The patient has a rib deformity due to severe idiopathic infantile thoracic scoliosis and is status post placement of vertical expandable prosthetic titanium rib (VEPTR). The patient is admitted for bilateral VEPTR lengthening. During surgery, the old incisions over the VEPTR lengthening mechanism were used for the approach. The left and then the right locking mechanisms were exposed; the clips were removed; and the distractor was inserted to extend the VEPTR lengthening mechanism approximately 1 cm on the right and similarly on the left. A new locking clip was placed into position and crimped to secure a satisfactory seating. The patient also had intra-operative evoked potential monitoring done during the surgery. How should this case be coded?
Assign code Z45.89, Encounter for adjustment and management of other implanted devices, as the principal diagnosis. Codes M95.4, Acquired deformity of chest and ribs, and M41.04, Infantile idiopathic scoliosis, thoracic region, should be assigned as additional diagnoses. For the surgery, assign the following ICD-10-PCS procedure codes:
0PW104Z Revision of internal fixation device in right rib, open approach
0PW204Z Revision of internal fixation device in left rib, open approach