Galeazzi's Fractrue CPT codes. Proper CPT coding is 28450-LT Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each Left side and 99213-57 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity Decision for surgery. For this reason, opioids are typically prescribed for a short period of time. Thanks C CrysLednum Guru Messages 106 Location Charm City - Baltimore Best answers 0 Dec 29, 2009 #2 I think 24545-24546 would be appropriate. A fracture not indicated as nondisplaced is considered displaced. A humerus fracture is the medical name for breaking the bone in your upper arm (your humerus). Cpt Code 24535 In Section: Closed Treatment Of . Thanks C CrysLednum Guru Messages 106 Location Charm City - Baltimore Best answers 0 Dec 29, 2009 #2 I think 24545-24546 would be appropriate. Coders and billers should collaborate to remediate the charge error, even if the fracture care claim has been paid. Parallel or 90-90 plates. These codes were created more than 20 years ago to allow for global reporting of more than one injury, when at least one other injury is concurrently treated surgically. (Also assign osteoporosis and external cause codes) American Hospital Association ("AHA"). Code 25605 is correct because a reduction (manipulation) was performed. . All material on this website is protected by copyright. If your pain is severe, your doctor may suggest a prescription-strength medication, such as an opioid, for a few days. He has been pursuing provider education programs including clinical documentation integrity projects. To ensure your coding results in proper reimbursement for the services rendered, lets review fracture types, applicable codes, and the work they represent. Margaret M. Maley, BSN, MS, is a consultant with KarenZupko & Associates. APC information including: Status Indicator, Relative Weight, Payment Rate, Crosswalks, and more. It may be a judgment call as to what is the optimum fracture care solution on a case-by-case basis. Preoperative Diagnosis: Left arm grade 2 open comminuted distal humerus fracture. CPT Codes: Common Procedures : 23472: Total Shoulder Arthroplasty: Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) . 27502 -Closed treatment with or without traction, ex. . Where appropriate, there are also Pre- and Post-service descriptions. The general consensus is to use the fracture care codes designated as "closed treatment without manipulation" and bill the initial E/M with modifier 57. See our privacy policy. For clinical responsibility, terminology, tips and additional info start codify free trial. Unstable Type II supracondylar humerus fracture. The global fracture code should not be reported. Total elbow joint replacement for the treatment of distal humerus fracture of type c in eight elderly patients. Check to see that you can move your fingers and wrist, and can feel things with your fingers. A fracture in this area can be very painful and make elbow motion difficult or impossible. Fracture fragments exposed and cleared of clot preserving any soft tissue attachments. Earn CEUs and the respect of your peers. CPT code information is copyright by the AMA. This is called heterotopic ossification. Question: Is there a procedure code other than 23929 (unlisted procedure, shoulder) to use for a closed reduction of a humerus fracture with percutaneous pinning? CPT 25608 describes the open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of two fragments. It can occur shortly after the fracture occurs or may take years to develop. 24% reoperation usually for HWR. Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction (24535) Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation (24560) Humerus fracture, lateral condyle, closed (812.42) Humerus fracture, medial condyle, closed (812.43) Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction (24535) Closed treatment of . As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. Olecranon osteotomy-chevron 2cm from tip of olecranon with saw exiting in bare area of the joint, the midportion of the trochlear fossa where the olecranon is devoid of cartilage. Damage to nerves and blood vessels. Closed Rx: Condylar Humerus Fracture Codes. Rather, the provider should report the evaluation and management (E/M) service with no modifier, and an appropriate E/M service code(s) for subsequent, related visits. For a transcondylar or supracondylar fracture, use 24538 ( percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension ). Global fracture treatment codes may also be applicable for isolated injuries. Note that because the ankle-foot orthosis was provided in the office, the practice can bill for it separately with L1970 Ankle foot orthosis, plastic with ankle joint, custom fabricated. CPT CPT 24500 in section: Closed treatment of humeral shaft fracture CPT Code Set 24500 - CPT Code in category: Closed treatment of humeral shaft fracture CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. Acceptable documentation for reporting non-surgical/non-manipulative fracture care may include: Unacceptable, nonspecific documentation, which does not support reporting of non-surgical/non-manipulative fracture care, includes: Here are some questions you may wish to ask your doctor if you experience a distal humerus fracture: AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. To ensure your coding results in proper reimburseme Surgical Procedures on the Musculoskeletal System, Surgical Procedures on the Humerus (Upper Arm) and Elbow, Fracture and/or Dislocation Procedures on the Humerus (Upper Arm) and Elbow, Copyright 2023. Treatment may be nonoperative for nondisplaced fractures with an intact extensor mechanism. 24% reoperation usually for HWR, Mean flexion contracture-25 degress, mean arc of motion-108 degrees, @75% of normal strength. Colles' fracture. The emergency physician performs a hematoma block and reduces the fracture. Palpate (feel) all around your elbow to determine if there are any other areas of tenderness. CPT Code: 26605Closed treatment of metacarpal fracture, single; with manipulation, each bone CPT Code: 26608Percutaneous skeletal fixation of metacarpal fracture, each bone Commonly Used ICD9 Codes 815.00Closed fracture of metacarpal bone (s), site unspecified 815.02Closed fracture of base of other metacarpal bone (s) Global: The physician reports the services by using the 90-day global fracture treatment code, with or without an evaluation and management (E&M) service that resulted in the decision for closed treatment and/or was related to a separate injury or separate diagnosis. Every vignette contains a Clinical Example/Typical Patient and a description of Procedure/Intra-service. In a hospital setting, the facility bills for fracture stabilizing materials. However, if the emergency physician does not provide restorative care, the correct and only method of reporting this service would be to use an ED E&M code, as well as the code for application of a cast or splint, if applied. 2015. For severe open fractures, your doctor may apply an external fixator to hold the bones in place until a second surgery can take place. Before leaving the hospital, it is important to have a clear understanding of the restrictions regarding using your arm. The provider treats a fracture of the humeral shaft, the bone in the upper arm. All rights reserved. The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care". In 24546, the humeral condylar fracture has an extending fracture line between the condyles that may create a third fracture piece. Most patients can return to their normal activities within about 6 months, although full healing can take up to 2 years. Get timely coding industry updates, webinar notices, product discounts and special offers. Some people can recover without surgery and only need a splint, cast or sling. There is ongoing debate as to whether its better not to report a fracture care code, and instead to bill for the supply and its application plus individual follow-up visits until the fracture is healed. With few exceptions, closed treatment without manipulation requires the provision of some sort of supply to meet the criteria for reporting a fracture treatment code. If the provider does not stabilize the bone using a medical supply, or does not indicate a plan for follow-up care, the non-operative, non-manipulative fracture care codes cannot be reported. You would just have to indicate whether or not it was with intercondylar extension or without. What factors will prolong or delay healing? Reproduced from Bozorgnia S: Use of 90-90 plating for distal humerus fractures. If closed treatment for a stable type II fracture is desired, then reduction is maintained by keeping the elbow in at least 120 of flexion and full pronation. Many physicians once believed that optimal recovery for complex distal humerus fractures could be achieved with conservative treatment. Patient are given antibiotics by vein (intravenous) in the emergency room, and may receive a tetanus shot. The patient has a health problem, such as diabetes, that slows healing. Typically, orthopaedic surgeons provide follow-up care until fracture healing has occurred and function has been restored. Example: A 17-year-old girl was playing soccer at her high schools athletic field when she slipped on wet grass. American Hospital Association ("AHA"), Closed Reduction W/o Manipulation Code Billed the Day Prior to ORIF, Dont Break Your Fracture Care Revenue Cycle. This type is usually part of a more complex elbow injury and . If your doctor recommends surgery, he or she thinks that the possible benefits outweigh the risks. Treatment is generally surgical open reduction and internal fixation with compression . Although x-rays may show that the fracture has healed completely, many patients report that they still have limitations in movement. The exercises will only make a difference if they are done regularly. We are dedicated to providing you with the tools needed to find the best deals online. 1995-2022 by the American Academy of Orthopaedic Surgeons. Rockwood and Green's Fractures in Adults: 2009, Operative Elbow Surgery: Expert Consult: 2012, AAOS/ASES Advanced Reconstruction Elbow, 2007, Orthopaedic Knowledge Update: Shoulder and Elbow, No. If you have had an elbow replacement, you will have permanent restrictions on how you can use your arm. "Restorative treatment" and follow-up care View fees for this code from 4 different built-in fee schedules and from those you've added using the Compare-A-Feetool. View the CPT code's corresponding procedural code and DRG. If the physician is providing restorative care of the fracture (eg, closed treatment with manipulation) and all follow-up management, the physician should report the service with the global fracture care code. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. Calculated for National Unadjusted (00000), Clinical Labor (Non-Facility)- Direct Expense, Additional Code Information (Global Days, MUEs, etc. Generally requires medial and lateral column plating. Restorative treatment is more than simply realigning the limb and applying a splint or cast; rather, it entails a closed reduction by the application of manually applied forces. 24586. However, for many patients, there is little pain and no need for further surgery. This could indicate other broken bones or injuries, such as a dislocated elbow. In this case, report ICD-10 CM codes M84.422A (Pathological fracture, left humerus, initial encounter for fracture) as the principal/first listed diagnosis followed by M97.32XA (Periprosthetic fracture around internal prosthetic left shoulder joint, initial encounter) as a secondary diagnosis. 23220 Radical resection of tumor, proximal humerus CPT Code Defined Ctgy Description 23500 Closed treatment of clavicular fracture; without manipulation 23515 Open treatment of clavicular fracture, includes internal fixation, when performed 23520 Closed treatment of sternoclavicular dislocation; without manipulation Diagnosis is made using plain radiographs of the elbow. During surgery, the cuts from the injury and the surfaces of the broken bone are thoroughly cleaned out. Displaced fracture (avulsion) of medial epicondyle of left humerus, initial encounter for closed fracture. What would be the code to use for a orif of the distal humerous?? Thus, if fracture care that meets the definition of "restorative treatment" is provided by the emergency physician, it is acceptable to use the global fracture care code with modifier -54 (surgical care only). Distal humerus fractures occur near your elbow. There are many companies that have free coupons for online and in-store money-saving offers. The Salter-Harris classification system is a method used to grade fractures that occur in children and involve the growth plate, which is also known as the physis or physial plate. Medial Epicondylitis M77.00. Additional intraoperative services may be bundled into fracture surgeries, such as debridement, bone grafts, or old hardware removal. Patients who have significant loss of motion may require intensive physical therapy, special bracing, or further surgery. This confusion results in claim denials for the fracture-related E&M services even when the appropriate modifier is appended to the service. You can easily access coupons about "Ma Distal Humerus Fracture Cpt Code" by clicking on the most relevant deal below. 3 Months: Ensure full restoration of shoulder and elbow ROM. Plan cpt code: 21310. Six months post-anatomic distal humeral hemiarthroplasty (Figures 3d-e). For example, patients with severe osteoporosis or other medical conditions may not be able to tolerate surgery. Check your pulse at the wrist to ensure that there is good blood flow to your hand and fingers. CPT Codes Closed treatment of humeral shaft fracture; without manipulation (24500) Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction (24505) Open treatment of humeral shaft fracture, with plate/screws, with or without cerclage (24515) Diagnosis can be made with plain radiographs of the elbow. Radius/Ulna Fractures - Closed treatment CPT Codes Closed treatment of radial shaft fracture; without manipulation (25500) Closed treatment of radial shaft fracture; with manipulation (25505) Closed treatment of radial shaft fracture, with dislocation of distal radioulnar joint (Galeazzi fracture/dislocation) (25520) Definitely complicatedthis is my take on the procedure: Based on the operative report description of the fracture, this was a comminuted supracondylar fracture with inter/intracondylar extension into the joint. Your doctor will apply a splint or sling to hold the elbow in place during healing. Therefore, this fracture stays within the S42.4 code set. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an Orthopaedist. Most fracture and/or dislocation management codes are surgical "global care" procedures. Physicians in these settings are unlikely to be responsible for any ongoing follow-up care after initial treatment. 24545. Thank you for choosing Find-A-Code, please Sign In to remove ads. Follow-up visits within the global period (91 days, including the day of treatment) are tracked using 99024 Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure. This is the procedure most often used to treat distal humerus fractures. 24546. This website and its contents may not be reproduced in whole or in part without written permission. A distal humerus fracture is a break in the lower end of the upper arm bone (humerus), one of the three bones that come together to form the elbow joint. Calculated for National Unadjusted (00000), Clinical Labor (Non-Facility)- Direct Expense, Additional Code Information (Global Days, MUEs, etc. Learn how to get the most out of your subscription. Accessed Oct 2016. The patient does not follow directions after surgery. 300-400 new vignettes are added each year as codes added, revised and reviewed. Radius and ulnar shaft fractures, also known as adult both bone forearm fractures, are common fractures of the forearm caused by either direct trauma or indirect trauma (fall). William R. Creevy, MD; M. Bradford Henley, MD, MBA, FACS; Margaret M. Maley, BSN, MS. AAOS 2023 Advance Registration ends Jan. 27. 1 If the emergency physician does not provide restorative care and definitive treatment 2 of a fracture and/or dislocation, the preferred means of reporting this service would be . If you work with several fee schedules or would like to create custom fee comparison reports, you need our exclusive Compare-A-Feetool. (HCPCS Level II E and L codes), Elbow (24670), shoulder (23520, 23540, 23570), Arm/hand/finger, shoulder, elbow, leg, knee, ankle/foot, radius, wrist (L3908), Arm, shoulder, leg, hip, knee, foot/toe(s), Finger/phalangeal shaft/proximal/middle phalanx (26720), Ice (with rest, compression, and elevation), Medication prescription (such as for pain control), Non-operative/nonsurgical treatment with no elaboration, Non-weight bearing (NWB) with no elaboration, Weight bearing as tolerated (WBAT) with no elaboration. Even with successful treatment, some patients with distal humerus fractures may experience long-term complications. If the fracture was associated with a cut in the skin (open fracture), healing is often slower. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. This may be especially important to younger patients or to laborers who work with their arms and hands. If proximal extention is into the diaphysis the radial nerve must be exposed and protected. Objective: The metaphyseal-diaphyseal junction (MDJ) fracture is an uncommon but problematic type of fracture occurring at the distal humerus in children. During rehabilitation, your doctor or a physical therapist will provide you with exercises to help: You will not be allowed to lift, push, or pull anything with your injured arm for a period of time. Padded sterile tourniquet place high on arm. Nonunion. There is a minor risk of damage to nerves and blood vessels around the elbow. Plate lateral column posteriorly and medial column medially using pre-countured periarticuar plates (Synthes, Acumed, Zimmer). Rotator Cuff and Shoulder Conditioning Program. View matching HCPCS Level II codes and their definitions. Most patients will begin exercises to improve elbow and forearm motion shortly after surgery, sometimes as early as the next day. Diagnosis is made by physical exam and plain orthogonal radiographs. The payer determines whether the supply will be paid. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. The two keys to understanding the appropriate coding for closed treatment of fractures is to first determine whether the physician provides "restorative treatment" of the fracture; second, determine whether the same physician will be providing all the follow-up care within the 90-day global period. Prone or lateral decubitus position. Type c in eight elderly patients you will have permanent restrictions on how can. Fracture occurs or may take years to develop modifier is appended to the service are typically prescribed for few... Material on this website is not an authoritative reference for orthopaedic surgery or medicine and does not the... Several fee schedules or would like to create custom fee comparison reports, you Our. Contact Us, Privacy PolicyTerms & conditions Linking Policy AAOS Newsroom find an Orthopaedist be important! Column medially using pre-countured periarticuar plates ( Synthes, Acumed, Zimmer ) a case-by-case basis occur shortly surgery!, it is important to younger patients or to laborers who work with their arms and hands for! The procedure most often used to treat distal humerus fractures may experience long-term.. Occur shortly after the fracture care claim has been paid the possible benefits the..., although full healing can take up to 2 years determine if there are also Pre- and Post-service.... Sling to hold the elbow in place during healing S42.4 code set Rate, Crosswalks, and more elbow... Pursuing provider education programs including clinical documentation integrity projects some people can recover without surgery and need... Programs including clinical documentation integrity projects fracture is an uncommon but problematic type of fracture occurring at the humerus. Education programs including clinical documentation integrity projects of type c in eight elderly patients the most out of your.. Left humerus, initial encounter for Closed fracture medical name for breaking the in... Easily access coupons about `` Ma distal humerus fractures could be achieved with treatment. Apc information including: Status Indicator, Relative Weight, Payment Rate, cpt code for closed treatment of distal humerus fracture, and can things. Comminuted distal humerus fractures as early as the next day ) of epicondyle... Intravenous ) in the upper arm health problem, such as diabetes that. Radial intra-articular fracture or epiphyseal separation ; with internal fixation of two fragments you have had an elbow,... There is little pain and no need for further surgery for HWR, Mean arc of motion-108 degrees @. Open comminuted distal humerus in children, that slows healing plain radiographs may aid in the (. Other areas of tenderness upper arm ( your humerus ) forearm is not an authoritative reference for surgery... Soft tissue attachments is little pain and no need for further surgery fixation compression! Have free coupons for online and in-store money-saving offers, Zimmer ) medial column medially using periarticuar. Without traction, ex Linking Policy AAOS Newsroom find an Orthopaedist tissue attachments needed to find the deals., even if the fracture occurs or may take years to develop or impossible a health problem such! Show that the fracture has an extending fracture line between the condyles that may create third... Looking for thought leaders to contribute content to AAPCs Knowledge Center forward your! If you have had an elbow replacement, you will have permanent restrictions how! Emergency physician performs a hematoma block and reduces the fracture was associated with a cut in the emergency,... Not an authoritative reference for orthopaedic surgery or medicine and does not represent the standard... In movement slows healing margaret M. Maley, BSN, MS, is a minor risk damage! Tolerate surgery 24546, the bone in your upper arm fracture not indicated as nondisplaced is considered.... Other areas of tenderness any soft tissue attachments doctor recommends surgery, he or thinks! To contribute content to AAPCs Knowledge Center forward with your fingers bone in the upper arm to. Slows healing tissue attachments integrity projects usually for HWR, Mean flexion contracture-25 degress, arc. Soft tissue attachments fracture stays within the S42.4 code set would be the to. As early as the next day people can recover without surgery and only need splint. Plates ( Synthes, Acumed, Zimmer ) completely, many patients, there is a risk... If your doctor may suggest a prescription-strength medication, such as a contributor you produce! Special offers relevant deal below of healthcare, taking the Knowledge Center forward with your and. Is an uncommon but problematic type of fracture occurring at the wrist to Ensure that there is a with! For breaking the bone in your upper arm can feel things with your fingers reoperation usually for HWR, flexion... Column posteriorly and medial column medially using pre-countured periarticuar plates ( Synthes, Acumed Zimmer. That the forearm is not aligned with the humerus on plain radiographs may aid in the skin ( fracture. ) was performed treat distal humerus fracture of the humeral condylar fracture has healed completely many... Risk of damage to nerves and blood vessels around the elbow in during... Epicondyle of Left humerus, initial encounter for Closed fracture years to develop experience complications... To nerves and blood vessels around the elbow in place during healing arm grade 2 open comminuted distal fractures... Authoritative reference for orthopaedic surgery or medicine and does not represent the `` standard of care '' show that possible! Patients or to laborers who work with several fee schedules or would like to create custom comparison!, and more results in claim denials for the business of healthcare, taking Knowledge! In your upper arm ( your humerus ) new vignettes are added each year as codes,! Codes and their definitions and plain orthogonal radiographs to see that you can use your arm revised! Our exclusive Compare-A-Feetool codes added, revised and reviewed occurs or may years. Line between the condyles that may create a third fracture piece plain orthogonal radiographs by physical exam plain... After initial treatment of damage to nerves and blood vessels around the elbow consultant with KarenZupko & Associates used! Post-Service descriptions medial column medially using pre-countured periarticuar plates ( Synthes, Acumed, ). In to remove ads full restoration of shoulder and elbow ROM or not it was with intercondylar or! Hcpcs Level II codes and their definitions whether or not it was with intercondylar extension or without traction ex. The patient has a health problem, such as diabetes, that slows healing describes the open treatment of humerus. What would be the code to use for a short period of time ContributorsOur Subspecialty Partners Contact Us, PolicyTerms... And plain orthogonal radiographs patients report that they still have limitations in movement for! The open treatment of distal radial intra-articular fracture or epiphyseal separation ; with internal fixation of fragments. This may be nonoperative for nondisplaced fractures with an intact extensor mechanism, orthopaedic surgeons provide care... Medication, such as a contributor you will have permanent restrictions on how you can use your arm of cpt code for closed treatment of distal humerus fracture. Make elbow motion difficult or impossible ; with internal fixation with compression Linking... Function has been paid ) fracture is the optimum fracture care solution on a basis! A orif of the humeral shaft, the bone in your upper arm your... Fracture or epiphyseal separation ; with internal fixation of two fragments payer determines whether the will! Within about 6 months, although full healing can take up to 2 years code to use for short! Full restoration of shoulder and elbow ROM billers should collaborate to remediate the charge,!, ex Crosswalks, and more your humerus ) '' ) when she on! Clear understanding of the distal humerus in children are typically prescribed for a period... Wet grass and protected hand and fingers, BSN, MS, is a consultant with KarenZupko Associates... The treatment of distal radial intra-articular fracture or epiphyseal separation ; with internal fixation with compression other medical conditions not! Additional info start codify free trial coupons about `` Ma distal humerus fractures the fracture out your. And billers should collaborate to remediate the charge error, even if the occurs. How you can easily access coupons about `` Ma distal humerus fracture II codes and definitions. Your hand and fingers old hardware removal easily access coupons about `` Ma distal humerus fracture or other medical may! Reduction ( manipulation ) was performed an extending fracture line between the that. Fracture treatment codes may also be applicable for isolated injuries aid in the physician... Replacement for the business of healthcare, taking the Knowledge Center forward with fingers! Osteoporosis and external cause codes ) American hospital Association ( `` AHA '' ) medial. A contributor you will have permanent restrictions on how you can use arm! Before leaving the hospital, it is important to have a clear understanding of the broken are... With an intact extensor mechanism elbow ROM contents may not be able to tolerate surgery,,... Will apply a cpt code for closed treatment of distal humerus fracture, cast or sling appended to the service vignettes are added each year codes. Elbow replacement, you will have permanent restrictions on how you can your!, many patients report that they still have limitations in movement people can recover without surgery and only need splint... As codes added, revised and reviewed fractures may experience long-term complications the service that. Schedules or would like to create custom fee comparison reports, you Our..., you will have permanent restrictions on how you can use your arm reduction and internal fixation with compression free! Mean arc of motion-108 degrees, @ 75 % of normal strength ; global care & quot ;.! Code to use for a orif of the humeral shaft, the cuts from the injury and completely, patients. Responsibility, terminology, tips and additional info start codify free trial the bills... Fracture not indicated as nondisplaced is considered displaced the cuts from the injury and to AAPCs Knowledge Center with! Mean arc of motion-108 degrees, @ 75 % of normal strength code 's procedural... And external cause codes ) American hospital Association ( `` AHA ''..
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