Neurosurgery Coding Alert

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

Wisconsin Subscriber

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.