Reference no: EM133569050

The patient is a 40-year-old female with Down syndrome who was admitted to the hospital for a repeat penetrating Keratoplasty (corneal transplant). The patient lives 120 miles away from the hospital with elderly parents and, because of the distance to be traveled, was being admitted instead of having an outpatient procedure. The patient had a penetrating keratoplasty on the left I in the past. She developed a corneal ulcer and perforation, requiring a repeat penetrating keratoplasty via percutaneous approach in the left eye. The patient did understand the procedure and agreed to it but the consent form was signed by her father. At the time of the corneal transplant it was noted again that her eye was soft and appeared to be perforated with a flat anterior chamber. The donor cornea was prepared. The previous donor cornea was removed from the patient's eye. Four interrupted 10 - 0 nylon cardinal sutures were placed to secure the new donor tissue to the host, an asymmetrical rhomboid crease on the donor was noted. A total of 12 more interrupted 10 - 0 nylon sutures were placed equally distant from each other to secure the donor to the host, and the chamber was intermittently formed. The wound was checked for leaks, and none were seen. Subtenon injections of 80 mg Depo-Medrol and 40 mg gentamicin were given as part of the procedure. Vigamox eye drops were placed in the eye. A bandage contact lens was placed in the eye with a shield on top. The patient was awakened and transferred to the recovery room. She stayed in the hospital overnight for pain control and management. She was examined the next morning by the ophthalmic surgeon and discharged to the care of her adult brother and parents to be driven home.

Question 1. Identify the principal diagnosis and list the appropriate code and include the appropriate POA status indicator.

Question 2. Explain your rationale for selecting the principal dx.

Question 3. Identify any secondary diagnoses and list the appropriate code(s) and include all appropriate POA status indicators for each code.

Question 4. Explain your rationale for selecting secondary diagnoses and the sequencing of these codes.