicle is properly integrated into the surrounding tissues before final severance.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The nerve pedicle transfer procedure is indicated for patients who have sustained nerve injuries that require surgical intervention to restore function. The following conditions may warrant this procedure:

  • Severe Nerve Injury - This includes cases where the nerve has been completely transected or significantly damaged, necessitating surgical repair to restore motor function.
  • Neuropraxia - A temporary loss of motor and sensory function due to blockage of nerve conduction, which may require intervention if recovery is not progressing adequately.
  • Axonotmesis - A condition where the nerve is damaged but the surrounding connective tissue remains intact, often requiring surgical repair to facilitate regeneration.
  • Neurotmesis - A complete disruption of the nerve, where both the nerve and its surrounding structures are damaged, necessitating a more complex surgical approach.

2. Procedure

The nerve pedicle transfer procedure consists of several critical steps that ensure the successful transfer and integration of the nerve pedicle. The following outlines the procedural steps involved:

  • Step 1: Incision and Exposure - The procedure begins with the surgeon making an incision over the injured nerve. This incision allows for the elevation of skin, fascial, or muscle flaps as needed to adequately expose the injured nerve and its branches. The exposure is crucial for the subsequent steps of the procedure.
  • Step 2: Harvesting the Nerve Pedicle - Once the injured nerve is exposed, the surgeon may extend the incision or create a second incision at the site where the nerve pedicle will be harvested. Using microscopic visualization, the surgeon carefully dissects the donor nerve along with its motor endplate from the surrounding tissue, ensuring that muscle tissue is also included in the harvest.
  • Step 3: Creating the Tunnel - After harvesting the nerve pedicle, a tunnel is created from the donor site to the injured nerve. This tunnel serves as a pathway for the nerve pedicle to be transferred to the site of injury.
  • Step 4: Transferring the Nerve Pedicle - The harvested nerve pedicle is then pulled through the tunnel to the injury site. This step is critical as it positions the nerve pedicle for integration with the injured nerve.
  • Step 5: Securing the Nerve Pedicle - Once the nerve pedicle is in place at the injury site, it is secured using sutures. This fixation is essential to ensure that the nerve pedicle remains stable as healing and regeneration occur.

3. Post-Procedure

After the nerve pedicle transfer procedure, patients can expect a recovery period during which nerve axons will regenerate and nerve function will gradually return. Post-procedure care may include monitoring for signs of infection, managing pain, and following rehabilitation protocols to promote recovery. The surgeon will provide specific instructions regarding activity restrictions and follow-up appointments to assess the healing process. Once nerve function has been restored, the final step involves severing the nerve pedicle at its site of origin, which is performed in the second stage of the procedure.

Short Descr NERVE PEDICLE TRANSFER
Medium Descr NERVE PEDICAL TRANSFER SECOND STAGE
Long Descr Nerve pedicle transfer; second stage
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5E - Ambulatory procedures - other
MUE 1
CCS Clinical Classification 9 - Other OR therapeutic nervous system procedures

This is a primary code that can be used with these additional add-on codes.

69990 Addon Code MPFS Status: Restricted APC N ASC N1 PUB 100 CPT Assistant Article 1Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
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