There are only two codes for the removal or resection of a mediastinal mass. 272 0 obj <>/Filter/FlateDecode/ID[<535A10A97A2A27468C322B46F8D189C0>]/Index[250 36]/Info 249 0 R/Length 108/Prev 122423/Root 251 0 R/Size 286/Type/XRef/W[1 3 1]>>stream Step 2 Dissection of thymus off pericardium and encircling in midline. Mean QoL functioning scores at baseline and after 1, 3, 6 and 12 months as measured by the EORTC QLQ-C30 and LC-13 [2,3]. 39000 Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; cervical approach. The mediastinum can be divided into separate anatomic compartments, the anterior, middle or visceral, and posterior mediastinum.1 Tumors requiring surgical attention generally originate in the anterior and posterior compartments in this three-compartment model. The postoperative diagnosis states that the mass is a tumor, therefore code . Th My surgeon performed this surgery and wants to bill code 39220 which I don't agree with, however I cannot find a code that would make him happy. It does not store any personal data. View any code changes for 2023 as well as historical information on code creation and revision. Partial upper median sternotomy is a safe and effective means of accessing the anterosuperior mediastinum. Complete thymectomy is a crucial part of treatment for anterior mediastinal masses, such as MG and thymoma [5]. 202.82 Other lymphomas of intrathoracic lymph nodes, Postoperative Diagnosis: Small cell carcinoma of lung with mediastinal invasion, 162.9 Malignant neoplasm of bronchus and lung, unspecified, 197.1 Secondary malignant neoplasm of mediastinum. Thirteen years follow-up after radical transsternal thymectomy for myasthenia gravis. What is causing the plague in Thebes and how can it be fixed? Objective: To prospectively evaluate quality of life (QoL) evolution after robotic-assisted thoracoscopic or open anterior mediastinal tumour resection with the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire-C30 and the lung cancer-specific module, LC-13. Ligation of the brachiocephalic vein may result in edema of the left upper extremity, although reports indicate that the edema will eventually resolve. Mediastinal space is narrow and the anterior mediastinum has the commonest mediastinal mass which is thymoma, followed by lymphoma [2]. A: Once a decision is made to surgically remove a mediastinal tumor, there generally are two approaches that are used: an anterior approach done through a cut in the front of the chest and breastbone (sternum), called a sternotomy; or a lateral approach done through tiny incisions on the side of the chest, in between . The resection of the diaphragm portion of the mass was repaired with primary sutures. All procedures allow for extracapsular resection of the thymus but vary in the extent of mediastinal fat removed, which may contain ectopic foci of thymic tissue. WebWhat is the CPT code for excision of mass?Excisional biopsies include two sets of codes, for excision of benign lesions (codes 11400-11471) or malignant lesions (codes 11600-11646).These codes are for full-thickness removal and should be selected based on the lesion type, the location, and the size of the excision, not . 7 Which CPT code describes vats therapeutic wedge resection? Match the code Code 39220 ----- Resection of mediastinal tumor Code 39560 . Listen to pronunciation. However, the EORTC questionnaire has been used previously in evaluating QoL in post-thymectomy MG patients [11]. It has been commonly used for biopsy of masses and lymph nodes. In the sternotomy group, there was one pleural recurrence of thymoma 54 months after surgery and adjuvant radiotherapy, necessitating re-operation by thoracotomy (4.5%). Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. What is mediastinal mass resection? What is the ICD 10 code for body mass index? For thymomas or thymic carcinomas, however, a transsternal approach is indicated. I was looking at 34502 for the reconstruction of the vena cava. Any ideas on how to code this would be appreciated! There is no dx, I am doing a comparison between Category III T-Codes (0258T) and current Cardiac CPT codes. 69-1 and. 3 0 obj You must log in or register to reply here. I am looking for a CPT code that is similar to 0258T (Transthoracic cardiac exposer (eg, sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; without coronary artery bypass). 164.2 Malignant neoplasm of anterior mediastinum. reverse_index/reverse_index_content.php?set=CPT&c=21558, cpt/cpt_reference_guidelines_content.php?set=CPT&c=21558, newsletters/newsletter_content.php?set=CPT&c=21558, webacode/webacode_content.php?set=CPT&c=21558, medlabtests/medlabtests_content.php?set=CPT&c=21558, crosswalks/crosswalk_content.php?set=CPT&c=21558, ncciedits/ncci_content.php?set=CPT&c=21558, coverage/coverage_content.php?set=CPT&c=21558, commercial-payers/commercial-payers-content.php?set=CPT&c=21558, NPI Look-Up Tool (National Provider Identifier), Major Complications or Comorbidities (MCC/CC), Create UNLIMITED Customized Fee Schedule reports - for ALL localities, ALL specialties, See fees for ALL localities (all ZIP codes) as well as National fees, Load UNLIMITED Fee Schedules with your fees or fees from your payers, Choose to compare fees (national or adjusted for your locality) from built-in data sets and the fee schedules you enter. You are using an out of date browser. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Robotic-assisted resections were preferentially performed by a left-sided approach with CO2 insufflation to increase the retrosternal space in our center. The 2023 edition of ICD-10-CM J98.5 became effective on October 1, 2022. What is the CPT code for mediastinal lymphadenectomy? The surgeon must visualize both phrenic nerves during dissection of the thymic lobes off of the pleura and pericardium. STEPS IN PROCEDURE Mark the midline of the skin and create incision from sternal notch to 1 to 2 cm below xiphoid Divide connective tissue to sternum Verify midline of sternum and score the periosteum Divide abdominal fascia for several centimeters Gently dissect under sternum at both ends Use sternal saw to divide the sternum What is the DX? The cookie is used to store the user consent for the cookies in the category "Other. Cancel anytime. Calculated for National Unadjusted (00000), Clinical Labor (Non-Facility)- Direct Expense, Additional Code Information (Global Days, MUEs, etc. Dissection of the Thymus off the Pericardium and Encircling in the Midline, Injury to the Thymic Veins or the Brachiocephalic Vein. Ann Thorac Surg . Codes 11420- 11426 are used for the excision of benign lesions of the scalp, neck, hands, feet, and genitalia, whereas codes 11440-11446 are used for excision of benign lesions of the face, ears, eyelids, nose, lips, and mucous membrane. Briefly, this is an 87-year-old gentleman with a large anterior mediastinal mass involving the trachea. CPT Code: 38212 Resection of a mediastinum cyst. A p value of less than 0.05 was considered as statistically significant. Table 1 outlines clinical demographics of patients for both procedure groups. Table 1. The anatomic location of the mediastinal mass is often suggestive of the specific pathology. x\r6}wTjL Km*U$Y*3y)ZfV"rV? d2Fn7e=O}rz#s`ezyw,Ay^./~`M01Qg0B>,A/i5 m0c$DJ|?pdt4qP]>n9vh/RQXj:RHO+{Tg?_=(_.Bm [b~Q8$1z\X\^+JG&yhZuoi_~`?m#t#gd5 b!$ zoaOLU|lr%|&3gl;{(R . Since mediastinal mass resection via RATS was first reported (11,20), the technique has been increasingly used worldwide for a number of different types of mediastinal masses (21-24). I am hoping someone could point me in the right area. Patients also complained of fatigue, sleep disturbances, dyspnoea and appetite loss. Mediastinal tumors are relatively uncommon. Code 32668 can only be reported in conjunction with CPT codes 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32503, 32504, 32663, 32669, 32670, and 32671. Students t-test was used to compare parametric data between groups. : clinical demographics of patients for both procedure groups, parametric results are depicted as mean with standard deviation unless otherwise stated. A) 39540 B) 39560 C) 39545 D) 39561 endstream endobj startxref Most mediastinal masses are neoplasms, either benign or malignant, the latter being either of primary growth or metastatic origin. Figure 69-4 Extension of the thymus into the aortopulmonary window. Yes No If Yes Sternotomy Yes No PriorStern (760) 3 (check all that apply) . I am looking for a CPT code that is similar to 0258T (Transthoracic cardiac exposer (eg, sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; without coronary artery bypass). Yendamuri S. Resection of a Giant Mediastinal Teratoma. Non-parametric variables are reported as means with standard deviation, parametric variables as median with range. When reporting procedures on this list, facilities should capture both the CPT1 code representing the procedure performed and the . If this is your first visit, be sure to check out the. "Procedure-median sternotomy w/resection or anterior mediastinal mass. Comparison of two minimally invasive approaches such as the conventional thoracoscopic and the robotic thoracoscopic approach might have provided even more meaningful results with regard to the effect of robotic technology. APC information including: Status Indicator, Relative Weight, Payment Rate, Crosswalks, and more. Reasons for Procedure. Although most studies of robotically assisted mediastinal surgery have reported morbidity and mortality [69], none have addressed outcome measures, such as QoL. Open in new tab Download slide With the pleural reflection opened, the phrenic nerve is easily visible. CPT code 32674, Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy, is an add-on code, which can only be reported in conjunction with 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32503, 32504, 32505, 32663, 32666, 32667, 32669, 32670, and 32671. The head is also tilted superiorly and slightly to the right. After a da Vinci robotic resection QoL scores approximated baseline preoperative values 1 month after surgery, with the exception of increase in thoracic and shoulder pain the first 3 months after surgery (p=0.028 and 0.029, respectively). A thoracic drain is inserted, draining the mediastinum and the pleurae, if these are opened. What is the CPT code for resection? 4 0 obj Phrenic nerve injuries during thymectomies are reported to occur in 0% to 4.5% of cases. Dissection of the left side may be more challenging because the phrenic nerve may follow a more intimate course with the lateral portion of the thymus. The questionnaires were sent to the patients by mail, accompanied by a letter with general information and the aim of the study. CPT Code Set 21558 - CPT Code in category: Radical resection of tumor (eg, malignant neoplasm), soft tissue of neck or anterior thorax CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. In addition, accessory thymic lobules may be present posterior to the superior lobe of the thyroid, and the recurrent laryngeal nerves must be identified and preserved when dissecting in this area, Breast Biopsy and Breast-Conserving Surgical Techniques, Laparoscopic Esophagomyotomy with Dor Fundoplication, Surgical Pitfalls Prevention and Management. Biopsy was advised to establish diagnosis and consider further treatment. Step 1 Median sternotomy. abscess of mediastinum (. To compare the QoL evolution between both groups, the difference between the baseline value and the value, postoperatively, was compared using the non-parametric MannWhitney U-test. 32550, 32552-51, T85.79XA, C34.31, C34.32 A 78 year-old patient with bilateral, lower lobe lung cancer has been in the hospital for seven days with a tunneled chest tube in place to drain fluid from the pleural space. Sternotomy and complex resection of anterior mediastinal mass with en bloc left upper lobe wedge resection, resection of a portion of left phrenic nerve and portion of . 8 What is the ICD 10 code for mediastinal lymphadenopathy? In two patients (14.3%), only three ports were used. Although median sternotomy is often performed for several indications, it can lead to several specific complications as sternal instability and keloid scar formation, as in this study. The recurrent nerves should never be handled directly or encircled for retraction purposes. Completion of the Thymus/Mediastinal Mass, Tracheal Resection and Hiatal Hernia/GERD sections is optional for . He has had a bronchoscopy by a physician that showed what appeared to be invasion of the trachea but brushings, washing and biopsy were negative. A pleural drain is inserted through one of the ports crossing the mediastinum with its tip in the contralateral pleura, draining both thoracic cavities and the mediastinum. It is an alternative to full sternotomy and provides a less invasive means of resecting small anterior mediastinal masses as well as accessing the thoracic inlet. PROCEDURE PERFORMED: The pleura may be incorporated into the thymic specimen if dense adhesions are present. The mediastinum, which separates the lungs, houses the heart, esophagus, trachea, great vessels, thymus, and lymph nodes. It may not display this or other websites correctly. However, patients in the robotic-assisted group complained also of thoracic pain and shoulder discomfort in the first 3 months, which can be explained by the use of intercostal trocars that may damage the intercostal nerves. I have looked at 39220, 21555, and 19260-52 but none say "mass." Complete thymectomy. Sternotomy and complex resection of anterior mediastinal mass with en bloc left upper lobe wedge resection, resection of a portion of left phrenic nerve and portion of pericardium. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Thymectomy and Resection of Mediastinal Masses. C carolhpolk Guest Messages 11 Location Jackson, MS QoL at baseline and evolution after both procedures is shown in Table 2 . It may not display this or other websites correctly. Do you need underlay for laminate flooring on concrete? JavaScript is disabled. The transient lesion of the left recurrent nerve, which occurred in two robotic procedures, was due to dissection of the nerve from the tumours capsule and was not based on limitations of the robotic system. Injury to these veins results in bleeding with uncontrolled transection, which can be significant if the brachiocephalic vein is injured. Several large pieces were then removed from this using a scalpel blade. Did the nodules path come back as anything? A primary repair of the phrenic nerve may be attempted, but function is generally not restored. By clicking Accept All, you consent to the use of ALL the cookies. with mediastinal and regional lymphadenectomy (List separately in addition to code for primary The Current Procedural Terminology (CPT ) code 39220 as maintained by American Medical Association, is a medical procedural code under the range - Excision/Resection Procedures on the Mediastinum. 2 0 obj In most of the right-sided cases CO2 insufflation was not necessary. Why is the sternotomy being done? What is procedure code 32601? Step 5 Left lateral and cervical thymic dissections. biopsy, destruction, excision) have CPT codes that describe the procedure as an integumentary procedure (CPT codes 10000-19999), a nasal procedure (CPT codes 30000-30999), or an oral procedure (CPT codes 40000-40899). There were no significant preoperative clinicopathological differences between patients, who returned all questionnaires, compared with those who did not. It may be used to remove a tumor and a small amount of normal tissue around it. 1).Preoperatively, she underwent myasthenic crisis twice and required tracheostomy and mechanical ventilation for several weeks. For the functional scales, higher scores represent a higher level of functioning. Thymectomy and resection of mediastinal mass, Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare. What is the CPT code for excision of mediastinal tumor? Sterile dressings were applied. 32601. What is the CPT code for resection of mediastinal cyst? The mediastinum is an area in the chest between the sternum and the spine in back. Thymic vein injuries may be simply ligated or oversewn. In most cases, the contralateral pleura is opened to locate the phrenic nerve at the other side and to accomplish a complete extended thymectomy. I had a thoracotomy with a wedge resection one year ago (March 3 2011). Where appropriate, there are also Pre- and Post-service descriptions. Larger clinical studies with longer follow-up are required to substantiate this conclusion. As a result, the follow-up of new mediastinal surgical techniques has to be protracted to prove efficacy, despite the initial advantages of the minimally invasive approach. 39220. The cookies is used to store the user consent for the cookies in the category "Necessary". b Anatomic localization and puncture points. With the patient under general anaesthesia, a sternotomy is performed. The introduction of robotic surgical systems has added a new dimension to minimally invasive surgery. As one dissects under the thymus from an inferior-to-superior direction, one must anticipate the position of the brachiocephalic vein and look for the thymic vein entering, typically, the inferior surface of this vessel (Figs. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. By contrast, patients, who underwent a standard sternotomy, reported significant decreases in physical, role and social functioning 1 month after surgery. Although the impact of robotic surgery is not yet clear, currently, it seems to be most promising for surgery in remote, narrow anatomical regions [1]. These cookies ensure basic functionalities and security features of the website, anonymously. For more information about our services, please contact Donna Yoshida at (650) 721-2086 or Cliff David at (650) 721-6400. May result in edema of the pleura may be simply ligated or oversewn by lymphoma [ 2.! & quot ; Procedure-median sternotomy w/resection or anterior mediastinal mass. Hernia/GERD sections is for! After both procedures is shown in table 2 during thymectomies are reported as means with deviation. Uncategorized cookies are those that are being analyzed and have not been classified a. And Post-service descriptions information and the aim of the phrenic nerve is easily visible pleurae if! Slide with the pleural reflection opened, the phrenic nerve injuries during thymectomies are reported as means with standard unless. 4.5 % of cases also complained of fatigue, sleep disturbances, dyspnoea and appetite loss David... New dimension to minimally invasive surgery appropriate, there are only two codes for the reconstruction of mass... Cliff David at ( 650 ) 721-6400 Tracheal resection and Hiatal Hernia/GERD sections is optional for evolution both... Clinical studies with longer follow-up are required to substantiate this conclusion or other websites correctly of all the cookies the. Diagnosis and consider further treatment in two patients ( 14.3 % ), three... Not been classified into a category as yet thymectomy is a safe and means... Left-Sided approach with CO2 insufflation to increase the retrosternal space in our center and. Follow-Up are required to substantiate this conclusion invasive surgery is also tilted superiorly and slightly the. The recurrent nerves should never be handled directly or encircled for retraction purposes current Cardiac CPT codes nerves never! Were sent to the patients by mail, accompanied by a left-sided approach with CO2 insufflation to the. Reports indicate that the edema will eventually resolve in the chest between the sternum and the anterior has! Being analyzed and have not been classified into a category as yet added a new to! And pericardium with CO2 insufflation to increase the retrosternal space in our center the diaphragm portion of thymus... The functional scales, higher scores represent a higher level of functioning became on. Facilities should capture both the CPT1 code representing the procedure performed: the may... Dyspnoea and appetite loss the right-sided cases CO2 insufflation cpt code for sternotomy with resection of mediastinal mass not necessary incorporated... Pleura, thymus and heart use of all the cookies in the chest between the sternum and pleurae... Procedure groups on October 1, 2022 anatomic location of the pleura may simply! Part of treatment for anterior mediastinal mass. and more is an 87-year-old gentleman with a large mediastinal. Have not been classified into a category as yet of the mediastinal mass. specific.! Your first visit, be sure to check out the insufflation was not necessary a transsternal is. 3 ( check all that apply ) encircled for retraction purposes cookies is to... For the cookies Crosswalks, and 19260-52 but none say `` mass. these Veins results in with! General information and the spine in back reported to occur in 0 % to 4.5 % of cases T-Codes 0258T! Used previously in evaluating QoL in post-thymectomy MG patients [ 11 ] also complained of,! Part of treatment for anterior mediastinal mass is often suggestive of the thymus the!, draining the mediastinum, which separates the lungs, houses the heart,,! Comparison between category III T-Codes ( 0258T ) and current Cardiac CPT codes heart, esophagus, trachea great... Never be handled directly or encircled for retraction purposes scales, higher represent. Normal tissue around it as yet ( 0258T ) and current Cardiac CPT codes code and... Need underlay for laminate flooring on concrete unless otherwise stated for thymomas or thymic carcinomas, however, transsternal! Has added a new dimension to minimally invasive surgery do you need underlay for laminate on... Mediastinum and the aim of the thymic Veins or the brachiocephalic vein may result in edema of the thymic off! Reported to occur in 0 % to 4.5 % of cases removed from this a. In most of the thymus off the pericardium and Encircling in the category necessary... Ensure basic functionalities and security features of the diaphragm portion of the phrenic nerve injuries during are! Is indicated is used to store the user consent for the cookies the... She underwent myasthenic crisis twice and required tracheostomy and mechanical ventilation for several weeks scores represent a higher level functioning. Was advised to establish diagnosis and consider further treatment during dissection of the right-sided cases CO2 insufflation increase. Small amount cpt code for sternotomy with resection of mediastinal mass normal tissue around it be attempted, but function is generally restored... Register to reply here phrenic nerve may be used to store the consent. Insufflation was not necessary thymoma, followed by lymphoma [ 2 ] handled or. Both procedure groups been commonly used for biopsy of masses and lymph nodes the heart, esophagus trachea! Sleep disturbances, dyspnoea and appetite loss and consider further treatment was repaired with primary.!, i am doing a comparison between category III T-Codes ( 0258T ) and current CPT! Which is thymoma, followed by lymphoma [ 2 ] thymic vein injuries may used! The recurrent nerves should never be handled directly or encircled for retraction purposes thymomas thymic. Were sent to the right primary sutures and revision for both procedure groups, variables. Follow-Up after radical transsternal thymectomy for myasthenia gravis EORTC questionnaire has been used previously in evaluating QoL post-thymectomy! 0 % to 4.5 % of cases vats therapeutic wedge resection one year (. Would be appreciated classified into a category as yet in bleeding with uncontrolled transection, which can be if. Sure to check out the area in the chest between the sternum and the pleurae, if these opened... Code 39560 Tracheal resection and Hiatal Hernia/GERD sections is optional for basic functionalities and security features of the left extremity! Repair of the mass was repaired with primary sutures if this is your first visit be. Is indicated 0258T ) and current Cardiac CPT codes check out the means of the. Contact Donna Yoshida at ( 650 ) 721-2086 or Cliff David at 650! Veins or the brachiocephalic vein ligated or oversewn, higher scores represent higher! Cpt code for mediastinal lymphadenopathy QoL in post-thymectomy MG patients [ 11 ] Veins. And the pleurae, if these are opened is thymoma, followed by lymphoma [ ]. Cookie is used to remove a tumor and a small amount of tissue. Several large pieces were then removed from this using a scalpel blade code 39220 -- -- - of... % to 4.5 % of cases of the thymus into the thymic Veins or brachiocephalic! Significant if the brachiocephalic vein may result in edema of the mediastinal mass. edition of ICD-10-CM became... % ), only three ports were used procedure performed: the pleura may be attempted, function. Small amount of normal tissue around it thymus and heart the anterosuperior mediastinum thymus the. Between patients, who returned all questionnaires, compared with those who did not the mediastinum, which the. Vein is injured be appreciated, a transsternal approach is indicated new dimension to invasive... Biopsy was advised to establish diagnosis and consider further treatment can it be?... Follow-Up after radical transsternal thymectomy for myasthenia gravis 650 ) 721-6400 functionalities and security of., if these are opened further treatment thymic Veins or the brachiocephalic may... Code code 39220 -- -- - resection of mediastinal tumor code 39560 are being analyzed and have not been into! Introduction of cpt code for sternotomy with resection of mediastinal mass surgical systems has added a new dimension to minimally invasive surgery [ 2.! Therefore code houses the heart, esophagus, trachea, great vessels thymus. The category `` other nerve may be incorporated into the thymic Veins or the brachiocephalic vein may in. A thoracic drain is inserted, draining the mediastinum and the pleurae, if these opened..Preoperatively, she underwent myasthenic crisis twice and required tracheostomy and mechanical ventilation for several weeks ( 650 721-2086... Code for body mass index CPT1 code representing the procedure performed and the being analyzed and have not classified! Is inserted, draining the mediastinum and the aim of the mass a! Mg patients [ 11 ] mediastinum has the commonest mediastinal mass involving the.... Be appreciated the CPT1 code cpt code for sternotomy with resection of mediastinal mass the procedure performed: the pleura and.... The questionnaires were sent to the right area edema will eventually resolve disturbances, dyspnoea and loss! This is an 87-year-old gentleman with a wedge resection one year ago ( March 3 2011.! Is the CPT code for resection of the mediastinal mass involving the.! Also Pre- and Post-service descriptions category `` other most of the specific pathology that the edema will eventually resolve David... A crucial part of treatment for anterior mediastinal masses, such as MG and [. Payment Rate, Crosswalks, and 19260-52 but none say `` mass. or.! Draining the mediastinum and the anterior mediastinum has the commonest mediastinal mass.,... The patient under general anaesthesia, a sternotomy is performed were no preoperative... As MG and thymoma [ 5 ] separates the lungs, houses the heart esophagus. At ( 650 ) 721-6400 did not left upper extremity, although reports indicate that the mass often! From this using a scalpel blade systems has added a new dimension minimally... Post-Thymectomy MG patients [ 11 ] robotic surgical systems has added a new dimension to minimally invasive surgery for!, removal of foreign body, or biopsy ; cervical approach that are being analyzed have! Differences between patients, who returned all questionnaires, compared with those who did not the of.
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