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excision gouty tophi finger cpt

Anyone have any experience with coding excision of a tophus at the interphalangeal joint for gouty arthritis? Cpt Code Excision Of Gouty Tophi Finger - Gout Info Complete absence of all Bill Types indicates Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). No. Try entering any of this type of information provided in your denial letter. Learn how to get the most out of your subscription. Reproduced with permission. "JavaScript" disabled. *Report ICD-10 code E79.9 with ICD-10 code to identify leukemia, lymphoma, or solid tumor malignancy (C80.1, C95.90, C95.91, C95.92, C96.Z, C96.9, Z85.6, Z85.79, or Z85.9, as applicable) AND an ICD-10 code to identify anti-cancer therapy used (Z92.21, Z92.25, Z92.29, or Z92.3, as applicable). A patient is seen at our facility for an excisional debridement of severe gouty tophi of the left index and long finger of the proximal interphalangeal and distal You now have the opportunity to claim CME credit for time spent reading the monthly Bulletin of the American College of Surgeons. Cancel anytime. CPT 28041 Excision, tumor, soft tissue of foot or toe, subfascial (eg. Just no smell. CRs are not policy, rather CRs are used to relay instructions regarding the edits of the various claims processing systems in very descriptive, technical language usually employing the codes or code combinations likely to be encountered with claims subject to the policy in question. The diagnosis was gouty tophus of the interphalangeal joint of the little finger and the op report states a longitudinal incision over the PIP joint and the tophaceous material was removed by rongeur and scissors. DISTINCT PROCEDURAL SERVICE: UNDER CERTAIN CIRCUMSTANCES, THE PHYSICIAN MAY NEED TO INDICATE THAT A PROCEDURE OR SERVICE WAS DISTINCT OR INDEPENDENT FROM OTHER SERVICES PERFORMED ON THE SAME DAY. A patient is seen at our facility for an excisional debridement of severe gouty tophi of the left index and long finger of the proximal interphalangeal and distal interphalangeal joints. Reporting excision of soft tissue tumor codes | The Bulletin NPI Look-Up Tool (National Provider Identifier), The official publication for Level I HCPCS (CPT-4 codes) for hospital providers, Also specific Level II HCPCS codes for hospitals, physicians and other health professionals, Fully searchable through Find-A-Code's Comprehensive Search, Codes mentioned in articles are linked to Code Information pages, Code Information page link back to related articles. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. preparation of this material, or the analysis of information provided in the material. If the soft tissue mass was located in the foot and it appeared to a gouty tophus and it was not affecting a joint, the appropriate CPT codes to consider would be the following: CPT 28039 Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater, CPT 28041 Excision, tumor, soft tissue of foot or toe, subfascial (eg. Appreciable vessel exploration and/or neuroplasty may also be reported separately when performed. Gout attacks can last for numerous days and also also months. MODIFIER CODE 09959 MAY BE USED AS AN ALTERNATE TO MODIFIER -59. Report code 81479 and gene test CYP2B6 in the claim narrative/remarks. Neither the United States Government nor its employees represent that use of such information, product, or processes of every MCD page. Excision of fascial or subfascial soft tissue tumors involves the resection of tumors confined to the tissue within or below the deep fascia but not involving the bone. I had "toe" in my head! Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates. Report code 81479 and gene test BCHE in the claim narrative/remarks. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be In no event shall CMS be liable for direct, indirect, special, incidental, or consequential It may not display this or other websites correctly. Absence of a Bill Type does not guarantee that the required field. apply equally to all claims. The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81479 and Gene Test Nonspecific (NAT). The 2023 edition of ICD-10-CM M1A.0321 became effective on Medicare contractors are required to develop and disseminate Articles. Contactdrmikethecoder.comfor more information. 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". 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. If no CPT code is available for the gene(s) being tested, the unlisted molecular pathology procedure code 81479 should be used as indicated below.Utilization ParametersGermline testing may be performed once in a lifetime per beneficiary.Documentation Requirements. You should probably query the surgeon, I will bet you that he irrigated the joint but didnt document, especially when there is gout expressed from the joint. These tumors are usually benign and are resected without removing a significant amount of surrounding normal tissue. presented in the material do not necessarily represent the views of the AHA. Article document IDs begin with the letter "A" (e.g., A12345). Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period. The Medicare program provides limited benefits for outpatient prescription drugs. All documentation must be maintained in the patient's medical record and made available to the contractor upon request. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81479 and Gene Test IFNL4. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). Drmikethecoder special: Have 5 dates of service audited for $250 (new clients only). gout These courses are an opportunity to sharpen your coding skills. An official website of the United States government. The following ICD-10-CM code supports medical necessity and provides coverage for CPT code: 81479 and Gene Test CYP2B6. To read the full article, sign in and subscribe to the AHA Coding Clinic for HCPCS. Unless specified in the article, services reported under other If this is your first visit, be sure to check out the FAQ & read the forum rules. will not infringe on privately owned rights. For this supplementary claims processing information we rely on other CMS publications, namely Change Requests (CR) Transmittals and inclusions in the Medicare Fee-For-Service Claims Processing Manual (CPM). Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). Report code 81479 and gene test CACNA1S in the claim narrative/remarks. Report code 81479 and gene test CYP4F2 in the claim narrative/remarks. *Report ICD-10 code E11.8 or E11.9 with ICD-10 code(s) to indicate multiple risk factors for cardiovascular heart disease (e.g., E78.2, E78.49, I10, Z68.25-Z68.45, Z72.0, Z82.49). Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. Instructions for enabling "JavaScript" can be found here. CDT is a trademark of the ADA. Learn how to get the most out of your subscription. In most instances Revenue Codes are purely advisory. The codes are scattered throughout the musculoskeletal system subsection, with listings under each anatomical excision subsection. Radical resection of soft connective tissue tumors involves the resection of the tumor with wide margins of normal tissue. The following drugs and associated genes and CPT codes were added to Table 1 (CPIC): fosphenytoin, fluvastatin (CYP2C9/81227), fosphenytoin (HLA-B/81381, 81374), tramadol (CYP2D6/81226, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U), peginterferon alfa-2a, peginterferon alfa-2b (IFNL4/81479), pravastatin, atorvastatin, lovastatin, rosuvastatin, fluvastatin, pitavastatin (SLCO1B1/81328), gentamicin, amikacin, paromomycin, streptomycin, plazomicin, tobramycin (MT-RNR1/81401), and rosuvastatin (ABCG2/0193U). *Dual diagnosis requirement: ICD-10 code C43.0, C43.111, C43.112, C43.121, C43.122, C43.21, C43.22, C43.31, C43.39, C43.4, C43.51, C43.52, C43.59, C43.61, C43.62, C43.71, C43.72, C43.8 or C43.9 must be reported with ICD-10 code C77.9 to indicate nodal involvement. Genes assayed on the same date of service are considered to be assayed in parallel if the result of one assay does not affect the decision to complete the assay on another gene, and the two genes are being tested for the same indication. More than 10 years later, however, questions continue to arise about appropriate code selection and separately reportable services. Also, the Affected Subgroups in Table 2 was updated for pantoprazole, irinotecan and tramadol. CMS and its products and services are The following ICD-10-CM codes were added to the ICD-10-CM Codes that Support Medical Necessity section for Code Group 5: T38.3X5A and for Code Group 8: B51.0, B51.8, B51.9, D74.8, L70.0, M1A.0110, M1A.0111, M1A.0120, M1A.0121, M1A.0210, M1A.0211, M1A.0220, M1A.0221, M1A.0310, M1A.0311, M1A.0320, M1A.0321, M1A.0410, M1A.0411, M1A.0420, M1A.0421, M1A.0510, M1A.0511, M1A.0520, M1A.0521, M1A.0610, M1A.0611, M1A.0620, M1A.0621, M1A.0710, M1A.0711, M1A.0720, M1A.0721, M1A.08X0, M1A.08X1, M1A.09X0, M1A.09X1, M1A.1110, M1A.1111, M1A.1120, M1A.1121, M1A.1210, M1A.1211, M1A.1220, M1A.1221, M1A.1310, M1A.1311, M1A.1320, M1A.1321, M1A.1410, M1A.1411, M1A.1420, M1A.1421, M1A.1510, M1A.1511, M1A.1520, M1A.1521, M1A.1610, M1A.1611, M1A.1620, M1A.1621, M1A.1710, M1A.1711, M1A.1720, M1A.1721, M1A.18X0, M1A.18X1, M1A.19X0, M1A.19X1, M1A.2110, M1A.2111, M1A.2120, M1A.2121, M1A.2210, M1A.2211, M1A.2220, M1A.2221, M1A.2310, M1A.2311, M1A.2320, M1A.2321, M1A.2410, M1A.2411, M1A.2420, M1A.2421, M1A.2510, M1A.2511, M1A.2520, M1A.2521, M1A.2610, M1A.2611, M1A.2620, M1A.2621, M1A.2710, M1A.2711, M1A.2720, M1A.2721, M1A.28X0, M1A.28X1, M1A.29X0, M1A.29X1, M1A.3110, M1A.3111, M1A.3120, M1A.3121, M1A.3210, M1A.3211, M1A.3220, M1A.3221, M1A.3310, M1A.3311, M1A.3320, M1A.3321, M1A.3410, M1A.3411, M1A.3420, M1A.3421, M1A.3510, M1A.3511, M1A.3520, M1A.3521, M1A.3610, M1A.3611, M1A.3620, M1A.3621, M1A.3710, M1A.3711, M1A.3720, M1A.3721, M1A.38X0, M1A.38X1, M1A.39X0, M1A.39X1, M1A.4110, M1A.4111, M1A.4120, M1A.4121, M1A.4210, M1A.4211, M1A.4220, M1A.4221, M1A.4310, M1A.4311, M1A.4320, M1A.4321, M1A.4410, M1A.4411, M1A.4420, M1A.4421, M1A.4510, M1A.4511, M1A.4520, M1A.4521, M1A.4610, M1A.4611, M1A.4620, M1A.4621, M1A.4710, M1A.4711, M1A.4720, M1A.4721, M1A.48X0, M1A.48X1, M1A.49X0, M1A.49X1, N30.00* and N30.01* (with associated asterisk note). In addition, adjacent tissue transfer, flaps, and grafts may be reported separately when all the technical aspects of these closure procedures have been performed. GOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION, PRODUCT, OR PROCESSES Here are some hints to help you find more information: 1) Check out the Beneficiary card on the MCD Search page. CPT codes 81355 (VKORC1) and 81227 (CYP2C9) are not considered medically reasonable and necessary for warfarin testing. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). What is the difference between excision of subcutaneous/subfascial tumors and radical resection of soft connective tissue tumors? CPT coding guidelines are clear that excision of benign lesions of cutaneous origin, such as a sebaceous cyst, should be reported using codes 1140011446 and radical resection of malignant tumors of cutaneous origin (for example, melanoma that requires excision of the underlying soft tissue) should be reported with codes 1160011646. Enjoy a guided tour of FindACode's many features and tools. Please Note: For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes remain located in LCDs. It may not display this or other websites correctly. Excision Gout Tophus | TLD Systems THE 2022 Podiatry Coding Manual is now available in either Book or Flashdrive formats. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. It can strike at any part of the body, but it typically impacts the joints of the feet really often. Look for a Billing and Coding Article in the results and open it. View all the articles associated with any code, right from the code page. We NEVER sell or give your information to anyone. *Dual diagnosis requirement: ICD-10 code R11.2 must be reported with ICD-10 code Z48.89, Z51.0 or Z92.21. However, if a lab runs more than two distinct procedural services from this list on a single date of service, then the lab must use the 59 modifier with each additional service billed as an attestation that it is a distinct procedural service. Tophi often look like swollen, bulbous growths on your joints just under your skin. DISCLOSED HEREIN. The deadline to claim CME credit for the March issue is May 31, 2022. The margins refer to the most narrow margin required to adequately excise the tumor based on the physicians judgment. In order for CMS to change billing and claims processing systems to accommodate the coverage conditions within the NCD, we instruct contractors and system maintainers to modify the claims processing systems at the national or local level through CR Transmittals. The CPT/HCPCS Codes and ICD-10-CM Codes that Support Medical Necessity sections were revised to add the following new groups effective for dates of service on and after 02/07/2022: Group 15 for CPT code 81401, Group 21 for CPT code 81479 and gene test IFNL4, and Group 24 for CPT code 0193U and all subsequent groups were renumbered accordingly in both sections. CPT 27619 Excision, tumor, soft tissue of leg or ankle area; subfascial (e.g. that coverage is not influenced by Bill Type and the article should be assumed to *Dual diagnosis requirement: ICD-10 code B18.0, B18.1, or B18.2 must be reported with ICD-10 code K76.9 to indicate compensated liver disease. 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. *When reporting ICD-10 codes N39.41 or N39.46, also report ICD-10 code N32.81 for any associated overactive bladder. Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. This question has been bounced around a bit, but I am not 100% convinced my coding is correct on this one: OP note states, "..incision carried to the subcu, gouty tophus was encountered and removed with scissors and curette. Was your Medicare claim denied? Radical resection of soft tissue tumors is most commonly used for malignant connective tissue tumors or very aggressive benign connective tissue tumors. CMS and its products and services are not endorsed by the AHA or any of its affiliates. CPT 28024 Arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal joint, If the soft tissue mass was located in the foot and it appeared to a gouty tophus and it was not affecting a joint, the appropriate CPT codes to consider would be the following: The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81306, 81335, and 0286U. Deep Soft Tissue Tumor excision CPT Codes - eatonhand.com It has been completely updated including the E/M coding changes. The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81226, 81418, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, and 0076U. 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. The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81479 and Gene Test BCHE. The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 0193U. CPT 28045 Excision, tumor, soft tissue of foot or toe subfascial (e.g. Tagged as: CPT codes, soft tissue tumor codes, surgical care coding, Bulletin of the American College of Surgeons The following ICD-10-CM codes were added to the ICD-10-CM Codes that Support Medical Necessity section for Code Group 2: C25.4*, C64.1*, C64.2*, C65.1*, C65.2*, C66.1*, C66.2*, C67.0*, C67.1*, C67.2*, C67.3*, C67.4*, C67.5*, C67.6*, C67.7*, C67.8*, C68.0*, C68.1*, C68.8*, C7A.093*, D13.7*, D18.02*, D32.0*, D32.1*, D33.0*, D33.1*, D33.3*, D33.4*, D33.7*, I42.1, and L20.89 with associated asterisk note. MODIFIER -59 IS USED TO IDENTIFY PROCEDURES/SERVICES THAT ARE NOT NORMALLY REPORTED TOGETHER, BUT ARE APPROPRIATE UNDER THE CIRCUMSTANCES. 26080 would be the appropriate code if you can get that clarified. If the soft tissue mass that appeared to be a gouty tophus was located in the ankle on the lateral aspect, clearly it would be affecting the joint. Discover how to save hours each week. WebDeep Soft Tissue Tumor excision CPT Codes. The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81225 and 81418. If your session expires, you will lose all items in your basket and any active searches. JavaScript is disabled. www2-stage.aapc.com I don't see the code (26808) you wrote - but I guess I'd lean towards 28092 with the info you've given. The AMA does not directly or indirectly practice medicine or dispense medical services. See Table 1 for a list of all codes and their respective 2021 Medicare Physician Fee Schedule relative value units (RVUs). CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. 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. authorized with an express license from the American Hospital Association. Chicago, IL 60611. The only other alternatives seem to be 26115, 26210 or debridement. The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81226 and 81418. 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. *This response is based on the best information available as of 12/16/21. If you need more information on coverage, contact the Medicare Administrative Contractor (MAC) who published the document. not endorsed by the AHA or any of its affiliates. The AHA Coding Clinic for HCPCS includes: Thank you for choosing Find-A-Code, please Sign In to remove ads. 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. intramuscular); less than 1.5 cm, If the soft tissue mass that appeared to be a gouty tophus was located in the ankle on the lateral aspect, clearly it would be affecting the joint. However, please note that once a group is collapsed, the browser Find function will not find codes in that group. The price is still only $125 including shipping! If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. All rights reserved. The Coding Guidance section has been revised to add coding information for CPT code 81418. CPT 27618 Excision, tumor, soft tissue of leg or ankle area; subcutaneous; less than 3 cm The list of results will include documents which contain the code you entered. The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, The AMA does not directly or indirectly practice medicine or dispense medical services. 633 N. Saint Clair St. Our coders were instructed to code this procedure to an excision of tumor. You can use the Contents side panel to help navigate the various sections. No, he does not say that he has gone into the joint, but says that upon incision gouty tissue was immediately encountered from the PIP joint and was removed by rongeur and scissors. Superficial Skin Lesion; Skin Lesion - Benign; Skin Lesion - Malignant; Bursa / Ganglion/Synov; Deep Soft Tissue Tumor; Deep Skeletal Tumor; Excision subcutaneous soft tissue tumor; upper arm or elbow (24075) Excision, tumor, upper arm or elbow area; deep, subfascial The 2023 edition of ICD-10-CM M10.041 became effective on October 1, 2022. Copyright © 2022, the American Hospital Association, Chicago, Illinois. Applicable FARS\DFARS Restrictions Apply to Government Use. Back to Local Coverage What's New Report Results, ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, A52986 - Billing and Coding: Biomarkers for Oncology, A56541 - Billing and Coding: Biomarkers Overview, A58929 - Response to Comments: Pharmacogenomics Testing. This column responds to these questions and offers clarity to coding confusion for this set of codes. This group was also revised to add ICD-10 codes in relation to Gene/Test CYP2C9 for phenytoin. *Dual diagnosis requirement: ICD-10 code C34.90 must be reported with ICD-10 code Z92.21 to identify personal history of antineoplastic chemotherapy. Coding InformationWhen more than two codes from this list are submitted for the same beneficiary on the same date of service, the claims processing system will deny every code submitted after the first two services. The procedure consists of cutting a tophus out while keeping as much of the Some articles contain a large number of codes. Once tophus had been debrided and cultures taken, wound was irrigated, etc" Because he doesn't document removing bone I'm thinking 26116 (reasoning, he went to bone so it would have to be subfascial). The ICD-10-CM Codes that Support Medical Necessity, Group 5 for CPT code 81227 was revised to remove ICD-10 codes in this regard. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81328. ONLY IF NO MORE DESCRIPTIVE MODIFIER IS AVAILABLE, AND THE USE OF MODIFIER -59 BEST EXPLAINS THE CIRCUMSTANCES, SHOULD MODIFIER -59 BE USED. For a better experience, please enable JavaScript in your browser before proceeding. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. *Report ICD-10 code C65.1, C65.2, C66.1, C66.2, C67.0, C67.1, C67.2, C67.3, C67.4, C67.5, C67.6, C67.7, C67.8, C67.9, C68.0, or C68.8 with an ICD-10 code to identify anti-cancer therapy used (Z92.21, Z92.25 and/or Z92.29, as applicable). 4) Visit Medicare.gov or call 1-800-Medicare. that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. intramuscular); less than 5 cm. All other Codes (ICD-10, Bill Type, and Revenue) have moved to Articles for DME MACs, as they have for the other Local Coverage MAC types. WebCPTMusculoskeletal Excision of subcutaneous soft tissue tumors Simple & Intermediate repair bundled Confined to subcutaneous tissue below the skin, butabove the deep fascia Usually benign Code selection based on location and size of tumor Size determined by greatest diameter of tumor plusmost narrow margin necessary for excision 10 Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. No fee schedules, basic unit, relative values or related listings are included in CPT. The submitted CPT/HCPCS code must describe the service performed. intramuscular); less than 1.5 cm If the soft tissue mass that appeared to be a gouty Many offices across the country consider this to be their Bible when it comes to coding, billing and documentation. Gout arthritis and joint inflammation are linked due to the fact that several way of living aspects, such as excess weight, high blood pressure, bad diet and absence of exercise, can bring about the growth of the joint problem. Surgeon gave MBS number You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. recommending their use. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. You also will be provided online access to the KZA alumni site, where you will find additional resources and frequently asked questions about correct coding. The contractor information can be found at the top of the document in the, Please use the Reset Search Data function, found in the top menu under the Settings (gear) icon. registered for member area and forum access. The contractor information can be found at the top of the document in the Contractor Information section (expand the section to see the details). The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81283. 2) Try using the MCD Search and enter your information in the "Enter keyword, code, or document ID" box.

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excision gouty tophi finger cpt