# ICD-10 Discussion



## berickson

ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, which was developed by WHO in the 1970s. ICD-10 is in almost every country in the world, except the United States -- but it is coming. Add your voice to the discussion.

Learn More about ICD-10


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## mrillini01

*We do not need icd-10*

We do not need icd-10. Quite simply--the cost of implementation will bankrupt small hospital facilities and will create  mass confusion in the health industry.  thank you


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## kevbshields

With all due respect, those predicted events did not occur when we transitioned from ICD-8 to ICD-9.  The industry has weathered these transitions before, it's just that there aren't a lot of folks around who were "coders" from that era.

Also, don't you think that such a transition would ultimately be reflected in our paychecks and professional respect?

Just my thoughts, anyhow.


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## candyjl78

*Ic-10 Good & Bad*

Not to be totally focused on myself and not how it will affect providers, hospitals, billing companies, etc., but at least there will be lots of overtime available! I'm sure that when this is implemented everyone is going to be so busy trying to learn it that the work is going to fall wwaaayyy behind. I code around 130-140 Anesthesia charts a day and I can only imagine what kind of impact it will have on MY production. 

Sometimes you have to take the good with the bad.


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## Candice_Fenildo

I totally agree with you Kev,We are Coders !!! we can do this. Our job is all about challenges !


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## rfayec

Anyone have a clue WHEN it is coming? Also should a coder began learning now? If so where? I've been reading up on this and it seems Congress keeps putting it off. I do think it will happen, it's just when............


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## coder911

I'm actually looking forward to implementing ICD-10. Yes, it will take a while to get as proficient as ICD-9 - but it will give us more specificity and elevate our demographics to new levels in medicine. It will push us into having a deeper understanding of what we're coding - plus, it'll give us something new to sink our teeth into.

Cheers to the future!


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## kandigrl79

My opinion...it is what it is.  When it happens it will be mandatory, so why not be positive about it


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## JWESS

*Icd-11*

I Went To A Meeting Recently And Heard That It Is Possible We Could Blow Right Past Icd10 And Pick Up With Icd 11 I Believe This Is What They Use In Europe.


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## AnthonyBush

I think that ICD-10 is going to be a great change, especially for those of us with Coding Credentials.  This will solidify our profession in the Healthcare field.  It will make us more valuable and needed in even greater numbers.  Why should we fear something that will produce more dependence on Coders.  I personally don't see it as being something that will be hard.  Change is always good when it helps us to grow and succeed.  Im looking forward to see the value of Coders nationwide increase, its something we deserve.


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## Amy Brazell

I heard the same thing from someone about moving on to ICD11. Who knows? I was preparing a presentation on drug poisoning and adverse effects and I found it interesting that ICD10 is being used on the federal level and at South Carolina's Dept. of Health and Environmental Control for reporting of mortality.


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## Sheri Bernard

*Clarifications*

Europe is using ICD-10. In fact, just about every country in the world is using ICD-10.  

ICD-11 is still in development.

All State Health Departments in the United States currently use ICD-10 for all mortality reporting to the CDC, and then on to the WHO, but what will be implemented for morbidity reporting (and therefore affecting medical reporting) is ICD-10-CM.

ICD-10-CM cannot be implemented before October 2010 (which would be for the 2011 codes), and a more likely date is October 2011 or October 2012 (the 2012 or 2013 codes).

Hope this clears up confusion!


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## mstenochs

I think that the ICD-10 is going to be wonderful. We actually have a copy of the 2007 draft and although there are alot more codes, in terms of being able to code to the highest specificity I LOVE IT. I'm actually looking forward to the change over.


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## terrij38

I only have one thing to say with everything else going on the world of Health care my one motto is "If it ain't broke don't fix it"  It seems like everytime you turn around everything is changing in health care and it is only getting worse when is the insanity going to stop.  This ICD 10 is really going over board and going to extremes.


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## Sheri Bernard

*Timeline on ICD-10*

Relax! ICD-10-CM and ICD-10-PCS are still a few years out, and you will certainly have at least two years' notice, by law, before implementation. Most likely date is Oct 1 2011 or Oct 1 2012...but may be later than that.

ICD-11 isn't being used anywhere in the world. It is still under development.


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## 007CPC

ICD-9 doesn't have tabulated capabilities to reflect the change in our industry. Once they do implement ICD-10 that is when I plan on breaking back into the industry, if I am not forced to find employment over this summer.


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## Lkimsey

*Icd-10*

If you look at the 369 new ICD-9-CM codes to be implemented in October, it is clear that ICD-9 is trying to nudge us toward ICD-10.  There is more specificity to the new codes with increased use of 5th digits and the new pap smear codes alone are very specific.  People griped about the automobile in the horse and buggy era and we like to gripe about change but what would we do without our cars?  I am being very positive about this and have already started to work on presentations for our local chapter.  We will all learn together.  Lynn Kimsey, CPC, CPC-I, CPC-E/M


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## Chronicles Billing

*ICD-10 Implementation.*

I welcome the changes that the ICD-10 will bring. There are so many diagnostic findings that are reported as unspecified. The ICD-10 will provide additional detail to the DX and will be reported in a universal manner. Being included in that type of capacity will generate additional information to work on treatments and conditions. 

Does anyone know what the time frame will be as far the educational training for existing coders? 

Will this also lead to a dual certification between AHIMA and the AAPC?

~ Genieve Nottage MBA, BSHA, CPC, CPC-I


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## Treetoad

I think we should consider ICD-10 a good thing.  We have challenges in our lives everyday.  Since ICD-10 is going to be a mandatory endeaver, we should embrace it---it's not like we can refuse (unless we want to give up our jobs!).  We will have the availability of more specific codes, which should also help us out in the long run.


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## kevbshields

Gienieve brought up a great point:  what happens to credentials when we "roll over" into ICD-10?

In the past, AAPC has mentioned a "proficiency exam" for the transition and as far as I can tell AHIMA expects continuing education on the issue.  No other official words yet (and wouldn't anything be a tad premature at this rate?).

Regardless, how would coders feel about being made to "re-take" an exam or otherwise demonstrate proficiency in the ICD-10 system?

Would we (gasp!) create another credential for ICD-10 or require current holders to submit to another exam?


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## Kris Henry CPC-H

The transition will happen, and regaurdless of how, we as coders will need to adapt. The way in wich we find the code will be the same, making the transition easy (no need to teach old dogs new tricks). Lets think of the opportunities rather than fear the unknown!


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## janarose

kevbshields said:


> Gienieve brought up a great point:  what happens to credentials when we "roll over" into ICD-10?
> 
> In the past, AAPC has mentioned a "proficiency exam" for the transition and as far as I can tell AHIMA expects continuing education on the issue.  No other official words yet (and wouldn't anything be a tad premature at this rate?).
> 
> Regardless, how would coders feel about being made to "re-take" an exam or otherwise demonstrate proficiency in the ICD-10 system?
> 
> Would we (gasp!) create another credential for ICD-10 or require current holders to submit to another exam?



 I just took the CPC test 2 days ago ( I think I passed) but I don't want to take another test for 2010...I'm exhausted from studying ...Janarose


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## member7

*HHS has proposed adoption of icd-10 code sets*

As of August 15th, HHS has proposed putting icd-10 in place on October 1, 2011.  I think it is time that we move forward with this. Yes, it's going to be challenging at first because that's the way change is but we can do this!  I am hopeful that the implementation of icd-10 icombined with the use of electronic medical records will cause us to see a significant improvement in documentation by all health care providers.  This should result in improved care and reduced errors across the continuum for our patients.


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## mlehmann

*Icd10*

I don't fear ICD10 and I like change. But I think realistically of the expense to everyone involved from CMS, insurance companies, clearing houses, hospitals, and physician offices. I would be interested to see a cost projection for this. It has to be astronomical!  Someone will have to pay for this and that always seems to roll down to the tax payers, employees and patients, (all of which I am).

Medicare alone can never implement anything without glitches, I can't imagine having this not affect payments and that any of it will smoothly.  All the edits, and software changes, eek!

I know ICD10 has more specific codes, but I have worked in this business for over 20 years and have not had many physicians be specific enough in their documentation to code anything but the basics.  They need to be taught this in Medical School. 

Neverless I will be on board. Unless a rich uncle's inheritance comes along.


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## jenndeshon

*My 2 Cents*

I don't fear ICD-10 because I don't think I can learn it. I taught myself ICD-9 coding so I'll probably teach myself ICD-10 as well. As previously mentioned, it will be thrust upon us at some point anyway, so why worry too much about it?

No, my problem is also the expense. Medicare and Medicaid will inevitably screw it up somehow (I'm still fighting with them over NPI issues) and my software (which we just installed this year) probably will not support it and it will be a nightmare to upgrade - not to mention costly. Those certified coders who live near metropolitan areas will have plenty of opportunities to attend chapter meetings, workshops, and seminars on the topic but how will those of us in smaller, more rural areas, receive the education? I never attend chapter meetings for the chapter I am assigned to because it is over an hour away and gas is not cheap.

In addition, if we all will be required to take the exam again to retain our certification, how are we going to pay for that? I used my tax return a few years ago in order to pay for my books, exam, and membership dues. There was no extra money to pay for a coding course so I studied on my own. It was a hardship on my family at the time but ultimately worth it. I passed the exam on the first try but it turned my brain inside out and I do not want to go through another five hour test again. Can AAPC not just assume that we will become proficient in ICD-10 because we are certified coders? We didn't learn ICD-9 overnight. Will AAPC expect us to pick up on ICD-10 immediately?

I am the only certified coder in a very busy OMS practice in a rural area. I do not assign all the codes initially. I work with a few coworkers and the doctors to put those on the claims. Am I to be expected to be the only person to do that once ICD-10 is implemented until I can train everyone here? My caseload is already extremely overwhelming. This ICD-10 topic sounds more and more like a nightmare to me!!! 


Anyway, this is the ICD-10 situation as I see it.

Jennifer, CPC


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## mcandia

*ICD 10 discussion*

I cannot remember where I read it but I am sure it was on the AAPC site that they stated that they were not going to require us to be re certified and were going to do it in the form of CEU's.

Maria A Candia


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## janetmoh

All I can say is:  IT'S ABOUT TIME!!  It was put off with Y2K;then it was put off for HIPAA.  The rest of the world is using ICD-10 and it is time we started too.  It will be great to have more specificity. 

I've heard that it will have minimal effect at physician's offices as they usually only have one computer system.  It will have greater effect in hospitals where there are numerous system that will need to be changed over.

From what I understand the latest projection on ICD-11 for the US is perhaps 2020. It is still in development and even when the rest of the world goes to ICD11 the US makes changes to it and they are saying at the absolute earliest it would be 2020.  So let's get this ICD-10 going!  

As far as coding credentials - I cannot see that they will be taken away or retesting going on.  There will probably have to be some sort of "grandfathering" going on and need for additional education.  So start learning more about ICD-11 - there will be a lot of teaching opportunities out there!


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## meyerdo

*Janet...Thank you*

We have been thinking about delving into ICD-11.  However, we haven't heard anything official about its implementation.  So we are currently focused on ICD-10 CM.  Thank you so much for your feedback.


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## Elsa H Crocker

*Icd 11*

This system has not been implemented and it is not close to production as I understand it.  Everyone is still using ICD-10.  If you look at the number of codes that were added to ICD-9 for October you can see that we are out of space. It is not that difficult a system to learn. I think possibly the only issue will be knowledge of anatomy.


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## jeanace

*ICD-10 and physicians*

I know that many of the developed western countries are already on ICD-10.  While I agree with the AAPC's stance that 10/1/11 does not give the industry enough time to prepare for a transition from ICD9 to ICD10, I believe there is another point to be considered and that adds weight to the Academy's argument.  If I am not mistaken, in those countries where ICD10 is the diagnostic coding standard, physicians in their private practices are not using ICD10.  If I'm right (and I may not be), there are liable to be issues that will arise that cannot be anticipated if we are to be the first country to require this; especially since for the most part a physician will not be paid for his/her services without an accurate diagnostic code.  
Does anyone know if I'm way off base here?  Are there other countries in which the physician uses ICD10 in his day-to-day office practice?


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## janetmoh

I was under the impression that all other countries are using ICD10


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## JGGBALLEN

*I am both apprehensive and excited!*

I am both apprehensive and excited!
As a woman of a certain age who has only been in this industry for a total of 5 years and certified for only 2 of those 5.  
I see this an excellent opportunity...any new coders out there should start educating themselves NOW!
I suspect there will be many veteran coders and physicians who will have a very difficult time with the transition.
My only problem at this point is, where do I start!???
Does anyone have a insite or advice??
Thanks, June


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## fredabrinson

*ICD-10 Info*

CMS has a lot of information about ICD-10 on their website, as does AHIMA.

Try these links:

http://www.cms.hhs.gov/ICD10/01_Overview.asp#TopOfPage

http://www.ahima.org/icd10/


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## flmoore

I am excited about ICD-10-CM, I code for Bariatric Surgerons and I would love to be able to code more specifically so I won't have so many denials.


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## Chicoine

*Icd-10*

Here's a summary of the Final Rule that I put together to explain ICD-10 to myself.  That being said, I am going to have someone like Deb Grider teach me the details before 2013!!

Final Rule: ICD -10 and ICD-10 PCS

Current Code Sets:  Maintained and distributed by DHHS

About ICD-9-CM:  

•	The International Classification of Diseases (ICD) codes were developed and maintained by the World Health Organization (WHO) in the 60s to classify causes of death (mortality).  The goal was to make sure that  diseases (such as small pox, malaria and polio) have the same meaning and application from country to country.  The Morbidity component was added to subsequent revisions.

•	US and other countries adopted ICD and added clinical modifications (CM's) to meet the needs of their respective health care systems.

•	ICD-9 was adopted by US in 1979 for morbidity applications and was adopted as a HIPAA standard in 2000.

•	Updates: ICD-9 codes are updated twice a year. New codes are added to accommodate new technology and more sophisticated diagnoses and treatment of clinical conditions.

•	International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), Volumes 1 and 2 for coding diseases, injuries, impairments, and other health problems.  Approximately 13,000 codes

•	ICD-9-CM, Ninth Revision, Volume 3 for coding procedures on hospital inpatients. Approximately 3,000 codes

•	ICD-9-CM Volumes 1, 2 and 3 were already widely used in administrative transactions when HIPAA rule promulgated.

About ICD-10 Codes: 

•	Developed by WHO in 1989.

•	National Center for Health Statistics (NCHS) developed ICD-10 CM (early 1990's), followed by CMS developing ICD-10 PCS thereafter.

•	International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Code set for diagnosis.  Approximately 68,000 codes.  

•	International Classification of Diseases, Tenth Revision, Procedural Coding System (ICD-10 PCS). Code set for inpatient hospital procedures. Approximately 87,000 codes

Compliance Date:  October 1, 2013.

What's the difference between 9 and 10?

•	ICD-9 codes are three to five digits long and organized into chapters by body system, i.e. digestive, musculoskeletal, and respiratory.  This code set was never designed to provide for an increased level of detail needed to support emerging needs, such as bio-surveillance or pay for performance.  Limited digit and categories means limited functionality given evolving complexity of health care services and diagnoses.  Many chapters of ICD-9 are full.

•	ICD-10 codes are three to seven alpha-numeric characters.  ICD-10 arranges diseases according to an axis of classification based on etiology, anatomy, or severity with anatomy being the primary axis.  

•	ICD-9: Approximately 16,000 diagnosis and procedure codes

•	ICD-10:  Approximately 155,000 diagnosis and procedures codes.

Note, moving from ICD-9 to ICD-10 is not merely adopting a revised version.  This represents a complete change from one coding system to a new one that is structured in a completely different way.

Why are we doing this? â€“ Lack of Space for new procedures and conditions.

1. Its just plain old!

•	ICD-9 codes set were established in 1979. Numerous ICD-9 procedure codes are based upon technology that is now outdated.  

•	Not only that, it's running out of space for new codes.  New and changing medical advancements, including sophistication in diagnosis and disease management as well as technological advances in medicine over the past 29 years has increasingly made the ICD-9 code set unworkable in terms of responding to additional classifications or accommodating newly identified diseases or medical advances.

•	To accommodate changes, additions or workarounds have been added over the years.  As above, the current ICD-9 coding hierarchy is running out of room. New codes are being assigned to topically unrelated chapters as a workaround, but this creates the opportunity for significant error rates in coding for both reimbursement and information tracking purposes.

•	The American Hospital Association (AHA) has estimated that the ICD-9 code set will run out room for addition of diagnosis and procedure codes in 2009.

•	By way of example, at present there are approximately 3,000 ICD-9 codes for procedures.  Of the approximately 20 million procedures performed each year, roughly one percent or 200,000 are new.  

2.	Lack of Detail: 

•	Again, think of 1979. The ICD-9 codes are just not accurate enough for today's health care environment.

•	The new ICD-10 codes provide more information and detail within the codes than ICD-9 facilitating timely claims payment and fewer requests for additional information.  Additional improvements include:
i.	Coding primary care encounters, external causes of injury, mental disorders, neoplasms, and preventative health;
ii.	Advances in medicine and medical technology;
iii.	Coding detail on socioeconomic, family relationships, ambulatory care conditions, lifestyle related problems, and screening test results;
iv.	More space to accommodate future expansions;
v.	New categories for post-procedural disorders;
vi.	Additional of laterality- i.e., specifying organ or body part involved;
vii.	Expanded distinctions for ambulatory care or managed care encounters.

•	Think of the fact that the Diagnosis-Related-Group (DRG) payment system classifies hospital cases into groups that are based on diagnosis, procedures, age, sex, and the presence of complications and co-morbidities and you can understand why CMS is doing this.

•	ICD-10 will allow the use of DRG definitions that better define new technologies and devices and offer greater specificity for clinical conditions.  (Think of AIDS, SARS, Asian flu, etc.).

•	ICD-10 is also structured to expand to sufficiently accommodate future health care information.

•	ICD-10-PCS. Has no relationship to basic ICD-10 developed by WHO.  Developed by CMS to sufficiently describe complex medical procedures.  This becomes increasingly important when assessing and tracking the quality of medical processes and outcomes and compiling health care statistics.  Greater transparency as to what procedures are being performed in hospitals!

Benefits:

•	ICD-10 code sets will allow for accurate description of diagnoses and procedures that is critical for research, quality health care data monitoring, and cost containment.  Accuracy will facilitate better payment in pay-for-performance (P4P) programs, because these programs required detailed coding of diagnoses and the procedures performed to treat specific conditions.

•	ICD-10 will provide for specific diagnosis and treatment information that can improve quality measurements and patient safety, as well as better evaluation of medical processes and outcomes.  This means meaningful clinical outcome information, more accurate health grades, and again, improved quality of care.  

•	As we become a more global community, accuracy and cross-transparency of our health data in terms of medical conditions and technologies is vital.  This is especially true in terms of biosurveillance, ie monitoring for Severe Acute Respiratory Syndrome (SARS), Asian bird flu or similar illnesses.

•	CMS estimates the costs for implementing ICD-10-CM and ICD-10-PCS will be offset by the benefits within four years of implementation.

Any trend setters?

•	The ICD-9 diagnosis code set is no longer maintained by WHO.  Everyone one else got on the ICD-10 bandwagon a long time ago. 

•	The US is the only G-7 nation not using ICD-10. Canada, France, Germany, Great Britain, Italy and Japan adopted ICD-10 years ago.

•	The US adopted the ICD-10 for mortality reporting only in 1999. (Done by the CDC).

•	As of October 2002, 138 countries have adopted ICD-10 for coding and reporting mortality data, and 99 countries have adopted ICD-10 or a clinical modification for coding and reporting morbidity data.

The future?

WHO is currently working on ICD-11. This will not be available until 2020.  ICD-11 will build upon ICD-10.

What else?

•	CMS characterizes ICD-10 adoption as a â€œsignificant undertaking.â€�  That's an understatement. Adoption and implementation will be similar to our activities involving Y2K compliance.  But we can do it!

•	Watch for CMS FAQ's, fact sheets, and other supporting education and outreach materials.

•	All hipaa covered entities are affected by these rules. Covered entities include all health plans, health care clearing houses, health care providers that transmit electronic health information


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## renee868

*Embrace the inevitable*

We have been far behind for many years, and yes other countries are using ICD-11 already I do believe. And maybe they should just get us caught up instead!? Change is inevitable in this industry, once we are trained and know more it will be MUCH easier from what I have seen and researched on it. Much more specific, lot's more codes to remember but in the long run, it will be beneficial to everyone. It is a scary process to have to re-educate not just ourselves but our physcians as well, it will be costly and time-consuming, but the end result should be good. So we need to just bear down and join the band wagon and try to embrace this "monsterous" thing we have all been waiting years for!!! that is what I like about coding....it is a never-ending educational experience, but we can all rely on each other to learn more from!


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## kmhall

If you will look at the "Final Rule" on page 3332 it states ICD-11 has not yet been implemented and is based on the alpha numeric structure of the ICD-10 which would make the transition more complex and possibly more cost for all involved.  I agree with the final rule but I also understand what everyone is saying about just starting with ICD-11 but that won't be available until 2014 and according to the final rule, ICD-9 is quickly running out of options for new codes for the evolving technologies, etc...  So can we wait until 2014?  Just my view.


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