Neurosurgery Coding Alert

Question: What is an -Oberlin procedure- and how should I code for it?


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Answer: During an Oberlin procedure, the neurosurgeon transfers a nerve pedicle from a healthy (donor) nerve to a damaged (recipient) one.

In the first stage of the Oberlin procedure, the neurosurgeon locates the donor (ulnar) nerve and teases out a redundant portion of it by internal neurolysis (under an operating microscope).

Then, she transfers the portion of the donor nerve to the distal portion of the biceps or brachialis branches of the musculocutaneous nerve.

Coding: For the Oberlin procedure, you should:

- report 64905 (Nerve pedicle transfer; first stage) for the pedicle transfer.

-  report +64727 (Internal neurolysis, requiring use of operating microscope [list separately in addition to code for neuroplasty] [neuroplasty includes external neurolysis]) for the internal neurolysis via microscope.

Dx options: Neurosurgeons commonly perform the Oberlin procedure when a nerve injury has disrupted the brachialis nerve function, because the procedure restores the ability to flex the arm at the elbow. Typical ICD-9 codes for the Oberlin procedure include, but are not limited to:

- 953.4 -- Injury to nerve roots and spinal plexus; brachial plexus

- 344.4x -- Monoplegia of upper limb

- E929.0 -- Late effects of motor vehicle accident. Coders should be aware that 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 and 64727 for the first stage of the procedure.

- report 64907 (Nerve pedicle transfer; second stage) for the second stage.

- attach modifier 58 (Staged or related procedure or service by the same physician during the postoperatvie 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. Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.