Chapter 22
Global Surgery & Related Issues
Multiple surgeries are separate
procedures performed by a physician on the same patient at the same operative
session or on the same day. Multiple surgeries are distinguished from procedures
that are components of or incidental to a primary procedure. Intraoperative
services, incidental surgeries or components of surgeries will not be separately
reimbursed.
Reimbursement will be based on the following guidelines for multiple surgical
procedures:
100% of the allowance for the highest valued procedure.
50% of the allowance for the second through the fifth highest valued procedures.
Effective for dates of service January 1, 1995 and after, the regular multiple
surgery rules, as referenced above will be applied to the following procedure
codes when billed for the same beneficiary on the same day, by the same
physician:
Nuclear Medicine 78306, 78320, 78802-78803, 78806-78807
These pricing rules apply to
dermatology services:
100% of the allowance for the highest valued procedure.
50% of the allowance for the remaining
procedures.
The Limiting Charge is 115% of the reduced payment amount for each procedure.
When more than five procedures are performed, reimbursement for the sixth and/or subsequent procedures will be reviewed on an individual consideration basis. Operative notes should be submitted with the claim when five or more surgical procedures are performed during the same operative session.
Report the highest valued procedure.
Report additional surgical procedures with MODIFIER 51.
For example: If you are billing for a repair of a rotator cuff (Code 23412), and a ligament release (Code 23415), and a claviculectomy (Code 23120), report the codes as follows:
23412
23415 - 51
23120 - 51
If surgeons of different specialties are each performing a different procedure (with specific CPT codes) multiple surgery rules do not apply. If one of the surgeons performs multiple procedures, the multiple surgery rules apply to that physician's services.
b. Multiple Endoscopy Procedures
When multiple procedures are performed through the same endoscope, payment will be made for the highest valued endoscopy (100% of the allowance) plus the difference between the next highest and the base endoscopy.
c. Multiple Interventional Radiological Procedures
If multiple interventional radiological procedures are performed, both the radiology code and the primary surgical code are paid at 100% of the fee schedule. Subsequent surgical procedures will be reimbursed according to standard multiple surgery rules.
The payment for a surgical procedure includes a standard package of preoperative, intraoperative, and postoperative services. The preoperative period included in the global fee for major surgery is 1 day. The postoperative period for major surgery is 90 days. The postoperative period for minor surgery is either 0 or 10 days depending on the procedure. For endoscopic procedures (except procedures requiring an incision), there is no postoperative period.
The Medicare approved amount for these procedures includes payment for the following services related to the surgery when furnished by the physician who performs the surgery. The services included in the global surgical package may be furnished in any setting, e.g., in hospitals, ASCs, physicians' offices. Visits to a patient in an intensive care or critical care unit are also included if made by the surgeon. However, critical care services (99291 and 99292) are payable separately in some situations.
The following services are
included in the payment amount for a global surgery:
Preoperative Visits - Preoperative visits after the decision is made to operate
beginning with the day before the day of surgery for major procedures and the
day of surgery for minor procedures;
Intraoperative Services - Intraoperative services that are normally a usual and
necessary part of a surgical procedure;
Complications Following Surgery - All additional medical or surgical services
required of the surgeon during the postoperative period of the surgery because
of complications which do not require additional trips to the operating room;
Postoperative Visits - Follow-up visits within the postoperative period of the
surgery that are related to recovery from the surgery;
Postsurgical Pain Management - By the surgeon;
Supplies - Except for surgical trays for certain procedures in an office
setting; and
Miscellaneous Services - Items such as dressing changes; local incisional care;
removal of operative pack, removal of cutaneous sutures and staples, lines,
wires, tubes, drains, casts, and splints; insertion, irrigation and removal of
urinary catheters, routine peripheral intravenous lines, nasogastric and rectal
tubes; and changes and removal of tracheostomy tubes.
The following services are
not included in the
payment amount for a global surgery:
The initial consultation or evaluation of the problem by the surgeon to
determine the need for surgery;
Services of other physicians except where the surgeon and the other physician(s)
agree on the transfer of care. This agreement may be in the form of a letter or
an annotation in the discharge summary, hospital record, or ASC record;
Visits unrelated to the diagnosis for which the surgical procedure is performed,
unless the visits occur due to complication of the surgery;
Treatment for the underlying condition or an added course of treatment which is
not part of the normal recovery from surgery;
Diagnostic tests and procedures, including diagnostic radiological procedures;
Clearly distinct surgical procedures during the postoperative period which are
not re-operations or treatment for complications (A new postoperative period
begins with the subsequent procedure.) This includes procedures done in 2 or
more parts for which the decision to stage the procedure is made prospectively
or at the time of the first procedure. Examples of this are procedures to
diagnose and treat epilepsy (codes 61533, 61534-61536, 61539, 61541, and 61543)
which may be performed in succession within 90 days of each other.);
Treatment for postoperative complications which requires a return trip to the
operating room (OR). An OR for this purpose is defined as a place of service
specifically equipped and staffed for the sole purpose of performing procedures.
The term includes a cardiac catheterization suite, a laser suite, and an
endoscopy suite. It does not include a patient's room, a minor treatment room, a
recovery room, or an intensive care unit (unless the patient's condition was so
critical there would be insufficient time for transportation to an OR);
If a less extensive procedure fails, and a more extensive procedure is required,
the second procedure is payable separately;
For certain services performed in a physician's office, separate payment may be
made for a surgical tray (code A4550);
Immunotherapy management for organ transplants; and
Critical care services (codes 99291 and 99292) unrelated to the surgery where a
seriously injured or burned patient is critically ill and requires constant
attendance of the physician.
For minor surgeries and endoscopies, the Medicare program will not pay
separately for an evaluation & management service on the same day as a minor
surgery or endoscopy, unless a significant, separately identifiable service is
also performed, for example, an initial consultation or initial new patient
visit. As stated earlier, there is no postoperative period for endoscopic
procedures (unless an incision is required) and minor surgical procedures have
postoperative periods of 0 or 10 days, based on the procedure.
The Health Care Financing Administration has developed modifiers to bill for eligible services rendered in the pre- and postoperative periods of a surgery. These modifiers are: 22, 24, 25, 57, 58, 78, 79. The definitions of these modifiers, when and how they should be used, and some examples, are listed on the following pages:
22 - Unusual Procedural Services: When the service(s) provided is greater than what is usually required for the listed procedure, indicate this by adding modifier 22 to the procedure code. A report is also required.
For services on the physician fee schedule, modifier 22 is applicable only to those procedure codes for which the global surgery concept applies, whether the procedure code is surgical in nature or not. Supportive documentation, e.g., operative reports, progress notes, order sheets, pathology reports, etc., must be submitted with the claim.
Note: Modifier 22 will be removed when reported with procedures that do not have a global surgery period of 0, 10, or 90 days.
24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding the modifier 24 to the appropriate level of E/M service.
An excision of a malignant lesion on the left arm is performed in the office on May 10, 1996. The ICD-9-CM diagnosis code reported is 171.2. The post-operative period designated for excision code 11606 is 10 days.
The patient returns to the office on May 15, 1996 and is treated for contact dermatitis, ICD-9-CM code 692.0. The physician should report the appropriate evaluation and management code followed by the 24 modifier, e.g., 9921224.
In order for the evaluation and management service to be payable in the postoperative period with the 24 modifier, the diagnosis code supporting the E/M service must be different from the diagnosis code reported for the previously performed surgery and, at times, additional documentation which would indicate the service was unrelated to the previous surgery must also be submitted.
Under certain conditions, physicians may need to report an E/M service with modifier 24 even though the diagnosis is the same as that reported for the surgery. In these instances, documentation should be included with the claim to help us determine payment eligibility. A narrative explanation which indicates the E/M service was unrelated to the previous surgery is acceptable documentation.
Modifier 24 should not be used for the
medical management of a patient by the surgeon following surgery. Medicare
recognizes modifier 24
only for the care following a discharge unless:
The care is for immunotherapy management furnished by the transplant surgeon;
The care is for critical care (99291, 99292) for a burn or trauma patient under
diagnosis codes 800.0-929.9, 940.0-959.9; or
The documentation demonstrates that the visit occurred during a subsequent
hospitalization and the diagnosis supports the fact that it is unrelated to the
original surgery.
For minor surgeries and endoscopies, the Medicare program will not pay
separately for a evaluation & management service on the same day as a minor
surgery or endoscopy, unless a significant, separately identifiable service is
also performed, for example, an initial consultation or initial new patient
visit. As stated earlier there is no post-operative period for endoscopic
procedures (unless an incision is required) and minor surgical procedures have
post-operative periods ranging from 0 to 10 days, based on the procedure.
25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure: The physician may need to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the usual preoperative and postoperative care associated with the procedure that was performed. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service.
Note: This modifier is not used to report an E/M service that resulted in a decision to perform surgery. See modifier 57.
Visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed. For example, a visit on the same day could be properly billed with the 25 modifier in addition to billing for suturing a scalp wound if a full neurological examination was made for a patient with head trauma. Billing for a visit would not be appropriate if the physician only identified the need for sutures and confirmed allergy and immunization status. In the circumstance when the decision to perform a minor procedure is typically done immediately before the service, (e.g., whether or not sutures are needed to close a wound, whether or not to remove a mole or wart, etc.) it is considered a routine preoperative service and a visit or consultation should not be reported in addition to the procedure.
Effective immediately for dates of service on or after January 1, 1997, separate payment may be made for an initial hospital visit (CPT codes 99221-99223), an initial inpatient consultation (CPT codes 99251-99255) and a hospital discharge service (CPT codes 99238 and 99239) when billed by the same physician for the same date as an inpatient dialysis service (CPT code 90935-90947). It is no longer required that these evaluation and management services be unrelated to the treatment of the patient's ESRD in order for payment to be made. However, the 25 modifier must still be reported with these evaluation and management services in order to indicate that they are significant and separately identifiable services. Physicians may request reviews of previously denied services.
57 - Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.
E/M services on the day before or on the day of major surgery ( 90 day global period) which result in the initial decision to perform the surgery are not included in the global surgery payment. These E/M services may be billed separately and identified with the 57 modifier.
This modifier should not be used for visits furnished during the global period of minor procedures (0 or 10 day global period ) unless the purpose of the visit is a decision for major surgery. This modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. When the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure. See modifier 25.
58 - Staged Procedure or Service by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was (a) planned prospectively at the time of the original procedure; (b) more extensive than the original procedure; or (c) for therapy following a diagnostic surgical procedure. These circumstance may be reported by adding the modifier 58 to the staged procedure. A new postoperative period begins when the next procedure in the series is billed.
Note: This modifier is not used to report the treatment of a problem that requires a return to the operating room. (See modifier 78)
It would not be appropriate to report this modifier for codes which indicate in the terminology "one or more sessions", e.g., 66761, 67141, 67227. These codes are defined by CPT-4 as consisting of one or more sessions. The relative value units represent the work for the total number of sessions necessary for completion of the procedure. Therefore, subsequent sessions performed within the global period of the initial surgery are included in the global fee.
78 - Return to the Operating Room for a Related Procedure During the Postoperative Period: The physician may need to indicate that another procedure was performed during the postoperative period of the initial procedure. When this subsequent procedure is related to the first, and requires the use of the operating room, it may be reported by adding the 78 modifier to the related procedure.
When treatment for complications requires a return trip to the operating room, physicians must bill the CPT-4 code that describes the procedure (s) performed during the return trip. If no such code exists, use the unspecified procedure code in the correct series, e.g., 47999 or 64999. In this situation, you must include operative notes with the claim or a narrative description which will allow us to understand the extent of the service performed. The procedure code for the original surgery is not used except when the identical procedure is repeated.
An operating room for this purpose is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient's room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient's condition was so critical there would be insufficient time for transportation to an operating room).
A partial colectomy is performed in the hospital on March 1, 1996. The postoperative designation for this procedure (code 44140) is 90 days.
On March 15, 1996, the patient is returned to the operating room for a secondary suture of the abdominal wall. This procedure should be reported as 4990078.
Note: Modifier 78 should not be used for services outside the global surgery period.
79 - Unrelated Procedure by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using modifier 79.
A repair of a femoral hernia (49550) is performed on January 5, 1996. The postoperative period designation for this procedure code is 90 days.
On February 12, 1996, the same physician performs an appendectomy. The physician should report the appendectomy as 4495079.
d.1 Add-On Surgical Procedures
The Health Care Financing Administration has assigned various surgical procedures with global surgery post-operative periods of "ZZZ".
These procedures, while surgical in nature, are add-on codes that are always billed with another procedure. There is no post-operative work included in the fee schedule amount for "ZZZ" codes.
When billed independent of another qualifying service, "ZZZ" procedures will be denied since they, by definition, are not stand-alone procedures. When billed in conjunction with a primary surgical procedure or qualifying service, both the primary and add-on code will be paid. The global surgery rules will be applied to the primary procedure.
d.2 Splitting Post Operative Care
Specific billing guidelines must be followed when the surgical procedure and the post operative care is split between different physicians.
Modifiers 54 and 55 are used to indicate that the surgical care and post operative management services are being rendered by two different physicians. The physician who is rendering the one-day preoperative care, the intraoperative services, and any in-hospital visits bills his/her services with the date of the surgery, the procedure code for the surgery, and a 54 modifier to indicate that the bill is reflective only of the surgical care.
The physician rendering the
postoperative, out of hospital care associated with a given surgical procedure
should bill for his/her services with the date of the surgery, the procedure
code for the surgery, and a 55
modifier. If the surgeon also cares for the patient for some period following
discharge, the surgeon should bill the surgery with a 55
modifier and indicate the portion of the post-op care provided in addition to
the surgery with a 54
modifier. (to
indicate the intra-operative service)
In those cases where the postoperative
care is "split" between physicians, the billing for the postoperative
care should be reported as follows:
Report the date of service using the date of the surgical procedure.
Report the procedure code for the surgical procedure, followed by modifier
55.
Report the range of dates that you provided the postoperative care in the
procedure description (narrative) field on electronic claims, and block 19 on
the HCFA-1500 claim form. We do not need each date; only the range of dates.
Both the surgeon and the physician(s) providing the post-operative care must
keep a copy of the written transfer agreement in the beneficiary's medical
records.
When transfer occurs, the receiving physician cannot bill for any part of the
global services until at least one service has been provided. Once the physician
has seen the patient, the physician may bill for the period beginning with the
date care was assumed.
For example, a surgical procedure with 90 postoperative days was rendered on
March 2, 1996 by Doctor Johnson. He continued to provide the postoperative care
from the date of the patient's discharge, March 5, until April 5, 1996. Doctor
Rose then assumed the patient's care and continued to provide the postoperative
management until the end of the postoperative period. Each doctor would bill as
follows:
Doctor Johnson:
Report the date of service as March 2, 1996 using the surgical procedure code, and modifier 54.
Report the charge for this service.
On the next line, report the same date of service, March 2, 1996, using the surgical procedure code and modifier 55. Report the charge for this service.
In the procedure description (narrative) field for electronic claims, or in block 19 of the HCFA 1500 claim form, report March 5 - April 5, 1996.
Doctor Rose:
Report the date of service as March 2, 1996 using the surgical procedure code and modifier 55.
In the procedure description (narrative) field for electronic claims, or in block 19 of the HCFA 1500 claim form, report April 6 - May 29, 1996.
When the postoperative care is split between two physicians, payment is based on the percentage of postoperative care that each provided.
1. Bilateral surgeries are defined as procedures performed on both sides of the body during the same operative session or on the same day. HCFA has defined codes subject to the bilateral payment rule. Payment for claims reporting bilateral procedures will be based on 150% of the fee schedule amount. The Limiting Charge is 115% of that amount.
2. Procedure codes containing the terms "bilateral" or "unilateral or bilateral" in their definitions are not subject to bilateral pricing. Payment for these services is based on 100% of the fee schedule for a surgical code. Procedure codes with terminology indicative of unilateral or bilateral services, as in code 27395 (lengthening of hamstring tendon; multiple, bilateral) or code 52290 (Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral) cannot be reported with the bilateral procedure code modifier 50 since the terminology for the code identifies the service as bilateral.
3. Certain procedures are not applicable to the 150% payment rule for bilateral procedures. Payment is based on 100% of the fee schedule for each side, e.g., codes 92225 and 92226. When performed bilaterally, these codes should be reported with modifiers RT-LT or modifier 50 to ensure proper payment.
Report the procedure code with MODIFIER 50.
Report a one in the number of services field.
For example: If you are billing for a bilateral mastectomy, you would report the service as a single line item: 19180 50
Reminder: Procedure codes with terminology indicative of unilateral or bilateral services, as in code 27395 (lengthening of hamstring tendon; multiple, bilateral) or code 52290 (Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral) cannot be reported with the bilateral procedure code modifier 50 since the terminology for the code identifies the service as bilateral and the reimbursement for the code includes the work associated with providing it bilaterally.
e.2 Bilateral Processing for Code 67820
Procedure code 67820, correction of trichiasis; epilation, by forceps only, is assigned a bilateral indicator of `0', indicating that bilateral rules do not apply. The selection of a bilateral indicator of `0' was intentional (not withstanding the bilateral nature of the services) because application of the bilateral payment policy would result in incorrect payment for the services when the service is performed on both the upper and lower lids of both eyes. One unit of CPT code 67820 has been valued based upon the physician work in removing the lashes from one lid (either the upper or lower) of one eye.
To allow for proper payment, physicians would bill two or more units of 67820 as multiple procedures, without regard to whether the units were performed on either the same or different eyes. In the case where a physician removes lashes from both the upper and lower lids of both eyes, the physician should bill 67820 on a single claim line showing 4 units of service and the multiple surgery modifier -51.
The multiple surgery rules, not the bilateral rules, will be applied to the 4 units of the code. Effective for dates of service January 1, 1995 and after, if these are the only multiple surgical procedures performed, 250% of the payment for one unit of the code will be allowed (100% + 50% + 50% + 50%). For dates of service prior to January 1, 1995, a total of 200% of the allowance for a single unit will be allowed (100% + 50% + 25% + 25%).
Some surgical procedures require a primary surgeon and an assistant surgeon. HCFA has identified those surgical procedures for which an assistant surgeon may be reimbursed. Payment will not be made for the services of assistants at surgery furnished in a teaching hospital which has a training program related to the medical specialty required for the surgical procedure and has a qualified resident available to perform the service.
Payment for an assistant surgeon is limited to 16% of the fee schedule amount for the surgical procedure. The Limiting Charge is 115% of the assistant surgeon's fee schedule amount.
Services for an assistant-at-surgery must be reported with one of the following modifiers as appropriate to the situation.
Modifier 80
- This modifier is reported when the services are performed in a non-teaching
setting or in a teaching setting when a resident was available but the surgeon
opted not to use the resident. In the latter case the service is generally not
covered by Medicare unless the following circumstances exist and are reported on
the claim form:
the primary surgeon has an across-the-board policy of never involving residents
in the preoperative, operative, or post operative care of his/her patients.
exceptional medical circumstances existed, e.g. emergency, life-threatening
situations such as multiple traumatic injuries requiring immediate treatment.
Modifier 82
- This modifier is reported when there is no qualified resident surgeon
available or when the services are performed in a teaching hospital that does
not have an approved training program related to the medical specialty required
for the surgical procedure.
f.2 Procedures Eligible for Assistant at Surgery for 1996
The Health Care Financing Administration has revised the list of surgical procedures which are eligible for assistant-at-surgery services. Please reference Appendix I for an eligible list of assistant-at-surgery services.
Under some circumstances, the individual skills of two surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient's condition. In these cases, the additional physician is not acting as an assistant-at-surgery.
Co-surgery refers to a single surgical procedure which requires the skill of two surgeons (usually with different skills) of the same or different specialties performing parts of the same procedure simultaneously, e.g., heart transplant or bilateral knee replacements. It is not always co-surgery when two doctors perform surgery on the same patient during the same operative session. Co-surgery has been performed if the procedure(s) performed is part of and would be billed under the same surgical code, (e.g., the excision of a pituitary tumor (CPT code 61548) by an otolaryngologist and a neurosurgeon). In this case, each physician reports code 61548 with the 62 modifier (two surgeons). Payment for each surgeon is 62.5% of the Medicare Fee Schedule amount.
Co-surgery has not been performed when each physician performed a separate surgical procedure which is reported under a different surgical procedure code, e.g., a hammertoe operation (CPT code 28285) performed by a podiatrist and a palma fasciotomy (CPT code 26040) performed by a hand surgeon. When two unrelated procedures are performed, each physician should bill for and be paid the full global fee for the procedure he/she performed.
g.1 Eligible Co-surgery Procedure Codes
There are 2 categories of surgical procedures for which co-surgery may be covered. Codes not listed as Category I or Category II are not eligible for reimbursement for co-surgery.
When performing co-surgery, it is important to communicate with the other surgeon's office to be certain that the claims are submitted properly.
g.1a Category I Procedure Codes
Listed below are codes which the Health Care Financing Administration has determined can be paid for co-surgery when an operative report supporting the need for co-surgeons (of the same or different specialties) is submitted with the claim. If the surgical procedures performed by each surgeon can be clearly identified, and each surgeon's role during the operative session is explicitly described, the same operative report may be submitted with each surgeon's claim. Otherwise, an operative report dictated by each physician is required. If an operative report(s) is not submitted the claim will be denied.
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12007 12018 12037 12047 12057 15121 15732 15734 15736 15738 15770 15831 15832 15841 15842 15922 15935 15936 15937 15946 15951 15952 15953 15956 15958 15999 17999 19125 19126 19162 19180 19182 19200 19220 19240 19260 19271 19272 19316 19318 19340 19342 19357 19361 |
19364 19366 19367 19368 19369 19499 20150 20650 20692 20802 20805 20808 20816 20822 20824 20827 20838 20900 20902 20920 20922 20924 20931 20937 20938 20955 20956 20957 20962 20969 20970 20971 20973 20975 20999 21034 21044 21045 21060 21120 21123 21127 21138 21139 |
21141 21142 21143 21146 21154 21159 21172 21180 21182 21183 21193 21196 21198 21206 21215 21240 21242 21243 21244 21247 21255 21256 21260 21261 21263 21267 21268 21270 21275 21299 21339 21343 21346 21347 21365 21385 21390 21395 21406 21407 21422 21433 21454 21461 |
21462 21465 21470 21490 21493 21494 21499 21557 21600 21615 21620 21630 21632 21725 21740 21750 21825 21899 21935 22100 22101 22102 22103 22110 22112 22114 22116 22210 22214 22216 22220 22224 22226 22325 22326 22327 22328 22800 22802 22804 22808 22810 22812 22830 |
22840 22849 22850 22852 22855 22899 22900 22999 23000 23040 23044 23077 23100 23101 23105 23106 23107 23120 23125 23130 23145 23150 23155 23174 23180 23184 23190 23195 23200 23210 23220 23222 23332 23395 23397 23400 23405 23410 23412 23415 23420 23430 23440 23450 |
23455 23460 23462 23465 23466 23470 23472 23480 23485 23491 23515 23550 23552 23585 23615 23630 23660 23670 23680 23800 23802 23920 23929 24000 24077 24100 24102 24110 24115 24125 24130 24145 24147 24149 24150 24151 24152 24155 24160 24164 24301 24320 24340 24341 |
24342 24352 24360 24361 24365 24366 24400 24410 24420 24430 24435 24498 24515 24545 24575 24579 24586 24587 24615 24635 24665 24666 24685 24800 24900 24920 24999 25105 25107 25116 25119 25120 25135 25136 25150 25151 25170 25210 25215 25230 25240 25274 25280 25310 |
25312 25330 25331 25360 25375 25390 25391 25400 25405 25415 25420 25425 25426 25440 25441 25442 25443 25445 25446 25447 25449 25515 25545 25575 25670 25695 25800 25805 25810 25820 25825 25830 25999 26185 26255 26352 26390 26392 26477 26483 26485 26492 26494 26498 |
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26499 26518 26525 26531 26540 26541 26553 26554 26556 26558 26559 26561 26665 26685 26820 26841 26842 26843 26844 26852 26862 27000 27001 27003 27005 27006 27025 27030 27033 27035 27036 27048 27049 27050 27052 27054 27062 27065 27066 27070 27071 27075 27076 27077 27078 27079 27080 27087 27090 27091 27100 27110 27111 27120 |
27122 27125 27130 27132 27134 27137 27138 27140 27146 27147 27151 27156 27161 27165 27170 27176 27177 27178 27185 27187 27235 27236 27244 27248 27253 27254 27258 27280 27282 27284 27286 27290 27295 27299 27303 27305 27307 27310 27320 27329 27330 27331 27332 27333 27334 27335 27345 27350 27355 27356 27357 27360 27365 27380 |
27381 27385 27386 27391 27392 27393 27395 27396 27400 27403 27405 27407 27409 27418 27420 27422 27424 27425 27427 27428 27429 27430 27435 27437 27438 27440 27441 27442 27443 27445 27446 27447 27448 27450 27454 27455 27457 27465 27466 27468 27470 27472 27475 27477 27486 27487 27488 27495 27506 27514 27519 27524 27536 27540 |
27556 27557 27566 27580 27590 27591 27592 27596 27598 27599 27600 27602 27606 27612 27615 27620 27625 27635 27637 27638 27640 27641 27645 27646 27650 27652 27654 27658 27659 27665 27675 27680 27681 27685 27686 27687 27690 27691 27692 27695 27696 27698 27700 27702 27704 27705 27707 27709 27712 27715 27720 27722 27724 27725 |
27727 27730 27742 27745 27756 27758 27766 27784 27792 27814 27822 27823 27832 27846 27848 27870 27871 27880 27881 27882 27886 27888 27889 27899 28020 28035 28046 28050 28052 28062 28086 28100 28104 28106 28110 28111 28112 28114 28118 28119 28120 28122 28130 28140 28173 28175 28200 28202 28208 28225 28238 28250 28260 28262 |
28285 28292 28293 28294 28296 28297 28298 28299 28300 28302 28304 28305 28306 28308 28310 28312 28315 28320 28322 28344 28415 28420 28445 28485 28555 28585 28615 28645 28705 28715 28725 28730 28735 28737 28740 28755 28760 28800 28899 29799 29804 29815 29819 29820 29821 29823 29825 29826 29834 29835 29836 29837 29843 29845 |
29870 29880 29884 29885 29887 29888 29889 29894 29895 29898 29909 30118 30150 30160 30999 31040 31075 31081 31084 31085 31087 31205 31225 31230 31299 31300 31360 31365 31367 31368 31370 31375 31380 31382 31390 31395 31420 31580 31582 31584 31587 31590 31595 31599 31601 31611 31750 31755 31760 31766 31770 31780 31781 31785 |
31786 31805 31899 32002 32035 32036 32095 32100 32110 32120 32124 32140 32141 32150 32151 32160 32200 32215 32220 32225 32310 32320 32402 32440 32442 32445 32480 32482 32484 32486 32488 32500 32501 32520 32522 32525 32540 32650 32651 32652 32653 32654 32655 32656 32657 32658 32659 32660 32661 32662 32663 32664 32665 32800 |
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32815 32820 32851 32852 32853 32854 32900 32905 32906 32940 32999 33020 33025 33030 33031 33050 33120 33130 33241 33242 33243 33244 33245 33246 33247 33249 33250 33251 33253 33261 33300 33305 33310 33315 33320 33321 33322 33330 33332 33335 33400 33401 33403 33404 33405 33406 33412 33413 33414 33415 33416 33417 33420 33422 |
33425 33426 33427 33430 33460 33463 33464 33465 33468 33471 33474 33475 33476 33478 33500 33502 33503 33504 33505 33506 33542 33545 33600 33602 33606 33608 33610 33611 33612 33615 33617 33619 33641 33645 33647 33660 33665 33670 33681 33684 33688 33690 33692 33694 33697 33702 33720 33722 33730 33732 33736 33737 33750 33755 |
33762 33764 33766 33767 33770 33771 33774 33776 33778 33779 33780 33786 33788 33802 33803 33813 33814 33822 33824 33840 33845 33851 33853 33860 33861 33863 33870 33875 33877 33910 33915 33916 33917 33918 33919 33920 33922 33924 33935 33945 33970 33973 33999 34001 34051 34101 34111 34151 34201 34203 34401 34421 34451 34471 |
34501 34510 34520 34530 35001 35002 35005 35011 35013 35021 35022 35045 35081 35082 35091 35092 35102 35103 35111 35112 35122 35131 35132 35141 35142 35151 35152 35161 35162 35180 35182 35184 35188 35189 35190 35201 35206 35207 35211 35216 35221 35226 35231 35236 35241 35246 35251 35256 35261 35266 35271 35276 35281 35286 |
35301 35311 35321 35331 35341 35351 35355 35361 35363 35371 35372 35381 35390 35450 35452 35454 35456 35458 35459 35460 35472 35501 35506 35507 35508 35509 35511 35515 35516 35518 35521 35526 35531 35533 35536 35541 35546 35548 35549 35551 35556 35558 35560 35563 35565 35566 35571 35582 35583 35585 35587 35601 35606 35612 |
35616 35621 35623 35626 35631 35636 35641 35642 35645 35646 35650 35651 35654 35656 35661 35663 35665 35666 35671 35681 35691 35693 35694 35695 35700 35701 35721 35741 35761 35800 35820 35840 35860 35870 35875 35876 35901 35903 35905 35907 36299 36821 36825 36830 36832 36834 37140 37160 37180 37181 37250 37251 37565 37600 |
37605 37607 37615 37616 37617 37618 37620 37650 37660 37720 37730 37735 37760 37780 37788 37799 38100 38101 38102 38115 38308 38380 38381 38382 38530 38542 38555 38562 38564 38700 38720 38724 38740 38745 38746 38747 38760 38765 38770 38780 38999 39000 39010 39200 39220 39499 39501 39502 39503 39520 39530 39531 39540 39541 |
39545 39599 40799 40899 41120 41130 41135 41140 41145 41150 41153 41155 41599 41899 42120 42299 42410 42415 42420 42425 42426 42440 42510 42699 42725 42815 42844 42845 42890 42892 42894 42950 42999 43020 43030 43045 43100 43101 43107 43108 43116 43122 43123 43124 43130 43135 43300 43305 43310 43312 43320 43324 43325 43326 |
|
43330 43331 43340 43341 43350 43351 43352 43360 43361 43400 43401 43405 43410 43415 43420 43425 43496 43499 43500 43501 43502 43510 43520 43605 43610 43611 43620 43621 43622 43631 43632 43633 43634 43635 43638 43639 43640 43641 43800 43810 43820 43825 43830 43831 43832 43840 43846 43847 43848 43850 43855 43860 43865 43870 |
43880 43999 44005 44010 44015 44020 44021 44025 44050 44055 |