This info listed to assist Dr. W. with coding procedures.
Spine (Vertebral Column) (22100-22899)
Cervical, thoracic, and lumbar spine. Examples at end of text section.
Within the SPINE section, bone grafting procedures are reported separately and in addition to arthrodesis. For bone grafts in other Musculoskeletal sections, see specific code(s) descriptor(s) and/or accompanying guidelines.
Biopsy (open)
20250 vertebral body, thoracic
20251 lumbar or cervical
Subheading:
Grafts (or Implants) (20900-20938)
Do not append modifier ‘-62’ to bone graft codes 20900-20938.
(For spinal surgery bone graft(s) see codes 20930 20931 20936 20937 -20938)
20900 Bone graft, any donor area; minor or small (eg, dowel or button)
20902 Bone graft, any donor area; major or large
20924 Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris)
20926 Tissue grafts, other (eg, paratenon, fat, dermis)
(Codes 20930 20931 20936 20937 -20938 are reported in addition to codes for the definitive procedure(s) without modifier ‘-51’.)
20930 Allograft for spine surgery only; morselized
20931 Allograft for spine surgery only; structural
20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision
20937 Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision)
20938 Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision)
20939 (2018) Bone marrow aspiration for bone graft, spine surgery only, through separate skin or fascial incision.
(For needle aspiration of bone marrow for the purpose of bone grafting, see 38220)
To report bone grafts performed after arthrodesis, see codes 20930 20931 20936 20937 -20938. Bone graft codes are reported without modifier ‘-51’ (multiple procedure). Do not append modifier ‘-62’ to bone graft codes 20900-20938.
Vertebral procedures are sometimes followed by arthrodesis and in addition may include bone grafts and instrumentation.
When arthrodesis is performed in addition to another procedure, the arthrodesis should be reported in addition to the original procedure with a modifier ‘-51’ (multiple procedures). Examples are after osteotomy, fracture care, vertebral corpectomy and laminectomy. Since bone grafts and instrumentation are never performed without arthrodesis, modifier ‘-51’ (multiple procedures) is not used.
Arthrodesis, however, may be performed in the absence of other procedures and therefore when it is combined with another definitive procedure, modifier ‘-51’ (multiple procedures) is appropriate.
Incision
22010 Incision and drainage, open, of deep abscess (subfascial), posterior spine, cervical, thoracic, or cervicothoracic
22015 lumbar, sacral, or lumbosacral
(do not report 22015 in conjunction with 22010 or with instrumentation removal, 10180, 22850, 22852. For I&D of abscess or hematoma superficial, see 10060, 10140)
21501 Incision and drainage deep abscess or hematoma, soft tissues of neck or thorax
(for posterior spine subfascial incision and drainage, see 22010–22015)
Excision (22100-22116)
For the following codes, when two surgeons work together as primary surgeons performing distinct part(s) of partial vertebral body excision, each surgeon should report his/her distinct operative work by appending the modifier ‘-62’ to the procedure code. In this situation, the modifier ‘-62’ may be appended to the procedure code(s) 22100-22102, 22110-22114 and, as appropriate, to the associated additional vertebral segment add-on code(s) 22103, 22116 as long as both surgeons continue to work together as primary surgeons.
(For bone biopsy, see 20220 20225 20240 20245 20250 -20251)
22100 Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; cervical
22101 Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracic
22102 Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbar
22103 Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; each additional segment (List separately in addition to code for primary procedure)
(Use 22103 in conjunction with codes 22100, 22101, 22102)
22110 Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; cervical
22112 Partial excision of vertebral body for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; thoracic
22114 Partial excision of vertebral body for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; lumbar
22116 Partial excision of vertebral body for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure)
(Use 22116 in conjunction with codes 22110, 22112, 22114)
Osteotomy (22210-22226)
To report arthrodesis, see codes 22590 22595 22600 22610 22612 22614 22630 -22632. (Report in addition to code(s) for the definitive procedure with modifier ‘-51’.)
To report instrumentation procedures, see codes 22840 22841 22842 22843 22844 22845 22846 22847 22848 22849 22850 22851 22852 -22855. (Report in addition to code(s) for the definitive procedure(s) without modifier ‘-51’.) Do not append modifier ‘-62’ to spinal instrumentation codes 22840-22848 and 22850-22852.
For the following codes, when two surgeons work together as primary surgeons performing distinct part(s) of an anterior spine osteotomy, each surgeon should report his/her distinct operative work by appending the modifier ‘-62’ to the procedure code. In this situation, the modifier ‘-62’ may be appended to the procedure code(s) 22210-22214, 22220-22224 and, as appropriate, to associated additional segment add-on code(s) 22216, 22226 as long as both surgeons continue to work together as primary surgeons.
22210 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; cervical
22212 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; thoracic
22214 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; lumbar
22216 Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; each additional vertebral segment (List separately in addition to primary procedure)
(Use 22216 in conjunction with codes 22210, 22212, 22214)
22220 Osteotomy of spine, including diskectomy, anterior approach, single vertebral segment; cervical
22222 Osteotomy of spine, including diskectomy, anterior approach, single vertebral segment; thoracic
22224 Osteotomy of spine, including diskectomy, anterior approach, single vertebral segment; lumbar
22226 Osteotomy of spine, including diskectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure)
(Use 22226 in conjunction with codes 22220, 22222, 22224)
Fracture and/or Dislocation (22305-22328)
To report arthrodesis, see codes 22590 22595 22600 22610 22612 22614 22630 -22632. (Report in addition to code(s) for the definitive procedure with modifier ‘-51’.)
To report instrumentation procedures, see codes 22840 22841 22842 22843 22844 22845 22846 22847 22848 22849 22850 22851 22852 -22855. (Report in addition to code(s) for the definitive procedure(s) without modifier ‘-51’.) Do not append modifier ‘-62’ to spinal instrumentation codes 22840-22848 and 22850-22852.
For the following codes, when two surgeons work together as primary surgeons performing distinct part(s) of open fracture and/or dislocation procedure(s), each surgeon should report his/her distinct operative work by appending the modifier ‘-62’ to the procedure code. In this situation, the modifier ‘-62’ may be appended to the procedure code(s) 22318-22327 and, as appropriate, the associated additional fracture vertebrae or dislocated segment add-on code 22328 as long as both surgeons continue to work together as primary surgeons.
22305 Closed treatment of vertebral process fracture(s)
22310 Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing
22315 Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing, with or without anesthesia, by manipulation or traction
(For spinal subluxation, use 97140)
22318 Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting
22319 Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting
22325 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one fractured vertebrae or dislocated segment; lumbar
22326 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one fractured vertebrae or dislocated segment; cervical
22327 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one fractured vertebrae or dislocated segment; thoracic
22328 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one fractured vertebrae or dislocated segment; each additional fractured vertebrae or dislocated segment (List separately in addition to code for primary procedure)
(Use 22328 in conjunction with codes 22325, 22326, 22327)
(For treatment of vertebral fracture by the anterior approach, see corpectomy 63081 63082 63085 63086 63087 63088 63090 -63091, and appropriate arthrodesis, bone graft and instrument codes)
Manipulation (22505-22505)
22505 Manipulation of spine requiring anesthesia, any region
Revised codes as of 1/1/17:
22510 – Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cerviothoracic
22511 – Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral
22512 – – Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately) in addition to code for primary procedure)
22513 – Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic
22514 – Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar
22515 – Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure
Effective 11/28/2021, Palmetto updated their LCD's to change the ICD-10 codes that support medical necessity for Kyphoplasties. These codes are:
M80.08XA - Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.08XS - Age-related osteoporosis with current pathological fracture, vertebra(e), sequela
M80.88XA - Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.88XS - Other osteoporosis with current pathological fracture, vertebra(e), sequela
22526 – Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level
22527 – Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional level(s)
Lateral Extracavitary Approach Technique (22532-22534)
22532 Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic
22533 Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic lumbar
22534 Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic thoracic or lumbar, each additional vertebral segment (List separately in addition to code for primary procedure)
(Use 22534 in conjunction with codes 22532, 22533)
Arthrodesis (22548-22632)
Arthrodesis may be performed in the absence of other procedures and therefore when it is combined with another definitive procedure (eg, osteotomy, fracture care, vertebral corpectomy or laminectomy), modifier ‘-51’ is appropriate. However, arthrodesis codes 22585, 22614, and 22632 are considered add-on procedure codes and should not be used with modifier ‘-51’.
To report instrumentation procedures, see codes 22840 22841 22842 22843 22844 22845 22846 22847 22848 22849 22850 22851 22852 -22855. (Report in addition to code(s) for the definitive procedure(s) without modifier ‘-51’.) Do not append modifier ‘-62’ to spinal instrumentation codes 22840-22848 and 22850-22852.
Anterior or Anterolateral Approach Technique (22548-22585)
Procedure codes 22554 22556 -22558 are for SINGLE interspace; for additional interspaces, use 22585.
For the following codes, when two surgeons work together as primary surgeons performing distinct part(s) of an anterior interbody arthrodesis, each surgeon should report his/her distinct operative work by appending the modifier ‘-62’ to the procedure code. In this situation, the modifier ‘-62’ may be appended to the procedure code(s) 22548-22558 and, as appropriate, to the associated additional interspace add-on code 22585 as long as both surgeons continue to work together as primary surgeons.
22548 Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid process
22554 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); cervical below C2
22556 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic
22558 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); lumbar
22585 Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure)
(Use 22585 in conjunction with codes 22554, 22556, 22558)
(per Dr. Reynolds, 10/04, anter fusion codes include a minimal discectomy to prepare the interspace other than for decompression of nerve roots)
Effective 1/1/11:
Most significantly, there are new combined codes for anterior cervical discectomy and fusion (ACDF) that should be used instead of codes 63075 and 22554:
22551: Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots, cervical, below C2
22552: cervical below C2, each additional interspace (List separately in addition to code for separate procedure)
22586 Arthrodesis, pre-sacral interbody technique (AXIALIF), including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace (Do not report 22586 in conjunction with 20930-20938, 22840, 22848, 72275, 77002, 77003, 77011, 77012). Use code for services performed on or after 1/1/13.
For L45 level, use code 0309T (in conjunction with 22586)
Posterior, Posterolateral or Lateral Transverse Process Technique (22590-22632)
To report instrumentation procedures, see codes 22840 22841 22842 22843 22844 22845 22846 22847 22848 22849 22850 22851 22852 -22855. (Report in addition to code(s) for the definitive procedure(s) without modifier ‘-51’.) Do not append modifier ‘-62’ to spinal instrumentation codes 22840-22848 and 22850-22852.
22590 Arthrodesis, posterior technique, craniocervical (occiput-C2)
22595 Arthrodesis, posterior technique, atlas-axis (C1-C2)
22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment
22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, as of 2012)
22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse technique, and as of 2012, not to be reported with 22630 unless at separate levels)
22614 Arthrodesis, posterior or posterolateral technique, single level; each additional segment (List separately in addition to code for primary procedure)
(Use 22614 in conjunction with codes 22600, 22610, 22612)
Navigation (acc to Will Kilpatrick 11/13)
61783 Stereotactic computer assisted volumetric (navigational) procedure, spinal
22630 Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; lumbar
22632 Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (List separately in addition to code for primary procedure)
(Use 22632 in conjunction with code 22630)
22633 PLIF (as of 2012)
22634 add on PLIF levels (as of 2012)
Spine Deformity (eg, Scoliosis, Kyphosis) (22800-22819)
To report instrumentation procedures, see codes 22840 22841 22842 22843 22844 22845 22846 22847 22848 22849 22850 22851 22852 -22855. (Report in addition to code(s) for the definitive procedure(s) without modifier ‘-51’.) Do not append modifier ‘-62’ to spinal instrumentation codes 22840-22848 and 22850-22852.
For the following codes, when two surgeons work together as primary surgeons performing distinct part(s) of an arthrodesis for spinal deformity, each surgeon should report his/her distinct operative work by appending the modifier ‘-62’ to the procedure code. In this situation, the modifier ‘-62’ may be appended to the procedure code(s) 22800-22819 as long as both surgeons continue to work together as primary surgeons.
22800 Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments
22802 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments
22804 Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments
22808 Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments
22810 Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments
22812 Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments
22818 Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or 2 segments
22819 Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or more segments
(To report arthrodesis, see 22800 22802 -22804 and add modifier ‘-51’)
Exploration (22830-22830)
22830 Exploration of spinal fusion
Spinal Instrumentation (22840-22855)
Segmental instrumentation is defined as fixation at each end of the construct and at least one additional interposed bony attachment.
Non-segmental instrumentation is defined as fixation at each end of the construct and may span several vertebral segments without attachment to the intervening segments.
Insertion of spinal instrumentation is reported separately and in addition to arthrodesis. Instrumentation procedure codes 22840 22841 22842 22843 22844 22845 22846 22847 -22848, 22851 are reported in addition to the definitive procedure(s) without modifier ‘-51’. Do not append modifier ‘-62’ to spinal instrumentation codes 22840-22848 and 22850-22852.
(List codes 22840 22841 22842 22843 22844 22845 22846 22847 -22848, 22851 separately, in addition to code for fracture, dislocation or arthrodesis of the spine, 22325, 22326, 22327, 22548 22554 22556 22558 22585 22590 22595 22600 22610 22612 22614 22630 22632 22800 22802 22804 22808 22810 -22812.)
22840 Posterior non-segmental instrumentation (eg, Harrington rod technique), pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation
22841 Internal spinal fixation by wiring of spinous processes
22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminal wires); 3 to 6 vertebral segments
22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminal wires); 7 to 12 vertebral segments
22844 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminal wires); 13 or more vertebral segments
22845 Anterior instrumentation; 2 to 3 vertebral segments
22846 Anterior instrumentation; 4 to 7 vertebral segments
22847 Anterior instrumentation; 8 or more vertebral segments
22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum
22849 Reinsertion of spinal fixation device
22850 Removal of posterior nonsegmental instrumentation (eg, Harrington rod)
Effective for DOS 1/1/2017 & after you will choose from:
CPT Code 22851 – Application of intervertebral biomechanical device(s) – synthetic case – has been deleted
22853 – Insertion of interbody biomechanical device(s) (eg synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg. screws, flanges) when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace
22854 – Insertion of intervertebral (biomechanical device(s) (eg synthetic cage, mesh) with integral anterior instrumentation for devise anchoring (eg screws, flanges) when performed to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect
22859 – Insertion of intervertebral biomechanical device(s) (eg synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect.
22852 Removal of posterior segmental instrumentation
22855 Removal of anterior instrumentation
22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with endplate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace, cervical; do not report in conjunction with 22554, 22845, 22851, 63073, 69990.
22858 For second level, cervical. For three or more levels: 03575T (updated 7/19/15)
22864 removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical. (noted from google search 6/17/20)
New codes starting 1/1/17
Referring likely to Coflex:
22867 – Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level
22868 – Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; additional level
22869 – Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level
22870 – Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; additional level
Other Procedures (22899-22899)
22899 Unlisted procedure, spine
(acc to Dr. Reynolds, 10/04: used for Kyphoplasty. Pt must meet medicare requirements which are state driven before insurance will pay, i.e., 4 weeks bedridden, all conservative tx tried, etc. This must be dictated in op report.)
X-Stop
0171T Insertion of poster sp process distraction device, including necessary removal of bone or ligament for insertion and imaging guidance, single level, lumbar
0172T Insertion of poster sp process distraction device, lumbar each additional level
(Providers should contact or refer to the payer’s policy to confirm coding. Providers may also need to negotiate payment because category III or “T” codes are not assigned relative value units
(Dx codes: 724.02: spinal stenosis, lumbar)
Operating Microscope 69990
Navigation
61783, 0055T
copied 2 9 04
EXAMPLES:
Treatment of a burst fracture of L2 by corpectomy followed by arthrodesis of L1-L3, utilizing anterior instrumentation L1-L3 and structural allograft.
Report as 63090, 22558-51, 22585, 22845 and 20931.
When two surgeons work together as primary surgeons performing distinct part(s) of a single reportable procedure, each surgeon should report his/her distinct operative work by appending the modifier ‘-62’ to the single definitive procedure code. If additional procedure(s) (including add-on procedure(s)) are performed during the same surgical session, separate code(s) may be reported by each co-surgeon, without the modifier ‘-62’ appended (See Appendix A).
Example:
A 42-year-old male with a history of posttraumatic degenerative disc disease at L3-4 and L4-5 (internal disc disruption) underwent surgical repair. Surgeon A performed an anterior exposure of the spine with mobilization of the great vessels. Surgeon B performed anterior (minimal) diskectomy and fusion at L3-4 and L4-5 using anterior interbody technique.
Report surgeon A: 22558-62, 22585-62
Report surgeon B: 22558-62, 22585-62, 20931
(Do not append modifier ‘-62’ to bone graft code 20931)
(For injection procedure for mylelography, use 62284)
(For injection procedure for diskography, see 62290, 62291)
(For injection procedure, chemonucleolysis, single or multiple levels, use 62292)
(For injection procedure for facet joints, see 64470 64472 64475 -64476, 64622-64627)
(For needle or trocar biopsy, see 20220 -20225)
