You can still separately code for deep debridement that includes muscle and bone, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington, using a code such as 11044 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq. cm of skin substitute application (15271). Skin Lesion Excision Wait for Pathology? Q4*`F!PZuTA~}p?sB(C0qT, "~v6C[a]o]C%%=V This code is based on a wound size (singular or aggregate size; after cleansing, prepping, and/or debriding) minimally of 100 sq cm*. Avoid: Dont report a skin substitute graft when the surgeon applies non-graft wound dressings such as gel, powder, ointment, foam liquid, or injected skin substitutes, according to the guidelines. Reduction of pressure and/or control of infection will facilitate healing and may reduce the need for repeated debridement services. damages arising out of the use of such information, product, or process. RyfJwE@~:_t4lGY@iYTSBd(m6 DZk0XGxmpP+pF+ff,rBQ*A-E;qkdKom`5!0>?|;!Qb5(Hj QPiX)=Zc4cgQ+*lri59? No. For instance, Versajet debridement is considered to be nonsurgical, mechanical debridement because it does not involve cutting away or excising devitalized tissue. That means you should never report 97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) in addition to skin graft site preparation codes. Likewise, the Arobella Qoustic Wound Therapy System uses an ultrasonic assisted curette to debride wounds mechanically. 0 If you miss the separate skin preparation step, youll sacrifice pay your surgeon deserves. There are lessons to be learned to avoid damaging coding habits. The document is broken into multiple sections. As you can see, procedure code 86.69 (other skin graft to other sites) includes the debridement and closure of the amputation site via split-thickness skin graft. CMS and its products and services are Codes 15002-15005 apply specifically to describe the work of "preparing a clean and viable wound surface for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy," according to CPT guidelines. The AMA does not directly or indirectly practice medicine or dispense medical services. Copyright 2023 HCPro, a Simplify Compliance brand. 1253 0 obj <> endobj Note: This question can be found in the billing and claims category on the NAHRI Forums where you can find answers to questions on a variety of topics from billing and claims to compliance to reimbursement. Tip 2: Identify Type of Skin Substitute Graft CPT considers debridement a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure. Add together the surface area of multiple . Local Coverage Articles are a type of educational document published by the Medicare Administrative Contractors (MACs). Use of CPT codes 11000-11047 is not appropriate for the following services: washing bacterial or fungal debris from feet, incision and drainage of abscess including paronychia, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement. %%EOF The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. Question: Do not report 11042 -11047 in conjunction with 97597-97602 for the . iii. 0000001419 00000 n R'7bd snYJ@ 9PE@ cL endstream endobj 44 0 obj <>>> endobj 45 0 obj >/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/Tabs/W/Thumb 35 0 R/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 46 0 obj [/ICCBased 68 0 R] endobj 47 0 obj <> endobj 48 0 obj <>stream This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. A: It depends on the documentation. The objective of the procedure is to . The physician documentation is the key to being able to support both codes. Therefore, the more accurate code is a surgical preparation code (15002 15005) for excision (note the term is not debridement) of the open wound to prepare a viable wound surface for grafting. 39 0 obj <>stream Supportive Documentation Requirements (required at least every 10 visits) for 97597 and 97598: Medical records must be made available to Medicare upon request. Youre right about the skin graft code(s). Autologous skin grafts are those that the surgeon harvests from another healthy part of the patients own body, and you would use different codes for those graft procedures. Skin substitute grafts include the following: Avoid: Dont report a skin substitute graft when the surgeon applies non-graft wound dressings such as gel, powder, ointment, foam liquid, or injected skin substitutes, according to the guidelines. Neither the United States Government nor its employees represent that use of such information, product, or processes Size: To determine the surface area for code selection, add all areas within the same anatomic grouping, if the surgeon prepares multiple wounds. Privacy Policy | Terms & Conditions | Contact Us. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. hVmo6+ER|l%v5/:Bm#e'b|x;CA\X&V@[ ElBdd B()"8$^DHhFTDv):7^L]c"BJ#=,'$T#BJ! Two procedure codes need to be assigned-the excision and the graft closure. I work in an acute care center with a burn unit and . Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt. *This response is based on the best information available as of 09/05/19. LGXt5q]$]0"$T ?@Z"&&g2~caPa;SS:Sk \SA?3U'VXAHKJ66 R f`p/2XNd@T1 Another option is to use the Download button at the top right of the document view pages (for certain document types). If the provider is unable to use photographs for documentation purposes, the medical record should contain sufficient detail to determine the extent of the wound and the result of the treatment. Question: Otherwise, the graft code would have an includes note indicating the debridement is inherent in the code. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. Revenue Codes are equally subject to this coverage determination. What does Separate Procedure Mean in a CPT Code Description? o Total site less than 100 sq cm: 15271 first 25 sq cm or less; +15272 each additional 25 sq cm CPT codes 11000 and 11001 are not appropriate for debridement of a localized amount of tissue normally associated with a circumscribed lesion. What does Separate Procedure Mean in a CPT Code Description? U B( B>i ^6XPw1E_H*>4=i"U}`K}1~ymIoq=wza Debridement services are now defined by body surface area of the debrided tissue and not by individual ulcers or wounds. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. 465 Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC 573 Skin Graft for Skin Ulcer or Cellulitis with MCC *This response is based on the best information available as of 11/16/17. that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. You're right about the skin graft code (s). F(P.Q@/Q _(g Reproduced with permission. (See "Indications and Limitations of Coverage.") Debridement of diabetic foot ulcers more frequently than once every seven (7) days, for a period longer than three (3) months may not be reasonable and necessary. End Users do not act for or on behalf of the CMS. /| f-\n`Js^7u_p9X-WEpWio.@C6I@|V5J]5q;@OXAi*##C#YL,3+Ol]8t~{kR[.){l+-{AIe^\0(IA%ju~qy=(*FZ> l9a|ZJ>}*:2 {GI5|hV\)f#a43eEMM0s Do we bill 15271 as the size of the debridement documented or only the size of the skin substitute? Incision and debridement, right knee Exchange arthroplasty liner of right total knee arthroplasty OPERATIVE NOTE: . recommending their use. Specifically, this code is to be used for application of a skin substitute graft to a wound surface area size of 100 up to 200 sq Answer: Not exactly. Any other conditions that may significantly affect wound healing should also be appropriately addressed in the medical record. cm and then debridement codes (with an appropriate modifier) for the remaining 65 sq. 15004 and +15005 for face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits Federal government websites often end in .gov or .mil. Even a minor breach of patient protected health information (PHI) or [], Question: We have a new surgeon in our practice who specializes in vascular surgery, and [], Question: When our surgeon rounds on a patient in the critical care unit, can we [], Question: When and how should we use external cause codes? culture and sensitivity), osteomyelitis (e.g. Please visit the. Some articles contain a large number of codes. 1 2022 HCPro, a brand of Simplify Compliance. reasonable efforts to provide accurate coding information, this information should not be construed as providing clinical advice, dictating reimbursement policy, or substituting for the judgment of a practitioner. HWAnl))1p9CK,q@:(#"ET.OSnt$v\^lt6btT 9A'w>$bg71w= Y)s.girVu^T_N'%u7Ag>f|vsQ lCN}uCjdgIKLYvO0>E,bRpUuCXX_"RkdEN""/@1] $' O*o5-OEJmq@Hc^VVl 0 While every effort has been made to provide accurate and These codes are used for wound debridement but only when you are debriding an open wound with no intention of closing it; you expect the wound to heal by secondary intention. Include cleaning: When the surgeon performs a simple cleansing of the wound, that service is included within the skin substitute procedure codes, according to CPT instruction. MACs are Medicare contractors that develop LCDs and Articles along with processing of Medicare claims. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or Please do not use this feature to contact CMS. The treatment plan for a patient who requires frequent repeated debridement should be reevaluated, to ensure that pressure reduction and infection control have been adequately addressed. Trunk, arms, legs CPT considers debridement a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure.. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. hb```f``e`2jx Y8t00:00@9@ 6 jx In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. 0000002591 00000 n Remember: Wound surface area is what you should consider when selecting the code, not the size of the graft, cautions Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan. These codes are used for wound debridement but only when you are debriding an open wound with no intention of closing it; you expect the wound to heal by secondary intention. Article document IDs begin with the letter "A" (e.g., A12345). Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. 6. o Total site 100 sq cm or more: 15273 first 100 sq cm (or 1 percent body area infants and children); +15274 each additional 100 sq cm (or 1 percent body area infants and children) End User License Agreement: At a minimum, the Progress Report must document the continuing skilled assessment of wound healing as it has progressed since the evaluation or last Progress Report. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. ii. "2 2a TDl.Uae9c[yd\asU/(~8}ep This email will be sent from you to the recipient email address(es) you enter. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. What are the 2020 CPT code changes? The views and/or positions *4 Use CPT code 15340-15341 or CPT code 15360-15366 for the surgical preparation or creation of recipient site for the tissue skin graft. In ICD-9-CM, the Alphabetic Index main term entry is Graft; subterm entry fascia, which directs users to code 83.82, Graft of muscle or fascia. ,P* &r4DH#.|QW" ss In your example, you will be closing the wound. cm of the total 85.25 sq. Replacement material, graft size, multiple wounds all these factors and more will come into play when youre coding a skin replacement surgery using skin substitute grafts for conditions such as burns. Procedures involving the wrist and/or ankle are reported with codes that include arm or leg in the descriptor. If there is not enough clarity, then a query would be indicated. Biological implants To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom Thank you. No fee schedules, basic unit, relative values or related listings are included in CPT. Non-graft wound dressings or injected skin substitute codes are not used with skin replacement surgery application codes and are considered incorrect coding. Include dressing: You might find documentation of wound dressing in the op report for skin substitute grafts, but you shouldnt separately code routine dressing supplies for services performed in the office, according to CPT instruction. 43 32 "JavaScript" disabled. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Draft articles have document IDs that begin with "DA" (e.g., DA12345). Code 86.22, Excisional debridement, was defined as the "surgical removal or cutting away of devitalized tissue, necrosis, or slough," which could be performed in the operating room, emergency room, or at the patient's bedside. 0000018702 00000 n CPT codes 11000 and 11001 describe removal of extensive eczematous or infected skin. When performing debridement of a single wound, report depth using the deepest level of tissue removed. CMS believes that the Internet is Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. Include dressing: You might find documentation of wound dressing in the op report for skin substitute grafts, but you shouldnt separately code routine dressing supplies for services performed in the office, according to CPT instruction. While there is some consensus that repeated debridement may promote more rapid healing of diabetic foot ulcers, the appropriate interval and frequency of debridement depends on the individual clinical characteristics of patients and ulcers. rW`n":Q5g%_7:j)j9."QFGH(2My"hqt}%%l}]KkWmNhlI,(PjqK9%.v#|3^ya%h'e'e2iB@iFOk|q)7 If.ug q&QP;jNy>9cW=aB=je>m3/dDQMA;2VJ0E5&Qj2[iG"^l+E. 1 G/r f VY;fuC{r@,>^Q k1[1Q3#V^DJ;;j!E"&~'/;{1M, ~ B ^(\%@%t m+?Rh@yK The second code in each set (+15003 and +15005) are add-on codes that you should report for defect area beyond the initial size (for each additional 100 sq cm or 1 percent of body area or part thereof). Also, you can decide how often you want to get updates. appropriate codes to use when performing a non-surgical application of a skin substitute. Remember that the debridement codes, 11042-11047, are reported when you debride an open wound that will stay open to heal by secondary intention. CMS and its products and services are not endorsed by the AHA or any of its affiliates. Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. If the documentation supports that 20 sq. Tip 2: Identify Type of Skin Substitute Graft. hb```, cc`a4`` $0oP>+Z5:,PaE$L[R\w0`r`,p{^gnq))&%xBiS*,8yUSc3AOSAk*+L|0$nELLuH0|Rfp1drcH/i*@r? License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. Autologous skin grafts are those that the surgeon harvests from another healthy part of the patients own body, and you would use different codes for those graft procedures. The AMA is a third party beneficiary to this Agreement. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. Subsequent debridement is often more superficial and best described by CPT codes 97597 or 97598 rather than 11043 or 11044. %%EOF Grasp measurement rules. 0000006208 00000 n cm of the total 85.25 sq. CPT is a trademark of the American Medical Association (AMA). For patients with chronic wounds being treated in an outpatient setting, services beyond the fifth surgical debridement, CPT code 11043, 11046 and/or 11044, 11047, per patient, per year, per wound may require a medical review of records demonstrating the medical reasonableness and necessity. Bilateral Carpal Tunnel Procedures Different Days. 0000000016 00000 n qe<>O &j'>-3c\BMAi`/@SPPkS u6X \[bkjqkXdV41+ahqg& _p,d4ueQ@Ha s0O To bill for an Apligraf (HCPCS Q4101) package (equal to 44-sq. [ 4"!|F. k Auto- is different: If you see the term autograft or tissue cultured autograft, then you are dealing with the harvest and/or application of an autologous skin graft. of every MCD page. Determining the wound location and surface area is important in order to select the appropriate CPT code. The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. uKEmc2vy5\^gB:w76>9s=gKn4"=yJ} crv[d[ ML\:6q~6U6_Nc8Dc?nN8^>\RY[qZ{XO*JT!e,(7=m]7}}O@gSS(B"t658>~.%W['i9hch8bQT%ml 3. CDT is a trademark of the ADA. Wound care debridement codes 1104211047 Use these codes when the only procedure performed in wound debridement. He is an alumnus of York College of Pennsylvania and Clemson University. The Medicare program provides limited benefits for outpatient prescription drugs. Skin substitute grafts include the following: Youll find the codes for skin substitute graft procedures in the range 15271-+15278 (Application of skin substitute graft ). . 0000008118 00000 n %PDF-1.5 % and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only View ICD-10-PCS CODING 2022 - Case Studies and Code Building Exercises.docx from HLTH 1241 at St. John's University. 2021 Evaluation and Management Codes: Is a History Required? All rights reserved, Debridement of the skin that is preparatory to further surgery such as reduction of fracture, etc., should not be coded as a separate procedure., The surgeon debrided the necrotic tissue surrounding the amputation site, harvested skin from the patient's thigh and closed the wound with a split thickness skin graft. Distinguish the codes based on body site, as follows: Each pair of codes identifies the size of the defect created by the surgical preparation, with the first code (15002 or 15004) describing the first 100 sq cm for adults and children aged 10 and up, or 1 percent of body surface area for children under 10 years of age, including infants. jQuery(function() { _initLayerSlider( '#layerslider_57_r6v94to757da', {createdWith: '6.8.2', sliderVersion: '6.9.2', allowFullscreen: true, pauseOnHover: 'enabled', skin: 'v6', sliderFadeInDuration: 350, useSrcset: true, skinsPath: 'https://karenzupko.com/wp-content/plugins/LayerSlider/assets/static/layerslider/skins/', performanceMode: true}); }); KarenZupko & Associates, Inc. 2023 | All Rights Reserved. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). 25 0 obj <> endobj However, please note that once a group is collapsed, the browser Find function will not find codes in that group. article does not apply to that Bill Type. Codify Subscriber Answer: You should [], Copyright 2023. 5. Follow our experts tips to make sure you select the proper code and get all the pay your surgeon deserves for these services. Whether the surgeon performs both steps at a single encounter or delays grafting for a later time, report the surgical preparation using codes in the range 15002-+15005 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contractures ). This question was answered by Denise Williams, COC, senior vice president of the revenue integrity division and compliance auditor at Revant Solutions in Trussville, Alabama. cm; we know that many times the actual size of the skin substitute is larger than the area that was covered. All rights reserved. cm or less). All Rights Reserved. CPT code 15002/15005 are only appropriately used in place of service inpatient hospital, . 2021 Evaluation and Management Codes: Is a History Required? All Rights Reserved (or such other date of publication of CPT). Whether the surgeon performs both steps at a single encounter or delays grafting for a later time, report the surgical preparation using codes in the range 15002-+15005 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contractures ). End User Point and Click Amendment: . Answer: 0000016096 00000 n The procedure is essential for wounds that aren . Peruse CPTs Skin Replacement Surgery section, and youll see that the guidelines mention different types of skin grafts. Codes describing excision debridements deeper than skin only are organized by depth: 2. Non-human skin substitute grafts such as xenografts (from another animal such as pig) 11012 skin, subcutaneous tissue, muscle fascia, muscle and bone. A description of the tissue removed (e.g., necrotic, devitalized or non-viable) It's also done to remove foreign material from tissue. When can I report debridement separately? When debridements are performed, the debridement . Secondary Payor Doesnt Recognize Consultations. Frequent skilled observation and assessment of wound healing are recommended daily or weekly to justify the skilled service. I performed a simple debridement with a full thickness graft of the trunk and reported 15200 and coded also for the debridement, but my coder told me I could not report the debridement. Like the site preparation codes, CPT distinguishes these codes by anatomic site and wound surface area, as follows: o Total site less than 100 sq cm: 15271 first 25 sq cm or less; +15272 each additional 25 sq cm That means you should select the appropriate HCPCS Level II code such as Q4101 (Apligraf, per square centimeter) or C1763 (Connective tissue, non-human (includes synthetic)) for the graft material. Q: The physician documented debridement (11043x1 & 11046x4) of a wound 85.25 sq. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. 15271-15278 is the new CPT code series for skin substitute grafts. "JavaScript" disabled. If the wound is being excised, not just debrided, at the time of split thickness skin graft placement then you could also report a surgical preparation code (e.g., 15002, 15004) in addition to the skin graft code. If you would like to extend your session, you may select the Continue Button. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept". Bilateral Carpal Tunnel Procedures Different Days, Multiple Laminectomies to Place a Spinal Cord Stimulator. You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Refer to NCCI and OPPS requirements prior to billing Medicare.For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.The diagnosis code(s) must best describe the patient's condition for which the service was performed. The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. In your example, you will be closing the wound. (application of skin substitute graft to, for example, leg or ankle). hUmo0+q 0HUmIkN^D Wk$$[n;=AIWq@ In ICD-10-PCS, the user may elect to look in the Index under Advancement which provides options to see Reposition or see Transfer. j0 W0 Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Earn CEUs and the respect of your peers. of the Medicare program. cm and not just that the size of the skin substitute was 20 sq. Instructions for enabling "JavaScript" can be found here. Follow our experts tips to make sure you select the proper code and get all the pay your surgeon deserves for these services. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. 4 CPT code 15431 is always related to CPT code 15430 and, per the MFSDB is always included in the global period of the other service.
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