The patient is a 64-year-old woman with a history of aniridia who presents with a retroprosthetic membrane status post artificial corneal device. She has had multiple ocular surgeries, including penetrating keratoplasty (PKP), cornea device placement, YAG membranotomy for retroprosthetic membrane, and removal of retroprosthetic membrane. During this admission, the patient had revision vitrectomy with retroprosthetic membrane removal via pars plana and intravitreal injection of Avastin. What are the correct diagnosis and procedure codes for this case?
Assign code 996.51, Mechanical complication of other specified prosthetic device, implant, and graft, Due to corneal graft, as the principal diagnosis. Code 743.45, Aniridia, should be assigned as an additional diagnosis. Assign code 14.74, Other mechanical vitrectomy, for the pars plana vitrectomy for removal of retroprosthetic membrane and code 99.29, Injection or infusion of other therapeutic or prophylactic substance, for the intravitreal injection of Avastin.
Keratoprosthesis (artificial cornea) provides a clear corneal window in individuals with severe corneal opacification and corneal blindness and was developed due to the increased risk of regraft failure in these patients. Causes of regraft failure may include glaucoma, ocular surface disease and inflammation, limbal stem cell deficiency, and history of multiple eye surgeries.
The keratoprosthesis is made of a rigid polymethyl methacrylate (PMMA) optic/front plate. The front plate also has a stem that connects to a back plate. The back plate has holes to facilitate communication with the aqueous for nutrition and hydration of the cornea. The donor corneal tissue is placed between the front plate and the back plate; with the plate being snapped or screwed onto the stem. The device is locked together with a titanium locking ring and can then be sutured to the recipient eye like a typical corneal transplant.