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Icd 10 Coding Guidelines For Diabetes

Coding Diabetes Mellitus With Associated Conditions

Coding Diabetes Mellitus With Associated Conditions

Overseen by AHIMA’s coding experts for the Journal of AHIMA website, the Code Cracker blog takes a look at challenging areas and documentation opportunities for coding and reimbursement. Check in each month for a new discussion. There has been some confusion among coding professionals regarding interpretation of the coding guideline of “with.” An area that contains many instances of using this guideline in ICD-10-CM is coding Diabetes Mellitus with associated conditions. There are 53 instances of “with” subterm conditions listed under the main term Diabetes. The ICD-10-CM Official Guidelines for Coding and Reporting states the following at Section I.A.15: The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order. There was a recent clarification regarding this guideline published in the first quarter 2016 issue of AHA Coding Clinic on page 11. According to this clarification, the subterm “with” in the Index should be interrupted as a link between diabetes and any of those conditions indented under the word “with.” Following this guidance as we look to the main term Diabetes in the ICD-10-CM Codebook Index, any of the conditions under the subterm “with” such as gangrene, neuropathy, or amyotrophy (see below for the full list) can be coded without the physician stating that these conditions are linked. The classification assumes a cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves, and circulatory system. The following are all the subterms under “with” under th Continue reading >>

Coding Diabetes Mellitus In Icd-10-cm: Improved Coding For Diabetes Mellitus Complements Present Medical Science

Coding Diabetes Mellitus In Icd-10-cm: Improved Coding For Diabetes Mellitus Complements Present Medical Science

Results of a recent coding and clinical documentation pilot study indicate that the ICD-10-CM coding classification changes made for diabetes mellitus have significantly improved coding for this disease. The results of the study noted that although a few ICD-10-CM "unspecified" diabetes codes were assigned, the majority of the diabetes codes sufficiently captured the diagnoses as expressed in the clinical documentation. In addition, the pilot study noted that the ICD-10-CM diabetes codes complement present medical science-separate type 1 and type 2 diabetes category codes and body system combination codes are a major improvement over ICD-9-CM. Instead of classifying as controlled or uncontrolled, ICD-10-CM classifies inadequately controlled, out of control, and poorly controlled diabetes mellitus by type with hyperglycemia. This article highlights key ICD-10-CM features for diabetes mellitus coding. In ICD-10-CM, chapter 4, "Endocrine, nutritional and metabolic diseases (E00-E89)," includes a separate subchapter (block), Diabetes mellitus E08-E13, with the categories: E08, Diabetes mellitus due to underlying condition E09, Drug or chemical induced diabetes mellitus E10, Type 1 diabetes mellitus E11, Type 2 diabetes mellitus E13, Other specified diabetes mellitus The diabetes mellitus categories E08–E13 are further subdivided into four- or five-character subcategories. When a category has been subdivided into four-, five-, or six-character codes, the diabetes code assigned represents the highest level of specificity within ICD-10-CM. ICD-10-CM Tabular Instructional Notes Diabetes mellitus tabular inclusions notes are introduced by the term "Includes" and appear at the beginning of a category. Categories E10–E13 inclusion notes further define or provide examples of th Continue reading >>

New Diabetes-related Diagnosis Codes You Need To Know

New Diabetes-related Diagnosis Codes You Need To Know

New diabetes-related diagnosis codes you need to know Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D. From the November/December 2016 edition of AOA Focus , page 48-49. On Oct. 1, 2016, hundreds of new ICD-10 codes that impact doctors of optometry went into effect. Several additions and revisions have been made in Chapter 4 of the ICD-10 code set (endocrine, nutritional and metabolic diseases). This chapter includes diabetes-related diagnosis codes. Because doctors of optometry perform the majority of comprehensive, dilated eye examinations for people with diabetes in the United States and are well versed in the treatment and management of diabetic eye disease, it is critical that doctors of optometry are aware of these updated codes. In addition to the diabetes code changes, many other code changes have occurred. Included in this column are just a few of these important changes. New 'code additional' requirements for type II diabetes (E11) The ICD-10 guidelines provide direction on the sequence for reporting certain conditions. The guidelines indicate, "Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a 'use additional code' note at the etiology code and a 'code first' note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation." For type II diabetes (E11), the "use additional" instructions have changed. Previously physicians were guided to use an additional code to identify any in Continue reading >>

2018 Icd-10-cm Codes E11*: Type 2 Diabetes Mellitus

2018 Icd-10-cm Codes E11*: Type 2 Diabetes Mellitus

E08 Diabetes mellitus due to underlying condition... E08.0 Diabetes mellitus due to underlying condition... E08.00 Diabetes mellitus due to underlying condition... E08.01 Diabetes mellitus due to underlying condition... E08.1 Diabetes mellitus due to underlying condition... E08.10 Diabetes mellitus due to underlying condition... E08.11 Diabetes mellitus due to underlying condition... E08.2 Diabetes mellitus due to underlying condition... E08.21 Diabetes mellitus due to underlying condition... E08.22 Diabetes mellitus due to underlying condition... E08.29 Diabetes mellitus due to underlying condition... E08.3 Diabetes mellitus due to underlying condition... E08.31 Diabetes mellitus due to underlying condition... E08.311 Diabetes mellitus due to underlying condition... E08.319 Diabetes mellitus due to underlying condition... E08.32 Diabetes mellitus due to underlying condition... E08.321 Diabetes mellitus due to underlying condition... E08.3211 Diabetes mellitus due to underlying condition... E08.3212 Diabetes mellitus due to underlying condition... E08.3213 Diabetes mellitus due to underlying condition... E08.3219 Diabetes mellitus due to underlying condition... E08.329 Diabetes mellitus due to underlying condition... E08.3291 Diabetes mellitus due to underlying condition... E08.3292 Diabetes mellitus due to underlying condition... E08.3293 Diabetes mellitus due to underlying condition... E08.3299 Diabetes mellitus due to underlying condition... E08.33 Diabetes mellitus due to underlying condition... E08.331 Diabetes mellitus due to underlying condition... E08.3311 Diabetes mellitus due to underlying condition... E08.3312 Diabetes mellitus due to underlying condition... E08.3313 Diabetes mellitus due to underlying condition... E08.3319 Diabetes mellitus due to underlyin Continue reading >>

Icd-10 Training: Coding For Diabetes

Icd-10 Training: Coding For Diabetes

Health Care Information Technology , Health Care Information Technology , Practice Management , Modern Medicine Feature Articles In order to understand diabetes coding in ICD-10 , its worth making a comparison of the structural differences between ICD-9-CM and ICD-10-CM. Diabetes mellitus (DM) codes in ICD-10-CM are combination codes that include the type of DM, the body system affected, and the complication affecting that body system as part of the code description. Subcategory levels first specify the type of complication by system, such as diabetes with kidney complications, ophthalmic complications, neurological complications, and circulatory complications. The subclassification level then describes the particular manifestation. E11.3: Type 2 diabetes mellitus with ophthalmic complications. E11.32: Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy. E11.321: Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema. E11.329: Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema. A subcategory for diabetes mellitus with other specified complications is also provided that includes codes for DM with diabetic neuropathic arthropathy, diabetic dermatitis, foot ulcer, other skin ulcer, periodontal disease, hypoglycemia, and hyperglycemia. As many codes as are needed to describe all of the associated complications that the patient has should be assigned from a particular category. Because of this code structure, there is no instructional note found under diabetes mellitus codes in ICD-10-CM requiring an additional code to identify the manifestation since it is already part of the code description. There are specific diabetes codes that do require additional codes in order to i Continue reading >>

Icd-10-cm/pcs Diabetes Coding: Decipher Clinical Criteria And Documentation - On-demand

Icd-10-cm/pcs Diabetes Coding: Decipher Clinical Criteria And Documentation - On-demand

ICD-10-CM/PCS Diabetes Coding: Decipher Clinical Criteria and Documentation - On-Demand ICD-10-CM/PCS Diabetes Coding: Decipher Clinical Criteria and Documentation - On-Demand ICD-10-CM/PCS Diabetes Coding: Decipher Clinical Criteria and Documentation - Detailed knowledge of clinical criteria and documentation needs is imperative for properly reporting diabetes diagnoses and procedures. The complexity of diabetes, frequent holes in documentation, and overall lack of clinical criteria knowledge all make the coders job more difficult. Combine that with the frequent changes and updates in ICD-10, and diabetes reporting creates an environment ripe for denials. Join expert speakers Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, and Pam Hess, MA, RHIA, CDIP, CCS, CPC, for this 90-minute webinar as they discuss the recent ICD-10-CM/PCS coding changes and challenges for reporting diabetes. The speakers will explain best practices for clinical documentation of diabetic conditions, present pertinent coding and documentation guidelines, and identify 2018 ICD-10-CM/PCS changes for associated diabetic conditions. At the conclusion of this program, participants will be able to: Discuss the ICD-10-CM coding changes for diabetes Explain best practices for clinical documentation of diabetic conditions Present pertinent coding and clinical documentation guidelines for diabetic conditions to providers, coders, and CDI staff Identify ICD-10-CM/PCS changes for associated diabetic conditions Describe the ICD-10-CM linking requirements for diabetic conditions Discuss and illustrate appropriate documentation for ICD-10-PCS procedures related to diabetic conditions ICD-10-PCS procedures related to diabetic conditions Documentation tips for procedures related to diabetic conditions American Health I Continue reading >>

Diabetes Coding In Icd-10

Diabetes Coding In Icd-10

Diabetic coding in ICD-10 has changed significantly from ICD-9. The requirement for documenting the type of diabetes and linking it to any complications still exist. However, in ICD-10, there are very few diabetic codes that require an additional code for the manifestation. Those that do require an additional code are diabetes with CKD and diabetes with a foot ulcer. ICD-9 and ICD-10 guidelines for coding diabetes require the provider to document diabetes and the complication, ensuring the documentation states a relationship between the diabetes and the complication. For example, diabetes with kidney complications, specifically CKD, would be documented: Diabetes with nephropathy due to diabetes, CKD stage 3, and this would be coded as E11.22 and N18.3. Here, the additional code for the stage of CKD would be required, N18.3. Diabetes with a diabetic foot or other skin ulcer also requires an additional code for the ulcer. Example: Diabetes with heel ulcer of the right foot, fat layer exposed, would be coded E11.621 and L97.412. Note the additional code for the ulcer and the increase in specificity with this diagnosis. Documentation of laterality and degree of ulcer are both required to properly code this diagnosis. Unspecified codes are still present in ICD-10, however, it is best practice to document, and ultimately code, to the highest specificity. Documenting only “diabetes with renal manifestations” or “diabetes with neurologic manifestations”, etc. does not best support documenting diabetic complications, is not complete documentation, and is not recommended. This type of documentation does not distinguish a link, or relationship, between the diabetes and the manifestation or complication. ICD-10 makes this easier with the combination codes. Examples of some Continue reading >>

Test Your Coding Knowledge

Test Your Coding Knowledge

d. B20 and other diagnosis. Sequencing will depend on whether the condition is related or unrelated to the HIV. Some procedures in CPT say separate procedure after the code. According to the surgery guidelines some procedures are NOTto be reported in addition to another procedure. Which statement below is TRUE? a. Would not be reported in additional to the code for total procedure or service of which it is considered an integral component. b. Would be reported in addition to the code for total procedure or service and is not an integral component of the main procedure c. Would not be reported in additional to the code for total procedure or service of which it is considered an integral component, however you could add a modifer 51 to unbundle d. You will always bill both procedures, attach modifiers when needs and list the most expensive procedure first on the billing form. Patient brought into out-patient facility for a screening colonoscopy. The physician was unable to advance to the cecum because the colon was not completed evacuated with feces. The physician was unable to complete this screening colonoscopy. How would this be billed to the insurance? Which statement is true according to CPT guidelines for use of 72275 for Injection, Drainage, or Aspiration of the Spine and Spinal Cord codes? a. Code 72275 is not used when an epidurogram is performed images documented, and formal radiologic report is issued. b. Code 72275 is only used when an epidurogram is performed images documented, and formal radiologic report is issued. c. Code 72275 is only used when an epidurogram, a formal contrast study and formal radiologic report is issued. d. Code 72275 is only used when an epidurogram is included in a percutaneous insertion and removal of an epidural catheter and formal Continue reading >>

2018 Icd-10 Update Part 3: New Codes For Diabetes, Myopia Start October 1st

2018 Icd-10 Update Part 3: New Codes For Diabetes, Myopia Start October 1st

2018 ICD-10 Update Part 3: New Codes for Diabetes, Myopia Start October 1st | 2018 ICD-10 Update Part 3: New Codes for Diabetes, Myopia Start October 1st September 28, 2017 | Rhonda Buckholtz, CPC, CPCI, CPMA, CDEO, CRC, CHPSE, COPC, CENTC, CPEDC, CGSC, VP of Practice Optimization, Eye Care Leaders Like most eye care practices, you likely treat patients with co-morbid conditions. The patient population of many practices is often older than average, and many times chronically ill. So, correctly coding for co-morbidity is essential in avoiding costly revenue leaks that could drain cash from your practice. Recent studies have shown that the number of type 2 patients presenting with diabetic ketoacidosis has been increasing, and thats one reason for the new DKA codes. Prior to the 2018 revisions, the best coding option to describe a patient with type 2 DKA was E11.69 (Type 2 diabetes mellitus with other specified complication). Beginning October 1, 2017, youll see a new subdivision among the E11 (Type 2 diabetes mellitus) codes: E11.1 (Type 2 diabetes mellitus with ketoacidosis). This new subdivision includes two codes: Other DKA-related additions occur in the following code series: E08 (Diabetes mellitus due to underlying condition) E09 (Drug or chemical induced diabetes mellitus) E13 (Other specified diabetes mellitus ) All four series contain XXX.1 ( with ketoacidosis) as a subdivision containing two codes: Updates for Coding Medical Management of Diabetes General guidelines for coding diabetes mellitus and secondary diabetes mellitus instruct coders how to report the medical management of diabetes. TheICD-10-CM Official Guidelines for Coding and Reporting are available here .Youll find the first revisions in bold under Chapter 4.a.1, Diabetes mellitus and the use of in Continue reading >>

Coding Diabetes: Time To Look At The Coding Guidelines Again

Coding Diabetes: Time To Look At The Coding Guidelines Again

November is National Diabetes Awareness Month, prompting coders to review the coding guidelines for this disease suffered by more than 10.9 million U.S. residents. During November, the Centers for Medicare & Medicaid Services (CMS) is raising awareness about diabetes, diabetic eye disease, the importance of early disease detection, and related preventive health services covered by Medicare. According to the CMS website, diabetes can lead to severe complications such as heart disease, stroke, vision loss, kidney disease, nerve damage, and amputation, among others, and it’s a significant risk factor for developing glaucoma. People with diabetes are more susceptible to many other illnesses such as pneumonia and influenza and are more likely to die from these than people who do not have diabetes. Among U.S. residents 65 years and older, 10.9 million (26.9 percent) had diabetes in 2010. Currently, 3.6 million Americans 40 and older suffer from diabetic eye disease. Education and early detection are major components to combating this disease. Let’s take a look at the coding guidelines for diabetes to ensure that we accurately select and capture the ICD-10-CM code(s) for this disease. As all health information management (HIM) coding professionals know (or should know), the ICD-10-CM Official Coding and Reporting Guidelines have been approved by the four organizations that make up the Cooperating Parties for ICD-10: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the Centers for Medicare & Medicaid Services (CMS), and National Center for Health Statistics (NCHS). These official coding guidelines are organized into four sections. Section I includes the structure and conventions of the classification and general guidel Continue reading >>

Correctly Coding: Diabetes Mellitus

Correctly Coding: Diabetes Mellitus

When selecting International Classification of Diseases, Tenth Revision (ICD-10), diagnostic codes, accuracy is important when describing the patient’s true health. A joint effort between the healthcare provider and the coder/biller is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. Diabetes mellitus is one of the most inaccurately coded chronic conditions. Many billers/coders/providers are missing opportunities to show which patients are sicker and are at a higher risk. The prevalence of diabetes mellitus and the complexity of diabetes coding require a solid understanding of the ICD-10 coding guidelines to ensure accurate code assignment. These diagnosis codes are also used in determining the eligible population for the Comprehensive Diabetes Care quality measure and the threshold the member is held to in order to be in control for the Controlling High Blood Pressure quality measure. ICD-10 Category E11* Diabetes Mellitus: Tips on How to Code using ICD-10 Codes Diabetes Mellitus is an HCC (Hierarchical Condition Category) The diabetes mellitus codes are combination codes that include: 1. The type of diabetes mellitus 2. The body system(s) affected 3. The complications affecting the body system(s) When coding diabetes mellitus, you should use as many codes from categories E08-E13* as necessary to describe all of the complications and associated conditions of the disease. These categories are listed below: ICD-10 Code Category ICD-10 Description Note: E08* Diabetes mellitus due to underlying condition Code first the underlying condition Use additional code to identify any insulin use E09* Drug or chemical induced diabetes mellitus Code first poisoning due to drug or toxin, if applicable Use addi Continue reading >>

Icd-9-cm Vs. Icd-10-cm: Examine The Differences In Diabetes Coding

Icd-9-cm Vs. Icd-10-cm: Examine The Differences In Diabetes Coding

Most coders can quickly come up with 250.00. And if the physician only documented diabetes mellitus, that’s the correct ICD-9-CM code. If a physician doesn’t document complications or type of diabetes, coders default to code 250.00 (diabetes mellitus without mention of complications), says Jill Young, CPC, CEDC, CIMC, president of Young Medical Consulting, LLC, in East Lansing, MI. However, 250.00 is not necessarily the best code to describe the patient’s actual condition. Consider these two patients. Patient A is a type 2 diabetic with well controlled diabetes. Patient B is a type 2 diabetic with uncontrolled diabetes who also suffers from diabetes-related chronic kidney disease. If the physician documents “diabetes mellitus” for both patients, coders would report the same code, even though the patients have very different conditions. The physician loses reimbursement on Patient B, who is sicker and requires more care, Young says. Coding in ICD-9-CM When it comes to the code assignment for diabetes mellitus in ICD-9-CM (250 code series), coders identify whether the diabetes is type 1or 2 using a fifth digit, says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM/coding for HCPro, Inc., in Danvers, Mass, and an AHIMA-approved ICD-10-CM/PCS trainer. If the diabetes is secondary, coders choose from codes in the 249 series. Under series 250, coders will find 10 different subcategories that further define and refine the patient’s actual condition. All of those codes require a fifth digit to indicate whether the diabetes is controlled or uncontrolled, type 1or type 2. The fifth digit subclassifications are: Coders also need to note that codes 250.4, 250.5, 250.6, 250.7, and 250.8 all include instructions to use an additional code to ide Continue reading >>

Coding Tip: Dm With Assumed Conditions

Coding Tip: Dm With Assumed Conditions

Diabetes continues to be a challenge for coders since the new instruction/guideline was released in AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, First Quarter 2016. This is effective with March 18, 2016 discharges. ICD-10-CM does assume the link between diabetes and multiple common conditions. In the past, these were not assumed and only coded as related to diabetes when clearly documented or queried by the coder for further clarification. In the index of ICD-10-CM you will see several assumed conditions. Please continue to familiarize yourself with these so when you are coding the records you will know they are assumed conditions. Heres a list of the associated diabetic conditions where the link is assumed in ICD-10-CM: If the MD documents another etiology for the condition DO NOT code to a diabetic complication or assume the link with diabetes. Clarification of link of diabetes and osteomyelitis was published in the 4Q2016 AHA Coding Clinic. AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, First Quarter 2016 AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, Fourth Quarter 2016 ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly. Continue reading >>

Icd-10 Coding Challenge: Updated Coding Guideline A.15 “with”

Icd-10 Coding Challenge: Updated Coding Guideline A.15 “with”

A 47-year-old patient was admitted to the hospital with a chief complaint of an ulcer at the base of his left great toe. Patient has a history of diabetes mellitus, type 2, nephropathy with CKD stage 3, GERD, asthma and esophagitis. The patient’s medications include insulin, a proton pump inhibitor and a steroid inhaler. After examination, it was determined that this was a diabetic foot ulcer with exposure of the fat layer. The wound was cultured and the patient was placed on IV antibiotics. Two days later the patient was taken to the Operating Room for an excisional debridement of the ulcer down to the bone. The patient was discharged from the hospital on day #5 with a diagnosis of poorly controlled diabetes mellitus with diabetic foot ulcer and acute osteomyelitis. The patient is sent home with IV antibiotic therapy and instructions to follow up in outpatient Wound Clinic for outpatient treatment of the ulcer. Please assign diagnosis and procedure codes for this scenario. ANSWERS E11.621 Type 2 diabetes mellitus with foot ulcer L97.522 Non-pressure chronic ulcer of other part of left foot with fat layer exposed E11.65 Type 2 diabetes mellitus with hyperglycemia Z79.4 Long term (current) use of insulin E11.69 Type 2 diabetes mellitus with other specified complication M86.172 Other acute osteomyelitis, left ankle and foot Z79.2 Long term use of antibiotics E11.21 Type 2 diabetes mellitus with diabetic nephropathy E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease N18.3 Chronic kidney disease, stage 3 K21.0 Gastro-esophageal reflux disease with esophagitis J45.909 Unspecified asthma, uncomplicated Z79.51 Long term use of inhaled steroids 0KBW0ZZ Excision of left foot muscle open approach BLOG RESPONSE This month’s scenario provides us with an opport Continue reading >>

Icd-10 Coding Guideline

Icd-10 Coding Guideline

If this is your first visit, be sure to check out the FAQ & read the forum rules . To view all forums, post or create a new thread, you must be an AAPC Member . If you are a member and have already registered for member area and forum access , you can log in by clicking here . If you've forgotten your username or password use our password reminder tool . To start viewing messages, select the forum that you want to visit from the selection below. Shall we bill E11.40(Combination code)for DM and CKD documented with out linakge In the below link from AHIMA stated we can bill E11.40 combination code since the physician documentation does not need to provide a link between the diagnoses of diabetes and CKD NOTE-The above mentioned guideline not available in ICD-10-CM Official Guidelines LINK-Code E11.40 would be used to report Type 2 diabetes mellitus with diabetic neuropathy. Please look at E11.22 and see instructional note to use additional coding for the CKD being reported N18.1-N18.6 2017 ICD-10 guidelines Chapter 14 a.3 states the following.... "3) Chronic kidney disease with other conditions Patients with CKD may also suffer from other serious conditions, most commonly diabetes mellitus and hypertension. The sequencing of the CKD code in relationship to codes for other contributing conditions is based on the conventions in the Last edited by Lynda Wetter; 06-27-2017 at 07:59 AM. AAPC-Chapter Association Board of Directors 2017-2020 Region 3, Virginia, West Virginia, North Carolina, South Carolina, Kentucky Vice President Richmond Virginia Chapter 2017 Originally Posted by [email protected] Shall we bill E11.40(Combination code)for DM and CKD documented with out linakge In the below link from AHIMA stated we can bill E11.40 combination code since the physician doc Continue reading >>

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