Answer: Code 58660 (Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)) for the lysis of adhesions is a National Correct Coding Initiative (NCCI) column 2 edit for both 58661 (… with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) and 58662 (… with …0. Apr 2, 2008. #2. Unless you have documentation that the lysis of adhesions is very large it is included in the exploratory code. The documentation cannot only state that the lysis was done to obtain access to the site, it must be excessive. Most times you will not get the documentation you need in order to bill this separately.ACS Fellows can call the Coding Hotline for answers to questions related to CPT; Healthcare Common Procedure Coding System; International Classification of Diseases, 10th Revision Clinical Modification codes; and global fee periods. To contact a coding specialist, call 800-ACS-7911 (800-227-7911), 8:00 am to 5:00 pm Central time, …In the world of medical billing and coding, CPT codes play a crucial role. These codes, also known as Current Procedural Terminology codes, are used to identify and document medica...Greetings, I am inquiring about a CPT code for Lysis of Adhesions. I have been getting an issue with Blue Cross Blue Shield of Illinois when I billed the following codes: 58740. 58720 (Salingo-oophorectomy) M 59. 58563 (Laparoscopy with endometrial ablation) M 59. The payor processed CPT code 58720 as the primary code, however I did not send ...Aug 16, 2021 · 49329 is "Unlisted laparoscopy procedure, abdomen, peritoneum and omentum". Unlisted is just that - unlisted, so you need to define what you are billing for, and a comparison code to compare the amount of work. However, what your physician did here should not be coded with unlisted. There are codes for laparoscopic lysis of adhesions, depending ... Sep 20, 2011 · Sep 20, 2011. #1. I need help with finding a CPT code to fit the procedure performed by the doctor. The title of the operation was laparoscopy, lysis of adhesions, and drainage of abscesses with irrigation. I will submit the operative report with the claim but I still need to know what CPT code to use. There is "taking down" and "freeing up ... Best answers. 0. Nov 12, 2008. #1. How would you code a Laparoscopic cholecystectomy w/intraoperative cholangiogram along with doing lysis of adhesions at the same time. I know you would use CPT 47563 for the cholecystectomy code & the only other lysis of adhesion code I seen was the 44180 because this was done laparoscopically also.Dec 1, 2002 · Answer: You should always list the most extensive procedure first on the claim form. In this case, the laparo-scopic lysis of adhesions (58660, Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]) is the higher-valued code, so you should list it first with modifier -59 ( Distinct procedural service ... ICD-10-PCS 0FN14ZZ converts approximately to: 2015 ICD-9-CM Procedure 54.51 Laparoscopic lysis of peritoneal adhesions. Note: approximate conversions between ICD-9-CM codes and ICD-10-PCS codes may require clinical interpretation in order to determine the most appropriate conversion code (s) for your specific coding situation.Skip Separate Lysis Coding. You should not separately bill for the laparoscopic lysis of adhesions using 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]). “The lysis of adhesions is really getting to the surgical field and pathology, the location where the surgery will be performed, …May 19, 2017 · In these cases, if clinically reported and documented, you can bill both procedures using the appropriate CPT ® lysis codes. Example: Appropriate coding would include 50230 for the open transabdominal radical nephrectomy and lysis of limited adhesions and 58660 for the laparoscopic lysis of extensive pelvic adhesions. Laparoscopic adhesiolysis was first described by a gynecologist for the treatment of chronic pelvic pain and infertility. [ 9] In the early days of laparoscopy, previous abdominal …If the uterus was > 250gm, the correct code would be 58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s). Since the op note specified over an hour (more specific like 75 minutes, etc would be better, but it is at least an hour) for lysis of adhesions, that to me justifies -22.Unless your doctor is doing the lysis of adhesions as the only procedure it is not separately reportable. If it was extensive and there is time in the op note you can use modifier 22.What is CPT code for lysis of adhesions? Code 58660, Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure), can be reported in addition to the primary procedure, only if dense/extensive adhesions are encountered that require effort beyond that ordinarily provided for the laparoscopic procedure.Abstract. Laparoscopic lysis of adhesions or treatment of bowel obstruction is performed for acute or chronic obstruction of the small bowel. The same techniques may also be used for cases of diagnostic laparoscopy. Download chapter PDF.CPT 58660 narrates the laparoscopy with lysis of fallopian tubes and ovaries adhesions; It is a surgical technique and counts as a separate operation. The global period is 90 – days. CPT 58740 narrates the lysis … The official description of CPT code 58660 is: Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure). 3. Procedure. The patient is placed in the dorsal lithotomy position, and the abdomen is prepped and draped. General anesthesia is administered. ACS Fellows can call the Coding Hotline for answers to questions related to CPT; Healthcare Common Procedure Coding System; International Classification of Diseases, 10th Revision Clinical Modification codes; and global fee periods. To contact a coding specialist, call 800-ACS-7911 (800-227-7911), 8:00 am to 5:00 pm Central time, …The ICD-10 Procedure Coding System (PCS) is an international system of medical classification used for procedural coding. The ICD-10-PCS code for the laparoscopic lysis of abdominal wall adhesions, or peritoneal adhesions, is 0FN14ZZ.This procedure is used to treat abdominal and chronic pelvic pain caused by adhesions. Adhesions are scars that form within the body, typically after surgery, as part of the healing process. Physical and Occupational Therapy. Subscribe to Our Patient Newsletter.The correct code for lysis of abdominal adhesions is 44005 (enterolysis [freeing of intestinal adhesion] [separate procedure]), but this procedure is bundled with 44021 (enterotomy, small bowel, other than duodenum; for decompression [e.g., Baker tube]). Therefore, the only procedure that may be billed is 44021, because both the lysis of ...58660 (Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)) 58740 (Lysis of adhesions (salpingolysis, ... In this case, you may be able to get more reimbursement by adding a modifier 22 to the abdominal surgery code, because the chances are good that the code for enterolysis …Nov 20, 2023 · The CPT Code for laparoscopic lysis Omental Adhesions is 44180. This code is used to describe a minimally invasive surgical procedure that is performed to remove adhesions that have formed between the omentum, a fatty tissue in the abdomen, and other structures in the abdominal cavity. Adhesions can develop as a result of previous abdominal View the CPT® code's corresponding procedural code and DRG. In a click, check the DRG's IPPS allowable, length of stay, and more. ... (hysteroscopy with lysis of intrauterine adhesions). ... [ Read More ] Office visit Procedure for Endometrial Adhesion. New one for me! IF the procedure had been completed, I would use unlisted and compare it to ...How do I code laparoscopic lysis of adhesions for a patient 11 days post gastric bypass. The patient returned to the hospital with severe epigastric pain. The physician performed a laparoscopy and noted a partial obstruction at the mesocolic defect. Some sutures were cut to relieve the obstruction. ... Check CPT indexBest answers. 0. Nov 12, 2008. #1. How would you code a Laparoscopic cholecystectomy w/intraoperative cholangiogram along with doing lysis of adhesions at the same time. I know you would use CPT 47563 for the cholecystectomy code & the only other lysis of adhesion code I seen was the 44180 because this was done laparoscopically also.Jul 20, 2020. #5. 58660 is a column 2 (never allowed) CCI edit for both 58661 and 58662. The insurance should not have paid separately for 58660 in the first place. If the lysis of adhesions are significant (> 1 hour) and described in the op note, I bill the primary procedure with -22 modifier and prepare an appeal letter.The laparoscope can be used in the lysis of intraperitoneal adhesions. The technique consists of electrofulgurating the adhesion and cutting the adhesion with scissors in the area electrocoagulated. The purpose of the operation is to lyse intraperitoneal adhesions, utilizing the advantages of the laparoscopic technique.In addition to the primary CPT code 47562 for laparoscopic cholecystectomy, there are other related CPT codes that may be used depending on the specific circumstances of the procedure. These include: CPT code 47563: Laparoscopic cholecystectomy with cholangiography. CPT code 47564: Laparoscopic cholecystectomy with exploration of the common duct.0. Apr 2, 2008. #2. Unless you have documentation that the lysis of adhesions is very large it is included in the exploratory code. The documentation cannot only state that the lysis was done to obtain access to the site, it must be excessive. Most times you will not get the documentation you need in order to bill this separately.CPT stands for Current Procedural Terminology and is administered by the AMA (American Medical Association). HCPCS stands for Healthcare Common Procedural Coding System and is base...In the world of medical billing and coding, accuracy is crucial. One small error in assigning a Current Procedural Terminology (CPT) code can lead to significant consequences, incl...CPT 58660 narrates the laparoscopy with lysis of fallopian tubes and ovaries adhesions; It is a surgical technique and counts as a separate operation. The global period is 90 – days. CPT 58740 narrates the lysis …This procedure is used to treat abdominal and chronic pelvic pain caused by adhesions. Adhesions are scars that form within the body, typically after surgery, as part of the …Skip Separate Lysis Coding. You should not separately bill for the laparoscopic lysis of adhesions using 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]). “The lysis of adhesions is really getting to the surgical field and pathology, the location where the surgery will be performed, Ferragamo ...You can report this procedure as 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [eg, ovarian cyst] [single or multiple]). Link this to tubo-ovarian abscess ICD-10 code N70.93 (Salpingitis and oophoritis, unspecified). You may not report lysis of adhesions separately with these codes.Adhesions are fibrous tissue connections (adherence tissues) between various tissue planes or organs usually caused by inflammatory causes, most commonly surgery. Fibrin deposition leads to fibrous connections between organs or tissues. These adhesions are part of the internal healing process and inflammatory reactions. They participate in the body's defense mechanisms against the causes of ...Lysis of adhesions is a procedure of destroying scar tissue that causes abdominal and chronic pelvic pain. The Current Procedural Terminology (CPT) codes for lysis of adhesions for small bowel are 44005 and 44180. CPT code 44005 is for open enterolysis while CPT code 44180 is for laparoscopic enterolysis.View the CPT® code's corresponding procedural code and DRG. In a click, check the DRG's IPPS allowable, length of stay, and more. ... (hysteroscopy with lysis of intrauterine adhesions). ... [ Read More ] Office visit Procedure for Endometrial Adhesion. New one for me! IF the procedure had been completed, I would use unlisted and compare it to ...The CPT code for laparoscopic lysis of small bowel adhesions is 44180.. This code describes a procedure in which a laparoscope is used to access the abdominal cavity and remove small bowel adhesions, or abnormal fibrous bands that have formed between tissues and organs.0. Apr 2, 2008. #2. Unless you have documentation that the lysis of adhesions is very large it is included in the exploratory code. The documentation cannot only state that the lysis was done to obtain access to the site, it must be excessive. Most times you will not get the documentation you need in order to bill this separately.For example, if the surgeon must perform extensive lysis of adhesions, 44200 (laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]) cannot be billed in addition to 47562 because the codes are bundled in the national Correct Coding Initiative (just as 44005, the code for open lysis of adhesions, is bundled to ...For a laparoscopic appendectomy at the time of another procedure, the coding choice is code 44970 (laparoscopic surgical appendectomy). You will need to append modifier 59 to this code to indicate it is separate and distinct from the other surgery. The operative report documentation should clearly describe the procedure and the reason forAnswer: The correct billing would be 56304 ( laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]) with modifier -52 ( reduced services) attached, says Susan Callaway-Stradley, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C. You probably will be required to submit ...Anyone who has worked in any portion of the medical field has had to learn at least a little bit about CPT codes. These Current Procedural Terminology codes are used to document an...1. Laparoscopic lysis of adhesions. 2. Laparoscopic cholecystectomy w/ intraoperative cholangiogram. adhesions in the right upper quadrant. port placed under direct vision. adhesions were lysis using electrocautery and sharp dissection. Approx 15 min of operative time. peritoneum overlying the gallbladder was incised. I have advised them 50715 is for an open procedure and there currently is no CPT code for a Laparoscopic Ureterolysis. Therfore we've been using 50949 - Unlisted but I'm doubting myself (attaching the operative report to the claim) Case 1 - Uro/GYN. If a physician states he performed a Laparoscopic Ureterolysis during a Supracervical ... myomas with total weight greater than 250 g, abdominal approach $ 1,212 ADHESION LYSIS 58740 Lysis of adhesions (salpingolysis, ovariolysis) $ 937 Example: STEP 1: Procedure Code 3E0 + Body Part L + Approach 0 + Device 5 + Qualifier Z = STEP 2: 3E0L05Z Surgeon CPT& DRG Codes Findings at Surgery: Endometriosis in cul-de-sac, adhesions from omentum to anterior abdominal wall and from sigmoid to left pelvic sidewall. Specimens: Peritoneal biopsies. Estimated Blood Loss: 5 ml. Drains: None. Complications: None. Condition: Stable. Description of Operative Procedure: After obtaining informed consent, the …Help with Ureterolysis coding. After a brief review, I would code this as: 50949 N13.5 {for laparoscopic ureterolysis for retroperitoneal fibrosis. request to value as 50715 open ureterolysis for retroperitoneal fibrosis} 58662-XU ... [ Read More ] Ileal loop urinary diversion WITHOUT cystectomy.1. Laparoscopic lysis of adhesions. 2. Laparoscopic cholecystectomy w/ intraoperative cholangiogram. adhesions in the right upper quadrant. port placed under direct vision. adhesions were lysis using electrocautery and sharp dissection. Approx 15 min of operative time. peritoneum overlying the gallbladder was incised.Jun 9, 2011 ... Laparoscopic lysis of peritoneal adhesions ... Lysis of adhesions of ovary and fallopian tube ... a CPT codes 56304 and 58985 were replaced by code ...58660-59-51 (Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]; Distinct procedural service; multiple procedures) for the adhesions linked to 568.0 (Omental adhesions), 621.5 (Uterine adhesions) and V64.4 (Laparoscopic surgical procedure converted to open procedure)View the CPT® code's corresponding procedural code and DRG. In a click, check the DRG's IPPS allowable, length of stay, and more. ... (hysteroscopy with lysis of intrauterine adhesions). ... [ Read More ] Office visit Procedure for Endometrial Adhesion. New one for me! IF the procedure had been completed, I would use unlisted and compare it to ...Best answers. 0. Nov 12, 2008. #1. How would you code a Laparoscopic cholecystectomy w/intraoperative cholangiogram along with doing lysis of adhesions at the same time. I know you would use CPT 47563 for the cholecystectomy code & the only other lysis of adhesion code I seen was the 44180 because this was done laparoscopically also.There was an obstruction of the distal small bowel from an internal hernia from adhesions. These bands were lysed, all of the bowel was mobilized from the ligament of Treitz to the ileocecal junction. The prior anastomosis was noted, was patent and the obstruction was just distal to this. We assured that the bowel was healthy.44180 Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure) 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) Sources 1. Current Procedural Terminology (CPT®), (2017) – American Medical Association 2. ICD-9-CM Coding Guidelines. (2013, January 1).In the healthcare industry, accurate coding is essential for proper billing and reimbursement. Two important coding systems used are CPT codes and diagnosis codes. These codes play...In this case, the laparoscopic lysis of adhesions (58660, laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]) is the …This procedure is used to treat abdominal and chronic pelvic pain caused by adhesions. Adhesions are scars that form within the body, typically after surgery, as part of the healing process. Physical and Occupational Therapy. Subscribe to Our Patient Newsletter.Question: The physician performed a left salpingo-oophorectomy with drainage of right paratubal cyst and lysis of adhesions. Would the aspiration of the paratubal cyst be included in the salpingo-oophorectomy (58661)? Maryland Subscriber Answer: No. You should report 58661 (Laparoscopy, surgical; with removal of adnexal …Laparoscopic Lysis of Adhesions ... Select your language: ... This procedure is used to treat abdominal and chronic pelvic pain caused by adhesions. Adhesions are ...Same with severe pelvic and abdomial adhesions, resolved. Procedure performed: Operative laparoscopy. LigaSure ligation of pelvic and abdominal adhesions. Op Findings: Anterior abdominal wall to omental adhesions over the entire anterior abdominal wall area adn cholecystectomy scar area of the anterior abdominal wall and …Nov 20, 2023 · The CPT Code for laparoscopic lysis Omental Adhesions is 44180. This code is used to describe a minimally invasive surgical procedure that is performed to remove adhesions that have formed between the omentum, a fatty tissue in the abdomen, and other structures in the abdominal cavity. Adhesions can develop as a result of previous abdominal CPT (R) includes a number of codes which are for lysis of adhesions categorized by location. For example: Tubes and ovaries, 58660 Laparoscopy, surgical; …UPDATE 1/30/15: Watch the updated version of this animation: https://www.youtube.com/watch?v=LVP6JngpgEEThis 3D medical animation shows how adhesions in the ...If laparoscopic lysis of adhesions is the only procedure performed can we code 49329 without the documentation of"extensive". Does that rule only appy when...The correct code for lysis of abdominal adhesions is 44005 (enterolysis [freeing of intestinal adhesion] [separate procedure]), but this procedure is bundled with 44021 (enterotomy, small bowel, other than duodenum; for decompression [e.g., Baker tube]). Therefore, the only procedure that may be billed is 44021, because both the lysis of ...52204 (path cystourethroscopy-biopsy) blepharoplasty of the upper eyelid. 15822 (path blepharoplasty, upper eyelid) (no modifier as upper eyelid is in the description) insertion of temporary prostatic urethral stent. 53855 (path: prostate-urethra-stent insertion, temporary) reference codes 31360-31368 for laryngectomy; what is the correct code ...CPT 44180 is a code used to describe a laparoscopic procedure called enterolysis. This procedure involves the surgical removal of intestinal adhesions, which are fibrous bands that form between tissues and organs, often as a result of previous surgery or injury. Enterolysis is performed using minimally invasive techniques, with small incisions ...Only if dense/extensive adhesions occur that require more effort than is normally required for the laparoscopic procedure can be reported in addition to the primary procedure (code 58660, surgical; with lysis of adhesions (salpingolysis, ovariolysis), can be reported in addition to the primary procedure.The Current Procedural Terminology (CPT ®) code 60650 as maintained by American Medical Association, is a medical procedural code under the range - Laparoscopic Procedures on the Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body.Is it ever acceptable to code lysis of adhesions and drainage of follicular cysts with a hysterectomy? R. rebecca lopez Networker. Local Chapter Officer. Messages 35 Location Whittier, CA Best answers 0. Jan 30, 2009 #2 tah and lysis if your doctor documents that is was Unusual procedure services you can code modifer 22 and send …The CPT code for gallbladder removal surgery is 47562 (laparoscopy, surgical; cholecystectomy). This code is used to bill for the surgical removal of the gallbladder, whether performed using a laparoscopic or open approach. It is important to use the appropriate CPT code when submitting claims for reimbursement and to ensure …CPT 58660 is a surgical procedure that involves the removal of adhesions that have formed around the fallopian tubes and ovaries using a laparoscope. This code is used when the lysis of adhesions is performed as a standalone procedure and not as part of another gynecological surgery.View the CPT® code's corresponding procedural code and DRG. ... 244944"]If laparoscopic lysis of adhesions is the only procedure performed can we code 49329 without ...CPT code 97110 provides information about medical procedures and services to payers and indicate that the procedure involves therapeutic exercises that develop endurance, range of ...In the healthcare industry, accurate coding is essential for proper billing and reimbursement. Two important coding systems used are CPT codes and diagnosis codes. These codes play... Answer: Laparoscopic repair of an Incisional hernia, code 49564 includes mesh placement. Therefore it may not be reported separately. Per CPT, mesh placement is included in all laparoscopic hernia repairs. Scenario #6 You perform an open abdominal procedure on a patient with extensive adhesions from previous surgeries. 58661 Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) This covers laparoscopic left oophorectomy. 58662 Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any...
Laparoscopy (CPT Code: 49320) Laparotomy (CPT Code: 49000) Excision of masses (CPT Code: 49010) Lysis of adhesions (CPT Code: 49002) Each procedure within the exploratory laparotomy requires its own unique CPT code, enabling accurate reporting and billing. By correctly assigning the appropriate CPT code, healthcare providers can …. Dade county department of corrections
For example, if the surgeon must perform extensive lysis of adhesions, 44200 (laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]) cannot be billed in addition to 47562 because the codes are bundled in the national Correct Coding Initiative (just as 44005, the code for open lysis of adhesions, is bundled to ...Best answers. 3. Dec 11, 2017. #4. We do it similarly here. If there are a couple of filmy adhesions, then I am certainly not billing -22. If there is a frozen pelvis, I will put -22 on the surgery. Be prepared to write an appeal letter. Depending on how much additional work/time is spent, I will ask for payment at somewhere around 140% of the ...Greetings, I am inquiring about a CPT code for Lysis of Adhesions. I have been getting an issue with Blue Cross Blue Shield of Illinois when I billed the following codes: 58740. 58720 (Salingo-oophorectomy) M 59. 58563 (Laparoscopy with endometrial ablation) M 59. The payor processed CPT code 58720 as the primary code, however I did not send ...I am looking for direction to properly code Diagnostic Laparoscopy and Lysis of adhesions. The preoperative diagnosis is pelvic pain. The postoperative diagnosis is bowel adhesions. The physician is OB-GYN. The procedure is started and while the surgeon is there he encounters bowel adhesions. I know that it can't be charged as …Best answers. 0. Nov 12, 2008. #1. How would you code a Laparoscopic cholecystectomy w/intraoperative cholangiogram along with doing lysis of adhesions at the same time. I know you would use CPT 47563 for the cholecystectomy code & the only other lysis of adhesion code I seen was the 44180 because this was done laparoscopically also.When you undergo a medical procedure, there’s a corresponding series of numbers that medical professionals use to document the process. This Current Procedural Terminology code hel...Pay attention to more specific abdominal CPT® sections, too. ... with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) These bundles emphasize that +49327 is an add-on code for use with other codes in the same CPT® section. "When indicated you will use + 49327 in conjunction with laparoscopic abdominal, ...Jul 14, 2011 · Unless your doctor is doing the lysis of adhesions as the only procedure it is not separately reportable. If it was extensive and there is time in the op note you can use modifier 22. Laparoscopy, surgical, with lysis of adhesions (salpingolysis, ovariolysis) (separate procedures)44180 Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure) 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) Sources 1. Current Procedural Terminology (CPT®), (2017) – American Medical Association 2. ICD-9-CM Coding Guidelines. (2013, January 1).Laparoscopic lysis of adhesions Laparoscopy procedures often include lysis of (incidental) adhesions, which are not separately billable most of the time. ... In the laparoscopic procedure (code 51992), the endopelvic fascia is opened and a tunnel is dissected between the urethra and vaginal mucosa; sling material (cadaver or synthetic) …Hmm, well without seeing the note, I'd say if the scope was used during the procedure then it's a laparoscopic procedure and then it would be an unlisted code for a lap trachelectomy. Lysis is usually always included in the main procedure but can add a 22 modifier if documentation supports significant extra work..
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