A patient with adolescent idiopathic scoliosis presented for anterior vertebral tethering. During surgery, three incisions were made over alternating ribs to allow access to vertebral levels T5-T11 and endoscopic instrumentation was placed. Right-sided vertebral screws were inserted and a tethering ligament was placed and tightened into the fixation screws of the Zimmer Dynesys tethering system while providing direct visualization with the thoracoscope. The device key instructs to “use Spinal stabilization device, pedicle-based for insertion in upper joints/lower joints,” but this device value is not available with the root operation “Reposition.” What is the correct root operation, reposition or insertion?
Assign the following procedure code:
0PS444Z Reposition thoracic vertebra with internal fixation device, percutaneous endoscopic approach.
The objective of the surgery was to reposition the thoracic spine to correct idiopathic scoliosis; therefore, “Reposition” is the correct root operation. In this use of the Dynesys system, the vertebra is the site of the procedure, not the joint. While the device key leads to “Spinal stabilization device, pedicle-based for insertion in upper joints, lower joints” when referencing “Dynesys Dynamic Stabilization System,” vertebral tethering for scoliosis treatment is an off-label use of the Dynesys system, and so its use in a vertebral tethering procedure should not be classified as a spinal stabilization device in the coded data.