View matching HCPCS Level II codes and their definitions. His history is significant for COPD, diabetes controlled with an insulin pump, and testicular cancer treated with bleomycin twenty years ago. Question ID : 15563. Nutritional status, directly impacting the ability of the postoperative site to heal, should be ascertained, including measurement of prealbumin, albumin, glycosylated hemoglobin, and total lymphocyte count. Conviction is just one of more than 130 such criminal cases involving 80 million A federal jury convicted a Colorado physician Jan. 13 for misappropriating about 250000 from two separate COVID19 relie Can depression increase the risk of heart disease In recent years scientists have attempted to establish a link between depression and heart disease. The fibularis longus and fibularisbrevis tendons insert into the lateral fibula. Which of the following amputations will lead to the greatest oxygen requirement per meter walked following prosthesis fitting? endstream endobj startxref (OBQ10.2) ICD-9-CM V49.75 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, V49.75 should only be used for claims with a date of service on or before September 30, 2015. A 66-year-old male sustains an open crush injury to his right lower leg with significant skin loss. There are several ways to perform a BKA, one of the most significant differences being guillotine versus completed amputation. Improved performance on the Sickness Impact Profile (SIP) questionnaire, Physicians were more satisfied with the cosmetic appearance, Decreased dependence with patient transfers. Which one of the following lower extremity amputations requires a soft-tissue balancing procedure to prevent deformity following amputation? JFIF C @=O\[Y^J]Z?xB{ (@>7D |M'0j3\q6`]kb8IKNS ED#k !mht2" 9Q Search across Medicare Manuals, Transmittals, and more. Influence of Immediate and Delayed Lower-Limb Amputation Compared with Lower-Limb Salvage on Functional and Mental Health Outcomes Post-Rehabilitation in the U.K. Military. Her ankle-brachial index (ABI) for her right posterior tibial artery is 0.4. Phantom limb pain, or the perception of pain or troubling sensation in the missing limb, is a common complaint. CPT Code Defined Ctgy Description 23900 Interthoracoscapular amputation (forequarter) . A through-knee disarticulation has been shown to have what advantage over a traditional above-knee (transfemoral) amputation? community guidelines. Regarding Syme amputations, which of the following is true? Taylor BC, Poka A. Osteomyoplastic Transtibial Amputation: The Ertl Technique. In this procedure, the provider amputates the patient's leg below the knee without leaving a skin flap. In all urgent cases, close communication between all team members is critical. Thenutrientartery supplies the diaphysis. Narula N, Dannenberg AJ, Olin JW, Bhatt DL, Johnson KW, Nadkarni G, Min J, Torii S, Poojary P, Anand SS, Bax JJ, Yusuf S, Virmani R, Narula J. thank you Katie - nice to hear from you and hope all is well. Given the difficulty of managing and operating circumferentially on a lower extremity, a first surgical assist and often a second are exceedingly helpful if available. Category I CPT Codes Consist of six main sections known as Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine. Definitive source control/debridement is critical, yet there is typically the time to optimize a patient over a few hours or days medically. endstream endobj 724 0 obj <>/Metadata 83 0 R/OCProperties<>/OCGs[752 0 R]>>/Outlines 91 0 R/PageLayout/SinglePage/Pages 715 0 R/StructTreeRoot 162 0 R/Type/Catalog>> endobj 725 0 obj <>/ExtGState<>/Font<>/Pattern<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 726 0 obj <>stream Pathology of Peripheral Artery Disease in Patients With Critical Limb Ischemia. Stahel PF, Oberholzer A, Morgan SJ, Heyde CE. What important step was forgotten during the amputation? ICD-10: Routine Aftercare Following Amputation (Coding Tip by PPS Plus) - Feb 2016. To plug inpatient facility revenue drains, subscribe to, Crosswalk to an anesthesia code and its base units, and calculate payments in a snap! A below-knee amputation ("BKA") is a transtibial amputation that involves removing the foot, ankle joint, distal tibia, and fibula with related soft tissue structures. (SBQ20TR.15) Which of the following is true of a knee disarticulation as compared to a transtibial amputation? [9], The penetrating branches of theposterior tibial artery supply the distal metaphysis and epiphysis from the periphery.[10]. Beyaz S, Gler , Bar G. The stump is dressed with a sterile dressing and placed into a well-padded splint or knee immobilizer. Chiodo CP, Stroud CC. (OBQ08.235) AHA Coding Clinic for HCPCS - 2016 Issue 2; Ask the Editor Excision pressure wound from the below-knee amputation stump with complex closure. We know we should query MDs to specify the root operation in terms for coding -- but this is a different level of definition. CPT 27886 Amputation, leg, through tibia and fibula; re-amputation . Which of the following statements best describes the forces resulting in this deformity? These nerves supply the dorsal surface of the foot, except for the dorsal webbed space between the first and second toe. Operative debridement and irrigation within 1 hour of injury. As with all surgical procedures, there are possibleacute complications of uncontrolled bleeding, infection, acute postoperative pain, and broader medical complications, including acute blood loss anemia and stress-induced cardiac ischemia. Ultimately, there are many forms of prosthetics for lower limbs, and patient preference, condition, and insurance, among other factors, will dictate which prosthetic is the best long-term option. View any code changes for 2023 as well as historical information on code creation and revision. This contains the peroneus longus and brevis and the superficial branch of the peroneal nerve for much of its course. %%EOF Which type of deformity is the most likely complication of this procedure? (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury. Thorud JC, Plemmons B, Buckley CJ, Shibuya N, Jupiter DC. Intravenous (IV) antibiotics are an important adjunct to operative treatment in these cases, limiting morbidity associated with a systemic bacterial infection. [4]The rates of lower extremity amputation have declined in recent years, but 3500trauma-relatedamputations are still performed in the United States each year. Describe the postoperative management of a patient who has undergone a below-the-knee amputation. Similarly, patients with chronic pain from lower extremity traumamay undergo a BKA as a palliative or similarly functionalmeasure, often withsatisfactory results. Van Den Hoven P, Van Den Berg SD, Van Der Valk JP, Van Der Krogt H, Van Doorn LP, Van De Bogt KEA, Van Schaik J, Schepers A, Vahrmeijer AL, Hamming JF, Van Der Vorst JR. Assessment of Tissue Viability Following Amputation Surgery Using Near-Infrared Fluorescence Imaging With Indocyanine Green. This is an AAOS Self Assessment Exam (SAE) question. [5]This surgical operation carries significant morbidity, yet it remains a treatment modality with vital clinical and often life-saving significance given appropriate indications. It allows for eversion and dorsiflexion. When discussing the amputation levels with the patient, which of the following should be noted to require the greatest increase in energy expenditure for ambulation? A 25-year-old male presents to the emergency department with a mangled lower extremity that is not salvageable. 33\ 8Xe97F2(v%"hjx^rE?Jg/!ghkgs+;R|gw3# :Z"(0E83ACg^0(w {T@RBhi`T Morisaki K, Matsubara Y, Kurose S, Yoshino S, Furuyama T. Evaluation of three nutritional indices as predictors of 2-year mortality and major amputation in patients with chronic limb-threatening ischemia. The patient should be prepped and draped supine, with a bump placed under the ipsilateral hip to internally rotate the operative extremity such that the knee and ankle are vertically oriented. The arterial supply to the tibia is multifaceted. ABI of 0.4 for the posterior tibial artery. A 70-year-old female with a history of poorly controlled diabetes mellitus presents with purulent ulcers along the plantar aspect of her right forefoot and exposed metatarsal bone. The extensor digitorum longus and extensor hallucis longus tendons insert on the medial fibula. Also valuable to this operation is a tourniquet, fluoroscopy, large amputation blade, oscillating bone saw or manual saw, drill and bit set for performing myodesis of muscle to bone ends, silk hand ties, rongeur, and a suction drain. Removal of the "dog ears", indicated by the red arrows, could cause direct damage to what vasculature leading to flap necrosis? (OBQ06.53) Documenting that a "below-the-knee amputation" took place really isn't sufficient. Ask Dr. Z Knowledge Base houses over 7,500 coding questions and answers dating back to 2013. Parker W, Despain RW, Bailey J, Elster E, Rodriguez CJ, Bradley M. Military experience in the management of pelvic fractures from OIF/OEF. The fascia is incised, and the muscles are carefully divided into the tibia and fibula. The January 2023 update to the HCPCS Level II code file from the Centers for Medicare 38 Medicaid Services CMS inclu Surgical Procedures on the Musculoskeletal System, Surgical Procedures on the Leg (Tibia and Fibula) and Ankle Joint, Amputation Procedures on the Leg (Tibia and Fibula) and Ankle Joint, Copyright 2023. (OBQ09.201) Leg Compartment Release - Single Incision Approach, Leg Compartment Release - Two Incision Approach, Arm Compartment Release - Lateral Approach, Arm Compartment Release - Anteromedial Approach, Shoulder Hemiarthroplasty for Proximal Humerus Fracture, Humerus Shaft ORIF with Posterior Approach, Humerus Shaft Fracture ORIF with Anterolateral Approach, Olecranon Fracture ORIF with Tension Band, Olecranon Fracture ORIF with Plate Fixation, Radial Head Fracture (Mason Type 2) ORIF T-Plate and Kocher Approach, Coronoid Fx - Open Reduction Internal Fixation with Screws, Distal Radius Extra-articular Fracture ORIF with Volar Appr, Distal Radius Intraarticular Fracture ORIF with Dorsal Approach, Distal Radius Fracture Spanning External Fixator, Distal Radius Fracture Non-Spanning External Fixator, Femoral Neck Fracture Closed Reduction and Percutaneous Pinning, Femoral Neck FX ORIF with Cannulated Screws, Femoral Neck Fracture ORIF with Dynamic Hip Screw, Femoral Neck Fracture Cemented Bipolar Hemiarthroplasty, Intertrochanteric Fracture ORIF with Cephalomedullary Nail, Femoral Shaft Fracture Antegrade Intramedullary Nailing, Femoral Shaft Fracture Retrograde Intramedullary Nailing, Subtrochanteric Femoral Osteotomy with Biplanar Correction, Distal Femur Fracture ORIF with Single Lateral Plate, Patella Fracture ORIF with Tension Band and K Wires, Tibial Plateau Fracture External Fixation, Bicondylar Tibial Plateau ORIF with Lateral Locking Plate, Tibial Plafond Fracture External Fixation, Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation, Ankle Simple Bimalleolar Fracture ORIF with 1/3 Tubular Plate and Cannulated Screw of Medial Malleol, Ankle Isolated Lateral Malleolus Fracture ORIF with Lag Screw, Calcaneal Fracture ORIF with Lateral Approach, Plate Fixation, and Locking Screws, RETIRE Transtibial Below the Knee Amputation (BKA), if severe vascular dysfunction may require revascularization procedure prior to amputation, check with nutrition labs: albumin, prealbumin, transferrin, total lymphocyte count, severe soft tissue injury has the highest impact on decision whether to amputate or reconstruct lower extremity in trauma cases, need to assess associated injuries and comorbidities (diabetes), traditional short BKA increases baseline metabolic cost of walking by 40%, AP/Lat views of foot, ankle, and tibia/fibula, MRI of the to look for integrity of soft tissue and infection, documents failure of nonoperative management, describes accepted indications and contraindications for surgical intervention, independence with mobility and ambulation with mobility devices, progress weightbearing and weight shifting exercises, perform rehabilitation exercises independently, return to high level/high impact exercises, begin shrinker once wounds are closed, healed and dry, transition to liner when prosthetist feels appropriate, diagnose and management of early complications, diagnosis and management of late complications, check neurovascular status to determine level of amputation, describe complications of surgery including, wound breakdown (worse in diabetics, smokers, vascular insufficiency), describes the steps of the procedure to the attending prior to the start of the case, describe potential complications and steps to avoid them, place small bump under ipsilateral hip to internally rotate the leg, mark the anterior incision 10cm distal to tibial tubercle, this incision is also15cm from knee joint line, anterior incision 2/3 total circumference, posterior incision 1/3 total circumference, mark out the posterior flap so that it is 1.5 times the length of the anterior flap, this is extremely important because it allows for redundant posterior flap upon closure, the posterior flap should be distal to the musculotendinous junction of the gastrocnemius, round out the distal ends of the posterior skin flap to reduce redundancy of skin upon closure, incise the entire circumference of the skin incision through the underlying fascia, direct the vertical incison over the anterior crest of the tibia to facilitate exposure of the anterior periosteal flap, identify the superficial and deep peroneal nerves, place gentle traction and resect nerves using sharp dissection, sharply dissect through the anterior compartment musculature at the most proximal end of the wound, this reduces bulk and makes the myodesis easier, identify, isolate and ligate the anterior tibial artery, elevate the perosteal flap using a single blade wide chisel, sharply incise the anterior and posterior margins of the anteriormedial tibia for 8 to 10 cm distally, raise the flap with the bevel positioned superiorly, protect the flap using a moist gauze sponge, isolate the rest of the tibia with a periosteal elevator, divide the interosseus membrane and identify the fibula, perform cut of the fibula several centimeters distal to the tibia cut, the proximal cut of the fibula is at the level of the distal tibia cut, elevate the periosteum of the fibula at this level of the cut and continue elevating for 1 cm distally, cut a notch into the posterolateral tibia to house the fibula, secure the bone bridge with non absorbable suture through holes that are made through the lateral aspect of the fibula, through the medullary canal of the transverse fibula to the medial aspect of the tibia, without a bone bridge approximately 1 cm proximal to the tibia cut at a lateral angle, distance from the lateral tibia to the media fibula, make fibula cut this distance plus 2 cm proximal to the tibia cut, use a power saw with irrigation to make the tibia cut, transect and taper the posterior musculature, this is done to provide a tension free myodesis, this should be performed at the level of the tibial bone cut, identify and dissect the tibial nerve from the vasculature, inject the nerve with 1% lidocaine then sharpy transect under gentle traction, identify and ligate the posterior tibial artery with ligature suture, ligate the veins with vasvular clips or ligature suture, resect remaining posterior compartment to the level of the distal tibia cut, begin the bevel outside of the medullary canal at 45 degree angle, drill holes just anterior to the bone bevel for myodesis, use a locking style Krackow suture through the gastroc apneurosis and secure it to the tibia, secure the borders of the gastrocnemius to the proximal anterior fascia, recheck for remaining peripheral bleeders, skin closure with 2-0 nylon (vertical/horizontal mattress), do not want to overly tighten skin as this can necrosis edges, soft incision dressing well padded to reduce pressure in incision, continue postoperative antibiotics until the drain is removed, order and interprets basic imaging studies, independent gait training with a walker or crutches, return balancing and conditioning to normal, appropriate medical management and medical consultation. 139 0 obj <>/Filter/FlateDecode/ID[<34F1831025982756D8AB8A2E92B86786><15F3D9AE19388C44911A30AD3602344A>]/Index[120 29]/Info 119 0 R/Length 107/Prev 820316/Root 121 0 R/Size 149/Type/XRef/W[1 3 1]>>stream A below-the-knee amputation (BKA) is a transtibial amputation that involves removing the foot, ankle joint, distal tibia, fibula, and corresponding soft tissue structures. A total of 478 nerves were transferred as TMR/vRPNI units, with the mean number of 3.9 TMR/vRPNI units per limb amputation site. (SBQ18FA.66) of the secondary closure. (OBQ18.255) CPT 27884 and 11044 - further excision of bone prior to secondary wound closure, Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare. The presence and proximal extent of any neuropathy can be determined via physical exam and monofilament testing, impacting the appropriate operative level. Torres AL, Ferreira MC. A long posterior skin flap and unequal (skewed) anterior and posterior muscle and skin (myocutaneous) flapshave been widely used. After BKA, floor nursing plays a significant role in managing pain, recording drain outputs, and informing the covering physicians of any change in vital signs or overall status. The lymphatic drainage of the tibia and fibula is to the superficial and deep inguinal lymph nodes. In the peri-surgical environment surrounding a BKA, close communication across all healthcare disciplines forming the interprofessional team is paramount. 3 This is the American ICD-10-CM version of Z89.511 - other international versions of ICD-10 Z89.511 may differ. This will also show the extent of osteomyelitis and associated soft tissue fluid collections if present. (OBQ04.227) These are branches of the deep femoral nerve and the tibial nerve. Each major artery, including the anterior and posterior tibial, is identified and ligated with a silk tie. ICD-10-CM Diagnosis Code S88.111A [convert to ICD-9-CM] Complete traumatic amputation at level between knee and ankle, right lower leg, initial encounter Complete traum amp at lev betw kn and ankl, r low leg, init; Traumatic amputation below right knee; Traumatic right below knee amputation ICD-10-CM Diagnosis Code S88.112A [convert to ICD-9-CM] (OBQ10.162) 0x6k0z8. Each nerve is injected with 1% lidocaine (optional), placed under gentle traction, and sharply divided with a fresh scalpel blade. [29], Chronic complications of BKAs include the development of painful neuromas from transected nerves, highlighting the importance of proper intraoperative technique as described above. Please note this question was answered in 2021. . Yes, I think the guidance would be the same. Additional Amputation Codes CPT 27882 Amputation, leg, through tibia and fibula; open, circular (guillotine) CPT 27884 Amputation, leg, through tibia and fibula; secondary closure or scar revision . This root operation defines a broad range of common procedures, since it can be used anywhere in the body to treat a variety of conditions, including skin and genital warts, nasal and colon polyps, esophageal varices, endometrial implants, and nerve lesions. The Burgess technique was later modified by Lutz Brckner to address the specific limitations of occlusive arterial disease. nFZU,I O;KoEdUSFyOO~mKutru!jv7Y{]/s-Wz\weogpR9pDZ4v?R>-oV2j}2E4 ,g6YzgdAiYXM`CN1O{1r"2pG;!"NA >K"OD`RHLWFd]. In cases of profound vascular insufficiency, bypass grafting or the placement of stents may be necessary before performing a BKA. Type of incision for below knee amputation. Label Printers. [31], Therefore,for frail or elderly patients, this is a procedure that must be undertaken in conjunctionwith nutritionalguidance and an overall discussion of patient health and mobility. The level of amputations for the entire cohort consisted of 6 shoulder disarticulations, 11 transhumeral amputations, 9 transradial amputations, 46 above knee amputations, and 47 below knee amputations. To plug inpatient facility revenue drains, subscribe to, Crosswalk to an anesthesia code and its base units, and calculate payments in a snap! Lower extremity amputation is planned to address non-viable lower extremity tissue for many reasons, including ischemia, infection, trauma, or malignancy. for A BKA, the Midshaft region would be mid, distal would be low, and proximal would be high. Copyright 2023 Lineage Medical, Inc. All rights reserved. A standard orthopedic operative set is essential. %%EOF . Four fascial compartments in the lower leg contain muscles to the leg and foot and critical neurovascular structures. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. These include urgent cases where source control of necrotizing infections or hemorrhagic injuries outweighs limb preservation. The indications for Below-Knee Amputation (BKA) are expansive and etiologic subgroups are not well defined. I hope this helps! ICD-10-PCS code 0Y6H0Z1 for Detachment at Right Lower Leg, High, Open Approach - Billable! Z89.512 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Wang K, Ye Y, Huang L, Wu R, He R, Yao C, Wang S. The Long Non-coding RNA AC148477.2 Is a Novel Therapeutic Target Associated With Vascular Smooth Muscle Cells Proliferation of Femoral Atherosclerosis. Patient presents for excision of a pressure wound from the below-knee amputation (BKA) stump. Which of the following has the most impact on the decision to attempt limb salvage versus amputation? Allowing the sciatic nerve to retract deep into the soft tissue. $30 (Cs? r (OBQ04.11) In addition to lengthening the Achilles, transfer of which tendon is most important for functional ambulation after performing a Chopart amputation of the foot? w !1AQaq"2B #3Rbr In general, below-the-knee amputations are associated with better functional outcomes than above-the-knee amputations. 2 The 2021 edition of ICD-10-CM Z89.511 became effective on October 1, 2020. Patient had a guilloti as Bella said for the re-amputation they have to be under the primary surgery site/code and there are two re-amps.1. secondary closure or scar revision is with no bone involvement and 2. re-amputa Read a CPT Assistant article by subscribing to. AMPUTATION, BELOW KNEE AMPUTATION LEG BELOW KNEE *27880 Amputation, leg, through tibia and fibula; Vascular, Orthopedics . It is important to note that an individual's metabolic demands with ambulation will rise significantly after a BKA, although this depends partly on the postoperative maintenance of lower extremity muscle strength. (#Ur5- u$59\|-a2yY5RnrwytqIszh(GQ~ps45>P"o.K8*NJOfVKi+{x' B9ltzASM=h.E2ZM@mp+k( Optimal surgical preparation of the residual limb for prosthetic fitting in below-knee amputations. Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies. Multiple limb salvage attempts for diabetic foot infections: is it worth it? Conversely, in cases of acute hemorrhage, local tourniquets may be applied for several hours while resuscitation occurs. endstream endobj 730 0 obj <>stream Which of the following deformities is most common after the amputation shown in Figure A? View the CPT code's corresponding procedural code and DRG. endstream endobj startxref Trauma is the next leading cause of lower-extremity amputations. Subscribe to. Inflammatory labs, including ESR and CRP, are important in determining the presence, degree, and acuteness of infection. tenodesing the extensor digitorum longus to the tibial shaft. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. A 33-year-old man requires a transfemoral amputation because of a mangling injury to his leg. Extensor digitorum longus originates at the lateral condyle of thetibia. }>#fFn{Du2C"c4xqO|Xd8]esHJhKhA The sural nerve is a cutaneous branch of the tibial nerve and provides sensory for the anteromedial lower leg. A corresponding procedure code must accompany a Z code if a procedure is performed. Horizontal head of semimembranosus muscle inserts on the medial condyle. supports all conditions were evaluated. 0 (OBQ18.31) A physical exam is also important to determine soft tissue viability; in cases of severe trauma, the wound may need to demarcate for several days until it is clear at what level the limb is salvageable. American Hospital Association ("AHA"), Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare. These patients are typically sick with multiple significant comorbidities and a chronic progressive or waxing/waning course of illness. Tensor fasciae latae inserts on the lateral (Gerdy) tubercle of thetibia. People Also Searches icd . For FREE Trial. H\N0y Shoulder360 The Comprehensive Shoulder Course 2023. This artery penetrates the tibia posteriorly, distal to thesolealline near the center of the tibia, and sends branches towards the proximal and distal ends of the diaphysis. View matching HCPCS Level II codes and their definitions. CPT code information is copyright by the AMA. If the guillotine is at the ankle, would it be more appropriate to bill a straight below-knee amputation code (27880)? A thigh tourniquet may be placed in a nonsterile fashion as high as possibleabove the knee to prep and expose as much of the extremity as possible, or a sterile tourniquet may be applied after the patient is draped. A small hole is placed with a drill in the distal tibial shaft; the gastrocnemius aponeurosis is secured via anonabsorbable suture. StatPearls Publishing, Treasure Island (FL). %PDF-1.5 % %PDF-1.6 % 88309 Level VI - Surgical pathology, gross and microscopic examination Add-on (+) CPT Codes to the Above Service Codes: Cytopathology 88104 Cytopathology, fluids, washings, or brushings, except cervical or vaginal; smears with interpretation 88106 Cytopathology, fluids, washings, or brushings, except cervical or vaginal; filter method only with interpretation We have looked at this reference but find that it has all anatomic locations described except the lower leg which is where we find it problematic. [Level 5].

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