2024 Icd 10 exploratory laparotomy

Purpose. How to Prepare. What to Expect. Recovery. Long-Term Care. An exploratory laparotomy, also known as a celiotomy or "ex lap," is a type of major surgery that involves opening the abdomen with a …. Fenkell bus times

Our American Express Business Platinum Card review shows it offers premium rewards and luxury travel perks but charges a high annual fee. Credit Cards | Editorial Review Updated Ju...ICD 10 AM Edition: Seventh edition Retired Date: 30/6/2017 Query Number: 2559. ... VICC considers that 30373-00 [985] Exploratory laparotomy should only be assigned when the abdomen is explored and no further surgery is performed. When an injury is found and repaired the exploratory laparotomy becomes the operative … Yes - Valid for Submission. Code Navigator: View Adjacent Codes. 0WJG0ZZ is a billable procedure code used to specify the performance of inspection of peritoneal cavity, open approach. The code is valid for the year 2024 for the submission of HIPAA-covered transactions. Table of Contents. ICD-10 code Z53.31 for Laparoscopic surgical procedure converted to open procedure is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services . ... Laparoscopic Nephroureterectomy Converted to Exploratory Laparotomy? [QUOTE="[email protected], post: 504495, member: …Jul 22, 2022 · Purpose. How to Prepare. What to Expect. Recovery. Long-Term Care. An exploratory laparotomy, also known as a celiotomy or "ex lap," is a type of major surgery that involves opening the abdomen with a large incision in order to visualize the entire abdominal cavity. Z48.815 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Short description: Encntr for surgical aftcr following surgery on the dgstv sys. The 2024 edition of ICD-10-CM Z48.815 became effective on October 1, 2023.In the world of healthcare, accurate coding and documentation are crucial for proper diagnosis, billing, and reimbursement. One of the key components in this process is the Interna...Malignant neoplasm of small intestine, unspecified. C17.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM C17.9 became effective on October 1, 2023.Fusion procedures of the spine B3.10a The body part coded for a spinal vertebral joint(s) rendered immobile by a spinal fusion procedure is classified by the level of the spine (e.g. thoracic). There are distinct body part values for a single vertebral joint and for multiple vertebral joints at each spinal level.Jul 22, 2022 · Purpose. How to Prepare. What to Expect. Recovery. Long-Term Care. An exploratory laparotomy, also known as a celiotomy or "ex lap," is a type of major surgery that involves opening the abdomen with a large incision in order to visualize the entire abdominal cavity. Sep 2, 2021. #1. Good morning, I am hoping to get some clarity on the correct code for Laparoscopic Right Salpingo-oophorectomy w/ mini laparotomy. Total- 6cm long incision was made in order to remove the specimen. (Cyst was 12cm) A 15cm bag was used. From what I can tell the code would probably be 58661, but a lot of work was done …Exploratory laparoscopy (also referred to as diagnostic laparoscopy) is a minimally invasive method for the diagnosis of intra-abdominal diseases through direct inspection of intra-abdominal...ICD-10-PCS; Female Only Procedure Codes; Male Only Procedure Codes; Analytics . Applicable To Crosswalk; Code Also Crosswalk; Code First Crosswalk; Includes Crosswalk; Note Crosswalk; Type 1 Excludes Crosswalk; Type 2 Excludes Crosswalk; Use Additional Crosswalk; Changes . ICD-10-CM; New 2024 Codes; Codes Revised in 2024; Codes Deleted in 2024 ...There was an obstruction of the distal small bowel from an internal hernia from adhesions. These bands were lysed, all of the bowel was mobilized from the ligament of Treitz to the ileocecal junction. The prior anastomosis was noted, was patent and the obstruction was just distal to this. We assured that the bowel was healthy.Note, however, that if tube placement or resection were performed the lysis of adhesions and laparotomy will likely be bundled to it. Specifically, CCI does not allow for separate billing of 44005 or 49000 with tube placement (44021, Enterotomy, small intestine, other than duodenum; for decompression [e.g., Baker tube] ).Evogene News: This is the News-site for the company Evogene on Markets Insider Indices Commodities Currencies Stocks0. Apr 2, 2008. #2. Unless you have documentation that the lysis of adhesions is very large it is included in the exploratory code. The documentation cannot only state that the lysis was done to obtain access to the site, it must be excessive. Most times you will not get the documentation you need in order to bill this separately.Open common bile duct exploration with removal of common bile duct stone. Intraoperative cholangiogram (gallbladder and bile ducts with high osmolar contrast) Incidental open total appendectomy. K83.1. Biliary obstruction, extrahepatic. K81.2. 0FT44ZZ. Cholecystitis, acute and chronic, with cholesterolosis. Total laparoscopic cholecystectomy.Open common bile duct exploration with removal of common bile duct stone. Intraoperative cholangiogram (gallbladder and bile ducts with high osmolar contrast) Incidental open total appendectomy. K83.1. Biliary obstruction, extrahepatic. K81.2. 0FT44ZZ. Cholecystitis, acute and chronic, with cholesterolosis. Total laparoscopic cholecystectomy.ICD-10-CM Diagnosis Code K35.201. Acute appendicitis with generalized peritonitis, with perforation, without abscess. ICD-10-CM Diagnosis Code N80.391 [convert to ICD-9-CM] Superficial endometriosis of the pelvic peritoneum, other specified sites. Superfic endometriosis of the pelvic peritoneum, oth sites.An exploratory laparotomy is a general surgical operation where the abdomen is opened and the abdominal organs are examined for injury or disease. It is the standard of care in various blunt and penetrating trauma situations in which there may be life-threatening internal injuries.We used ICD-10 code K63.2 (fistula of intestine) to identify postoperative fistula. We measured mortality rates and 30- and 90- day readmission rates censuring discharges occurring in December or from October-December, respectively. ... Exploratory laparotomy: 10,418 (1.9) 180 (2.3) Lysis of adhesions: 161,691 (29.9) 2,467 (31.5) Open …500 results found. Showing 101-125: ICD-10-CM Diagnosis Code E89.810 [convert to ICD-9-CM] Postprocedural hemorrhage of an endocrine system organ or structure following an endocrine system procedure. Postproc hemor of an endo sys org fol an endo sys procedure; Hemorrhage and/or hematoma of endocrine structure after procedure on endocrine …ICD-10-PCS 0WQF0ZZ is a specific/billable code that can be used to indicate a procedure. Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-PCS)The initial data set comprised 96 102 episodes with laparotomy and 1909 with a reclosure operation. After restricting data to reclosures paired with a laparotomy within 30 days, 1580 reclosures remained. After exclusions for pregnancy, childbirth and puerperium or immunocompromised state, age and length of stay, 78 299 laparotomies remained.The 2024 edition of ICD-10-CM Z90.722 became effective on October 1, 2023. This is the American ICD-10-CM version of Z90.722 - other international versions of ICD-10 Z90.722 may differ. Z90.722 is applicable to female patients. Z90.722 is considered exempt from POA reporting. Convert Z90.722 to ICD-9-CM.Exploratory laparotomy: status: active: date introduced: 2002-01-31: fully specified name(s) Exploratory laparotomy (procedure) synonyms: Exploration of peritoneal cavity; ... AHA Coding Clinic ® for HCPCS - current + archives AHA Coding Clinic ® for ICD-10-CM and ICD-10-PCS - current + archives AMA CPT ...500 results found. Showing 101-125: ICD-10-CM Diagnosis Code E89.810 [convert to ICD-9-CM] Postprocedural hemorrhage of an endocrine system organ or structure following an endocrine system procedure. Postproc hemor of an endo sys org fol an endo sys procedure; Hemorrhage and/or hematoma of endocrine structure after procedure on endocrine system ...Aug 21, 2014 · Laparoscopic-to-open Surgery Coding. When a procedure begins by laparoscopic approach, but for any reason must be converted (and completed) by open approach, you should report only the open approach. As described in chapter 1 of the National Correct Coding Initiative (NCCI) Policy Manual: What are the CPT® and ICD-10-CM codes reported for this service?, A patient with a long history of endometriosis has an open surgical approach to perform an exploratory laparotomy for an enlarged right ovary seen on ultrasound with other possible masses on the uterus and in the peritoneum. Exploration reveals these masses to be endometriosis ...You may not bill for the exploratory laparotomy since that is included in all open procedures, but you should add a modifier 22 (Increased procedural services) to code 59136 to cover the laparoscopic portion of the surgery. ICD-10-CM: You should also report Z53.31 (Laparoscopic surgical procedure converted to open procedure).Z48.815 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Short description: Encntr for surgical aftcr following surgery on the dgstv sys. The 2024 edition of ICD-10-CM Z48.815 became effective on October 1, 2023. 54.11 Exploratory laparotomy convert 54.11 to ICD-10-PCS; 54.12 Reopening of recent laparotomy site convert 54.12 to ICD-10-PCS; 54.19 Other laparotomy convert 54.19 to ICD-10-PCS; 54.2 Diagnostic Procedures Of Abdominal Region; 54.21 Laparoscopy convert 54.21 to ICD-10-PCS; 54.22 Biopsy of abdominal wall or umbilicus convert 54.22 to ICD-10-PCS 0. Apr 2, 2008. #2. Unless you have documentation that the lysis of adhesions is very large it is included in the exploratory code. The documentation cannot only state that the lysis was done to obtain access to the site, it must be excessive. Most times you will not get the documentation you need in order to bill this separately.AHA Coding Clinic ® for ICD-10-CM and ICD-10-PCS - 2014 Issue 3; Ask the Editor Ileocecectomy Including Cecum, Terminal Ileum and Appendix. A 55-year-old woman presents to the hospital with a five-day history of abdominal pain, fever and chills. An exploratory laparotomy was performed which revealed a perforated appendix.ICD-10-PCS 0UB74ZZ is a specific/billable code that can be used to indicate a procedure. ICD-10-PCS 0UB74ZZ is intended for females as it is clinically and virtually impossible to be applicable to a male. Code History. 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-PCS)By definition, an exploratory laparotomy is a laparotomy performed with the objective of obtaining information that is not available via clinical diagnostic methods.Recovery Timeline. After an exploratory laparotomy, you can expect to stay in the hospital for approximately two to 10 days. Your hospital stay may be longer if you underwent emergent surgery, had other procedures performed during the operation, or developed complications after surgery. As you recover in the hospital, you can expect …Recovery Timeline. After an exploratory laparotomy, you can expect to stay in the hospital for approximately two to 10 days. Your hospital stay may be longer if you underwent emergent surgery, had other procedures performed during the operation, or developed complications after surgery. As you recover in the hospital, you can expect …500 results found. Showing 101-125: ICD-10-CM Diagnosis Code E89.810 [convert to ICD-9-CM] Postprocedural hemorrhage of an endocrine system organ or structure following an endocrine system procedure. Postproc hemor of an endo sys org fol an endo sys procedure; Hemorrhage and/or hematoma of endocrine structure after procedure on endocrine system ...Bypass. Right below the knee amputation is coded to what root operation? Detachment. What root operation would you use or thoracentesis? Drainage. Study with Quizlet and memorize flashcards containing terms like What root operation would you code "total nephrectomy" to?, Ankle arthritis is coded to what root operation?, Exploratory …Seven. In ICD-10-PCS, multiple procedures are coded if: 1. The same root operation is repeated at different body part sites that are included in the same body part value. 2. Multiple root operations with distinct objectives are performed on the same body part. 3.A total of 72 patients underwent emergency exploratory laparotomy in our hospital from January 2004 to December 2017, accounting for 0.04% (72/168,860) of all deliveries during this same period. Among these 72 patients, successful conservative treatment was performed in 31 (43.1%) and hysterectomies were performed in 41 …We used ICD-10 code K63.2 (fistula of intestine) to identify postoperative fistula. We measured mortality rates and 30- and 90- day readmission rates censuring discharges occurring in December or from October-December, respectively. ... Exploratory laparotomy: 10,418 (1.9) 180 (2.3) Lysis of adhesions: 161,691 (29.9) 2,467 (31.5) Open … The 2024 edition of ICD-10-CM Z90.722 became effective on October 1, 2023. This is the American ICD-10-CM version of Z90.722 - other international versions of ICD-10 Z90.722 may differ. Z90.722 is applicable to female patients. Z90.722 is considered exempt from POA reporting. Convert Z90.722 to ICD-9-CM. ICD-10-PCS 0DT80ZZ is a specific/billable code that can be used to indicate a procedure. Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-PCS) Lysis of Adhesions. Coders should carefully review the entire operative report to determine the clinical significance of the adhesions and the complexity of the lysis of adhesions. Coders should not code adhesions and lysis thereof, based solely on mention of adhesions or lysis in an operative report. As is customary with other surgeries, it is ...The International Classification of Diseases, 10th Revision (ICD-10), is a standardized system used by healthcare professionals to classify and code medical diagnoses. Understandin...Accordingly, you cannot bill an exploratory laparotomy (49000) separately with any abdominal procedure. Thus, you should eliminate 49000 from the list. You’ll see …Gestational diabetes is a disorder characterized by abnormally high blood sugar levels during pregnancy. Explore symptoms, inheritance, genetics of this condition. Gestational diab...AHA Coding Clinic ® for ICD-10-CM and ICD-10-PCS - 2014 Issue 3; Ask the Editor Ileocecectomy Including Cecum, Terminal Ileum and Appendix. A 55-year-old woman presents to the hospital with a five-day history of abdominal pain, fever and chills. An exploratory laparotomy was performed which revealed a perforated appendix.The code O01.9 is for an exploratory laparotomy, which is a surgery to look inside the abdomen. The code S00.279D is for a tumor that cannot be removed, and the code T63.2X1A is for a left ureteral ligation, which is a surgery to tie off the left ureter. In summary, Joy Janson was admitted with severe urinary hemorrhage and it was discovered ...There was an obstruction of the distal small bowel from an internal hernia from adhesions. These bands were lysed, all of the bowel was mobilized from the ligament of Treitz to the ileocecal junction. The prior anastomosis was noted, was patent and the obstruction was just distal to this. We assured that the bowel was healthy.The need for exploratory laparotomy is not as great as it used to be. This is due to advances in imaging technology. Also, when possible, laparoscopy is a less invasive way to explore the abdomen.Missouri SubscriberAnswer: A patient may develop adhesions due to surgery, radiation, blunt trauma or infection, among other reasons. Because the organs in the abdominal region are in close proximity, the adhesions can cause the small bowel to adhere to itself or other organs, which can cause an obstruction (560.81, Other specified …2022. The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases, …Z90.49 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM Z90.49 became effective on October 1, 2023. This is the American ICD-10-CM version of Z90.49 - other international versions of ICD-10 Z90.49 may differ.ICD-10 requires you to code to the greatest degree of specificity. If you have bilateral ovarian cancer, you should use BOTH the right ovarian cancer (C56.1) and the left ovarian cancer (C56.2) codes. The unspecified code (C56.9) might be appropriate for a patient diagnosed on biopsy if it is impossible to determine a site of origin. ICD-10-PCS 0UB74ZZ is intended for females as it is clinically and virtually impossible to be applicable to a male. Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-PCS) ICD-10-PCS codes are composed of seven characters. Each character is an axis of classification that specifies information about the procedure performed. Within a defined ... Laparotomy performed to reach the site of an open liver biopsy is not coded separately. In a resection of sigmoid colon with anastomosis of descending colon to rectum, theOct 1, 2023 · 0DJD8ZZ is a valid billable ICD-10 procedure code for Inspection of Lower Intestinal Tract, Via Natural or Artificial Opening Endoscopic . It is found in the 2024 version of the ICD-10 Procedure Coding System (PCS) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . Visually and/or manually exploring a body part. The 2024 edition of ICD-10-CM Z90.722 became effective on October 1, 2023. This is the American ICD-10-CM version of Z90.722 - other international versions of ICD-10 Z90.722 may differ. Z90.722 is applicable to female patients. Z90.722 is considered exempt from POA reporting. Convert Z90.722 to ICD-9-CM.Royal Navy Captain James Cook died on February 14, 1779, after he was stabbed in a scuffle with Hawaiian islanders when he attempted to take the local leader hostage. His death occ...Sometimes, a laparotomy is exploratory — a way for your surgeon to see what’s going on inside your body and possibly take tissue samples in order to diagnose your condition. It can also be therapeutic — a way of treating some conditions.Instructions: Use the ICD-10-PCS index and tables to assign an appropriate code for each procedure. Remember! The ICD-10-PCS index entry usually contains just the first three or four characters of a code, which provides direction to the appropriate table to “build a code.”. When the entire seven-character code is provided in the index ... Z90.721 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM Z90.721 became effective on October 1, 2023. This is the American ICD-10-CM version of Z90.721 - other international versions of ICD-10 Z90.721 may differ. ICD-10-CM Coding Rules. A new report concludes that the current pace of loss for Arctic sea ice is unprecedented in the past 1,500 years. The Arctic’s report card is in, and it’s getting a failing grade i... Per PCS guidelines, a code is assigned for the biopsy and for removal of the polyp. The root operation is Resection because the entire Appendix was removed. ICD-10-PCS Official Guidelines for Coding and Reporting Effective October 1, 2013. Rules to consider when coding procedures in the Digestive System. Best answers. 0. Dec 16, 2013. #1. DATE OF PROCEDURE: 11/26/13. PREOPERATIVE DIAGNOSIS: Ingested foreign body. POSTOPERATIVE DIAGNOSIS: Same. PROCEDURE: Exploratory laparotomy with removal of foreign body x2 and extensive lysis of adhesions, adhesiolysis time timed at over 2 hours. ANESTHESIA: General.Best answers. 0. Mar 20, 2008. #3. Yes, it is necessary to know the diagnosis to accurately code this scenario. However, you state that a laparotomy was done, which is an open procedure and not a scope. I believe as long as this wasn't for an ectopic, the code you need to start with is 58940 - Oophorectomy, partial or total, unilateral or ...The code O01.9 is for an exploratory laparotomy, which is a surgery to look inside the abdomen. The code S00.279D is for a tumor that cannot be removed, and the code T63.2X1A is for a left ureteral ligation, which is a surgery to tie off the left ureter. In summary, Joy Janson was admitted with severe urinary hemorrhage and it was …ICD-10-PCS 0TQ70ZZ is a specific/billable code that can be used to indicate a procedure. Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-PCS)October 1, 2015. ICD-10-PCS was officially implemented in the United States on ____, for hospital reporting of inpatient procedures. Diagnostic. ___ information is not included in the procedure description. character. Each ___ in a code is an axis of classification that represents an a spect of the procedure. 1.ICD-9 2012 Update: Get Specific With New ICD-9 Cystostomy and Mesh Complication Codes in October You'll be able to stop using unspecified fifth digits. While the next edition of ICD-9 [...] ICD-10: ICD-10 Brings Even More Cystostomy Complication Specificity Tip: Get your urologist documenting details about the complications now.In ICD-10-PCS, how many approach types are there? Seven. In ICD-10-PCS, multiple procedures are coded if: 1. The same root operation is repeated at different body part sites that are included in the same body part value. 2. Multiple root operations with distinct objectives are performed on the same body part. 3. The intended root operation is ...The 2024 edition of ICD-10-CM Z48.81 became effective on October 1, 2023. This is the American ICD-10-CM version of Z48.81 - other international versions of ICD-10 Z48.81 may differ. Applicable To. These codes identify the body system requiring aftercare. They are for use in conjunction with other aftercare codes to fully explain the aftercare ...Virgin Orbit has secured an Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) for its ventilator, which the small satellite launch company designed...Your travel rewards credit card can grant you presale ticket access, the ability to purchase VIP packages and more for a variety of events, experiences and locations. Editor’s note...ICD-10-CM Code Z48.815Encounter for surgical aftercare following surgery on the digestive system. ICD-10-CM Code. Z48.815. Z48.815 is a billable ICD code used to specify a diagnosis of encounter for surgical aftercare following surgery on the digestive system. A 'billable code' is detailed enough to be used to specify a medical diagnosis.ICD-10-PCS 0WJG0ZZ is a specific/billable code that can be used to indicate a procedure. Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-PCS)

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According to experts in the established financial fields, until a few months ago all forms of crypto investment were considered a serious risk. It was an unknown quantity. It was a...Examples: Diagnostic arthroscopy, exploratory laparotomy Map Definition: Locating the route of passage of electrical impulses and/or locating functional areas in a body part Explanation: Applicable only to the cardiac conduction mechanism and the central nervous system Examples: Cardiac mapping, cortical mapping OcclusionOct 1, 2023 · 0DJ08ZZ. 0DJ08ZZ is a valid billable ICD-10 procedure code for Inspection of Upper Intestinal Tract, Via Natural or Artificial Opening Endoscopic . It is found in the 2024 version of the ICD-10 Procedure Coding System (PCS) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . Visually and/or manually exploring a ... Analysts have been eager to weigh in on the Technology sector with new ratings on Lumen Technologies (LUMN – Research Report), Alphabet Class A... Analysts have been eager to weigh...S39.91XA is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM S39.91XA became effective on October 1, 2023. This is the American ICD-10-CM version of S39.91XA - other international versions of ICD-10 S39.91XA may differ.Emergency laparotomy in non-trauma patients: Causes for non-trauma emergency laparotomy varies according to geographical areas and patient cohort studied. Among the low- and middle-income countries, appendicectomy is the most common non-trauma laparotomy, while intestinal perforation and obstruction are leading causes in high … Study with Quizlet and memorize flashcards containing terms like What are the steps in locating codes in ICD-10-PCS? Explain., Underline the main term for the following procedures: Excision, upper bones Cardiac bypass Exploratory laparotomy, It is always necessary to start with the Alphabetic Index before proceeding to the Tables to complete a code. and more. Exploratory laparotomy; Complex repair of cystotomy; Placement of fat flap between the vagina and bladder; Left ureteral reimplant. Diagnosis: Bladder and ureteral injury during C-section ... ICD-10: ICD-10 Brings Even More Cystostomy Complication Specificity Tip: Get your urologist documenting details about the complications now. In …Peritoneal abscess. K65.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM K65.1 became effective on October 1, 2023. This is the American ICD-10-CM version of K65.1 - other international versions of ICD-10 K65.1 may differ.There was an obstruction of the distal small bowel from an internal hernia from adhesions. These bands were lysed, all of the bowel was mobilized from the ligament of Treitz to the ileocecal junction. The prior anastomosis was noted, was patent and the obstruction was just distal to this. We assured that the bowel was healthy.The origin of the cancer could not be determined from the specimen given.What is the correct CPT® and ICD-10-CM coding for this report? 44140, 44139, C76.2, C18.8 Chapter 13 A patient with a long history of endometriosis has an open surgical approach to perform an exploratory laparotomy for an enlarged right ovary seen on ultrasound with other ...0DJ08ZZ. 0DJ08ZZ is a valid billable ICD-10 procedure code for Inspection of Upper Intestinal Tract, Via Natural or Artificial Opening Endoscopic . It is found in the 2024 version of the ICD-10 Procedure Coding System (PCS) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . Visually and/or manually exploring a ....

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