% If the medial clear space remains wide after fibular fixation, this may indicate that the deltoid ligament is entrapped in the medial gutter and needs to be explored more thoroughly. A group of four ligaments (the medial collateral ligaments) makes up the deltoid ligament. compilation for random notes and resources. We are looking at CPT codes and wondering if we should be reporting CPT code 27696 or CPT code 27698. Get crucial instructions for accurate ICD-10-CM S93.421A coding with all applicable Excludes 1 and Excludes 2 notes from . Three bones make up the ankle joint. It attaches the medial malleolus to the navicular, talus and calcaneus. Lets take a look at the two codes in question: 27696 Repair, primary, disrupted ligament, ankle; both collateral ligaments. Get timely coding industry updates, webinar notices, product discounts and special offers. 2023 Jared Lee, MD. 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference, 8th Annual Health IT + Digital Health + RCM Conference, 29th Annual Meeting - The Business & Operations of ASCs, Digital Innovation + Patient Experience and Marketing Virtual Event, 580+ ASCs with total joint replacements | 2023, State-by state breakdown of 2022's 183 new ASCs, 510 of America's 'Best' ASCs in 2023: Newsweek, 8 cardiologists leave Harbin Clinic for AdventHealth amid Atrium merger, OhioHealth, Surgery Partners team up to grow ASC care across the state, The advantage of PE-backed, physician-led ASCs, What physicians do when patients can't pay their bills, Surgery Partners to manage Intermountain Health ASCs, ASC Administrator of the Week: Michelle Eilander, Reimbursements remain low while costs keep climbing: 43 healthcare leaders share their biggest concerns regarding procedure reimbursements, The bargaining chip gastroenterologists are using to command higher salaries, Pennsylvania physician sentenced to up to 6 years for unlawful opioid prescription, Pennsylvania pain management physician pleads guilty to healthcare fraud, Connecticut physician fined for overprescribing narcotics, Florida physician pleads guilty to receiving kickbacks in $2.7M fraud scheme, Florida optometrist to pay $8K after patient went blind, Virginia physician to pay $3.1M to settle kickback allegations, Advanced practice registered nurse compensation: 7 facts, Patient died following plastic surgery at ASC where OB-GYN provided anesthesia, Wisconsin physician sentenced for drug crimes, Anesthesiologist accused of tampering with IV bags 'terrified' coworkers, Utah physician charged with performing surgeries without a license, Iowa clinic files for bankruptcy following $97M malpractice judgment, $15M malpractice suit brought against Virginia GI center alleging medical negligence, Physician cuts will create 'immediate financial instability': 4 thoughts on physician pay, Tufts Medical Center anesthesiologist charged with attempted child sex trafficking, USPI's $1.2B SurgCenter deal: How one of the industry's biggest acquisitions is unfolding, Physician leaders balk at Medicare 4.48% physician fee cut, Physician's license suspended in 2 states after allegedly using drugs on duty, Tennessee physician found guilty on 45 counts of controlled substance distribution, UCSD accused of ignoring anesthesiologist's fentanyl abuse, Physician pay is changing up in 8 specialties, down in 4 in 2022, Florida physician pleads guilty to receiving kickbacks, Kentucky physician, nurse practitioner sentenced for fraud, illegal controlled substance distribution, On the 'brink of financial collapse': California system CEO implores governor for funding, Why the No Surprises Act is harming anesthesiologists, Average income by experience: nurse practitioners vs. physician assistants, 13 most popular medical side gigs for physicians, 13 physician kickback suits totaling $332M+ in 2022, Florida physician involved in $60M fraud scheme forfeits license, Human trafficking among 16 charges faced by North Carolina hospital chief of staff, Top 3 hospitals for 14 specialties in 2022-23: US News. endobj A stress radiograph is often obtained to accentuate the medial clear space widening. With a primary repair the ends of the ligaments are brought back together and then sutured to each other. Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. The lateral ligaments are more commonly involved (ATFL more than CF, least PTFL). CPT Assistant has advised that a secondary repair code can be used is multiple circumstances, including for chronic injuries and when another tissue is used to perform the repair (reconstruction). Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. All Rights Reserved. endstream Non-operative first-line treatment for acute presentation includes sling immobilization and physical therapy while operative treatment is recommended for recurrent instability. You should not bill both codes. endobj Because there is no category ICPT code that describes the procedure using allograft, we must report theservice using code 27899 (unlisted procedure, leg or ankle). Don't confuse the Gould modification with a secondary repair. The soft tissue was pulled proximally and pinched into the bed of origin. A gap of over 4 mm with medial ankle pain over the deltoid ligament suggests a disruption of the deltoid ligament. The ATFL (anterior talofibular ligament) and the CFL ( calcaneofibular ligament) are ligaments of the lateral complex in the ankle. ICD-9-CM 845.01 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 845.01 should only be used for claims with a date of service on or before September 30, 2015. Often times, this treatment allows for adequate approximation of the deltoid ligament, which will then scar down and heal with time. Tony Poggio, DPM Alameda, CA All Rights Reserved. Magpi, Vflap) 54324 1stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by localskin flaps (eg, flipflap, prepucial flap) The AHA Coding Clinic for HCPCS includes: Thank you for choosing Find-A-Code, please Sign In to remove ads. CPT Codes. With these types of procedures there is no repair made to the ligament itself. be to bill for CPT 28270 (capsulotomy; metatarssal-phalangeal joint, with or without tenorrhaphy, each joint). By using a free tendon graft to recreate both the superficial and deep deltoid ligament attachments, surgeons are able to achieve a reproducible, rigid, anatomic reconstruction for patients presenting with medial sided ligament laxity. 1 0 obj 1 0 obj registered for member area and forum access. SHOULDER 23030 Incision and drainage, shoulder area; deep abscess or hematoma 23031 Incision and drainage, shoulder area; infected bursa . Sign-up to receive this newsletter by clicking here. 29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (i.e., arch) release, when performed (list separately in addition to code for primary procedure) 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair. |WB$SsTm@UvT7~BzR>>q.NXlHZA] $H AOSZI5\BaZ5>~rS|4)K A B+vn j%{JsL:|`>rb[JV $HjjjQEP(F*8Wdo9vpWV+;x/ek endobj Payment is denied for CPT code 29826. The diagnosis is "ligament insufficiency". endobj CPT code 28446 is used to describe repair of an osteochondritis dissecanslesion using autograft from the proximal tibia (open osteochondralautograft, talus [includes obtaining graft(s)]. Enjoy a guided tour of FindACode's many features and tools. Utilizing the TightRope construct provides the benefit of cortical fixation and gives surgeons complete control of the final construct tension. All rights reserved. This ligament is important in providing anterior to posterior stability as well as preventing lateral subluxation of the talus. If this is your first visit, be sure to check out the. CPT code 27698 describes the secondary repair (or reconstruction) of the collateral ligament of the ankle, while CPT code 27696 describes a primary repair of both the medial and lateral ligaments in the ankle. 27695 Repair, primary, disrupted ligament, ankle, collateral is reported for this type of repair when it is associated with an acute injury of the ATFL (anterior talofibular ligament) or CFL (calcaneofibular ligament). Learn how to get the most out of your subscription. Cookie Policy. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes). Without seeing the operative note, and addressing only your question, the correct code is CPT code 27698. For complimentary Telehealth tools and information, click here. , , Complications of the procedure include neurological injury, vascular injury, aneurysm, and infection; however, it is a relatively low-risk procedure. X-rays often show widening of the medial clear space between the medial malleolus and talus. When a right elbow lateral collateral ligament repair with both local tissue and application of an InternalBrace is performed, is the procedure reported with CPT code 24343 or is it more appropriate to report the unlisted code, 24999, since they are using an InternalBrace in addition to local tissue? The Deltoid Ligament Reconstruction Implant System provides a turnkey repair technique to treat this previously difficult to manage pathology using a TightRope and gold standard Bio-Tenodesis Screws. Although numerous procedures have been described, optimal treatment is still a matter of debate. Humeral avulsion of the inferior glenohumeral ligament (HAGL) has been shown to be an infrequent cause of shoulder instability. Injury, poisoning and certain other consequences of external causes. <> stream *This response is based on the best information available as of 09/30/21. Without seeing the operative note, and addressing only your question, the correct code is CPT code 27698. <> j $H AOS*:"fCj< UDtu#$^z/_~3KqZ){$H AlhE$!2]DI$tTF\^[i.I_Y*[MV $H*&2"3Rm@Ext?r-\ 'w{_? If this case, if the deltoid ligament continues to demonstrate laxity, a repair may be recommended. Deltoid ligament repair for a current injury would be 27695, but it sounds like from your diagnosis that this is an old injury, so I think 27698 would be right. NPI Look-Up Tool (National Provider Identifier), The official publication for Level I HCPCS (CPT-4 codes) for hospital providers, Also specific Level II HCPCS codes for hospitals, physicians and other health professionals, Fully searchable through Find-A-Code's Comprehensive Search, Codes mentioned in articles are linked to Code Information pages, Code Information page link back to related articles. % 2021 E/M Guidelines and Consultation Codes, Two Orthopaedic Surgeons, Two Separate Surgeries, Medical Decision Making Credit for Ordering an Audiogram. It attaches the medial malleolus to the navicular, talus and calcaneus. These reports will reflect only the primary CPT codes identified for each tracked case. It is one of many ankle ligaments that support this complex joint. The surgeon accurately reports these procedure to a private payer as 23412, 29824-51, and 29826. CPT copyright 2010 American Medical Association. D-g[9. If both the ATFL and CFL are repaired in an end-to-end fashion then 27696 both collateral ligaments would be reported. Protocols for Coding Tear and Rupture Injuries in BWC's System. When a right elbow lateral collateral ligament repair with both local tissue and application of an InternalBrace is performed, is the procedure reported with CPT code 24343 or is it more appropriate to report the unlisted code, 24999, since they are using an InternalBrace . You are using an out of date browser. This provides a type of book-end effect keeping the talus in its appropriate position. public use. ICD-10-CM Codes. Cancel anytime. Please clarify the difference. The deltoid ligament is a strong, broad, flat, triangular shaped ligament located on the medial (inside) of the ankle. 4 0 obj Without seeing the operative note, and addressing only your question, the correct code is CPT code 27698. Lateral ankle ligament reconstruction is a surgical procedure to tighten and secure one or more ankle ligaments on the outside of your ankle. shoulderarthritis.blogspot.com for an index of the many blog entries by Dr. CPT codes 29824 (Arthroscopic claviculectomy including distal articular surface), 29827 (Arthroscopic rotator cuff repair), and 29828 (Biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder. C cmedina Guest Messages 28 Location Montclair, NJ Best answers 0 Feb 13, 2008 #3 Short description: SPRAIN OF ANKLE DELTOID. Or the excision of the bone fragment, CPT 28124. endstream _Dyy!'H )?=9+b#1 :dwAP|zd Gf t8l+Q_"e\_GN$)Hb/?Y'MyR0q`=wx)qZds1X3;aC~?VmRzAh,ry m \a^.2r>`\xG};/#6Q&*Zo/-7X_|Cm'"a 3 0 obj Who is the most 'overpaid' CEO in healthcare? This convenient all-in-one implant kit includes all of the necessary implants and instrumentation to perform this procedure. x\r8}wo+mE4L\e;UuDjHv7@J ;@tRN'}9*Xqv}JYY}k]Q]f%\0%ww'HxX"vlN/OE]LjP, - v1$'vB&>$DKDb$ /P'l'Y)} <> uwshoulder.com. If you are looking for medical information about the treatment {zFryNFxlxM A zR+*20nd\H> r-\ '=~G5g'?\R:R&H A=MHJeR2>9vmBo^9LCR&H Ag"VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju'~LB.VQ{Fk{x=AUBBBBCECuCC1Ia``+^`AR.$"J}\ cDJ qAAI8:}r. >6v1[C3lH-(|( a!$2zrTXDtDF~^M.U"0&z'%J@*Qi9Q0Y%J2=DHIETtTrG"SR]BuqRW*P~mZK(VwIBGTHu^4X>KB&g*AUBBBBCECuCC1td,hYs SR:K32XG KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. Next, the FiberWire suture was used to reduce and repair the lateral collateral ligament and the ends were tied off. A right elbow lateral collateral ligament rupture, ripped from the origin with gross instability of the lateral soft tissue, was repaired with local tissue and application of an InternalBrace. After an incision was made along the lateral aspect of the elbow, the center axis of rotation was confirmed and holes were pre-drilled for the insertion of the InternalBrace system with placement of LabralTape and a FiberWire suture. There may also be an avulsion, or pulling away of a piece of bone, from the tip of the medial malleolus. 6"02aL"J*X8@}lW {T*:>@ q1`Z"6|L)r2OTTT9bu$. <> stream For questions on reimbursement or to find information for a specific product, please contact the Arthrex Coding and Reimbursement Hotline at 1-844-604-6359 or email us at arthrex@cmcopilot.com. This lesion occurs when the inferior glenohumeral ligament avulses from the inferior humeral neck. It has been established as a viable modality of treatment for anterior impingement and osteochondral defects. If, however, the surgery was done as a secondary injury repair (e.g., repair of chronic unstable ankle), the code would be CPT 27698 (repair, While the treatment armamentarium ranges from simple ligament repair to complex reconstructions with or without realignment osteotomies, direct repair augmented with an Internal Brace device . [dV'N'iR|nzy"['dO.0}FpOcb}_QNJ+~T*Av',B}v>>AAV 3 0 obj Coding Guides (28) 2023 Coding and Reimbursement Guide for the NanoScope Operative Arthroscopy System File Type: Ref. CPT Code Description 23000. <> 10 Ways ASC Coders Can Keep Up With Coding Rules at Little or No Cost, Coding Guidance: Endoscopic Balloon Dilation of Sinuses. Secondary means other tissue is brought in to perform the repair because it's too late to do a primary repair (usually a period of time after the injury). IHBO_$$$! Privacy Policy. You must log in or register to reply here. The Deltoid Ligament Reconstruction Implant System provides a turnkey repair technique to treat this previously difficult to manage pathology using a TightRope and gold standard Bio-Tenodesis Screws. endobj This ligament is important in providing anterior to posterior stability as well as preventing lateral subluxation of the talus. IHBO_$$$! A physician may perform a direct repair to the ligament(s) (primary) and supplement or reinforce that repair by transferring the extensor retinaculum up over the ligament(s) in what's called a Gould modification. The UW Shoulder Site @ The code 27814 is open txmt bimalleolar ankle fx, so would not be the code for the ligament repair. The deltoid or medial ligament is a strong band of connective tissue that helps stabilize your inner ankle. 29828 Arthroscopy, shoulder, surgical; biceps tenodesis No charge. Medial refers to the inside of your ankle. Surgical Technique Animations | 04:55 | English | 11/05/2015 | AN1-00134-EN A, Surgical Technique Videos | 07:24 | English | 08/26/2014 | VID1-00242-EN A, Surgical Technique Guides | English | 01/27/2022 | LT1-00002-en-US C, Product and Technique Highlights | English | 12/19/2014 | LS2-0418-EN A, 09:17 | English | 04/06/2016 | VID2-00603-EN A, 07:24 | English | 08/26/2014 | VID1-00242-EN A, 04:55 | English | 11/05/2015 | AN1-00134-EN A, 02:04 | English | 09/10/2015 | AN2-00158-EN A, 01:20 | English | 05/06/2019 | pAN1-00134-EN A. Discover how to save hours each week. |WB$$!=$N_ IHBW; |%$! Linking and Reprinting Policy. Diagnosis requires suspicions of injury and can be noted as an inferior pouch irregularity on MRI. Welcome to 2 0 obj 2021 Evaluation and Management Codes: Is a History and Exam Required? Rotator Cuff Repair: Arthroscopy, shoulder, surgical; with rotator cuff repair: 29826-51: Smooth and Move (with arthroscopic RCR) . 4 0 obj endobj ^u\i! 27698 Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure) Background: Patients with chronic deltoid ligament insufficiency (CDLI) present a challenging situation. o Sprain - Injury of capsule, ligament o Strain - Injury of muscles and tendons o Tear/Rupture of ligament/capsule codes to . Dr. Frederic A Matsen III and has not been proofread or intended for general Copyright 2023 Becker's Healthcare. I still billed the 27698. For a better experience, please enable JavaScript in your browser before proceeding. deltoid Capsuloligamentous Complex coracohumeral Ligament superior glenohumeral ligament (SGHL) middle glenohumeral ligament (MGHL) inferior glenohumeral ligament (IGHL) hammock-like Structure anterior band - between 2 and 4 o'clock posterior Band - between 7 and 9 o'clock axillary pouch 2 types of Insertion on Humerus The two ends of the LabralTape were placed on the suture anchor and implanted. endobj 27428 - Ligamentous reconstruction, knee; intra-articular (open) 27429 - Ligamentous reconstruction, knee; intra-articular and extra-articular. %PDF-1.7 cjZs~A In some patients who undergo fixation of the lateral malleolus, ankle instability may persist. jU 10]dtL&D$j3x }JdLFDXGCLrJACDRQA&0@;+R..*&djHRRf`VG0W~?q{YTTLN'b|C[9Y?|WVnI:KGb}X s>J[>R..zi+U^qC%N_4)La)@KeTZfsTt.h The CPT codes available in each category are listed below; note that fellows are NOT expected to report cases using all listed CPT codes. endobj Procedures like Evans, Watson-Jones and Chrisman-Snook are all considered secondary repairs because a proximal portion of the peroneus brevis is released and then passed through drill hole(s) in the fibula and navicular or calcaneal bones to reconstruct the ATFL and/or the CFL. Arthritis (Total and Reverse Total shoulder). We NEVER sell or give your information to anyone. The doctor confused me initially. x}kRa_?B&s706PHCl,hpX"&2RK-|)mQyNH=Y/:W_0x(%1X]qn! 8th Annual Becker's Health IT + Digital Health + RCM Annual Meeting. Introduction. During examination, the patient presents with medial ankle pain on palpation. 27698 Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure). The new system is in place now. Select the procedure code that most closely reflects the actual work you primarily performed. Capsular shift/capsulorrhaphy for multidirectional instability, Reconstruction of complete shoulder [rotator] cuff avulsion, chronic x\[s~!H$NvNwP(TsLH\9Hg1M~e?|k{"/!X&Ytqy9a`S?O `OvKo\^k^4+s*yv]mw^7 BB_CRvx{b4tD/vb=fx LIg.=+c(MPz5 A reconstruction would not be performed if the ligament was repairable. A disruption to the deltoid ligament requires a significant force to the ankle when the ankle is in eversion and dorsiflexion. Also, in high performance athletes or very active individuals, deltoid ligament repair may be indicated to facilitate a more robust fixation of the joint. KarenZupko & Associates, Inc. 2023 | All Rights Reserved, Shared Visits in the Hospital for Medicare, Secondary Payor Doesnt Recognize Consultations. stream *.##x8DDZr $0 24345 Repair medial collateral ligament, elbow, with local tissue 24346 Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft) #: OF1-000119-en-US Version: K 27427 - Ligamentous reconstruction, knee; extra-articular. Are you sure you want to trigger topic in your Anconeus AI algorithm? Question: CPT code 29826 (arthroscopic subacromial decompression), may be reported in conjunction with an open rotator cuff repair (23412) and arthroscopic distal claviculectomy (29824). Which code would you recommend? You might need this procedure to treat your broken ankle. Department of Rehabilitation Services Physical Therapy Protocol: Modified Brostrm-Gould Repair for Chronic Lateral Ankle Instability ICD 10 Codes: M25.37: Other instability, ankle and foot S93.4: Sprain of ankle S93.41: Sprain of calcaneofibular ligament S93.49: Sprain of other ligament of ankle See our privacy policy. 54322 1stage distal hypospadias repair (with or without chordee or circumcision); with simple meataladvancement (eg. To read the full article, sign in and subscribe to the AHA Coding Clinic for HCPCS. The elbow was then reduced and a horizontal stitch was placed through the origin of the lateral collateral ligament and tied off using FiberWire suture. 3 0 obj Please note that information on this site was NOT authored by Certain products may not be approved for sale in all countries. 2 0 obj Codingline Response: If the lateral ankle repair was done as a primary repair following a recent ankle injury, the correct CPT would be CPT 27695 (repair primary, disrupted ligament, ankle, collateral). Your surgeon will perform stress views intra-operatively to ensure reduction of the ankle mortise. Injuries to the ankle and foot. ICD-10 code S93.421A for Sprain of deltoid ligament of right ankle, initial encounter is a medical classification as listed by WHO under the range - Injury, poisoning and certain other consequences of external causes . Answer: Next, the isometric access was identified and holes were pre-drilled for the insertion of the second part of the InternalBrace while holding the reduction in place. Treatment includes stabilizing the ankle joint by fixing the lateral malleolus. xc``H0@_?a@np9? Humeral Avulsion of the Glenohumeral Ligament (HAGL) is an injury to the inferior glenohumeral ligament causing instability and/or pain and a missed cause of recurrent shoulder instability. JavaScript is disabled. DEFINED CASE CATEGORIES/CPT CODE MAPPING ELECTIVE RECONSTRUCTION FOREFOOT ELECTIVE RECONSTRUCTION MIDFOOT/HINDFOOT ARTHROSCOPY ARTHRODESIS ARTHROPLASTY TRAUMA ANKLE HINDFOOT (GENERAL) CALCANEUS TALUS PILON TRAUMA MIDFOOT/FOREFOOT (GENERAL) LISFRANC As such, the examiner must have a high index of suspicion of this injury when examining the patient as to not be distracted by a fracture and fail to assess the deltoid ligament. ?[;FVov Ylkr>oxiyOWL4/KB*a+Vas})~++z*76 @-+O w`/F-G"}81;oa*aH(!g?fo2Cqsg:Ac1 3ma{qoQ9YqZcp9\5oX7GaPXi&&(,v"]CMFB{ppx%aJ"B 0H2^~9Wfw. Copyright © 2023 Becker's Healthcare. View all the articles associated with any code, right from the code page. "zuW8Y?GJ'+bZdf$fVRm,7mNQ)VU*aJfd2L&Yb\.!V*:8C8.StuD"fa_(( 29888 - Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction. AX__rFQk4$.K6;D}Smx0N Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions. <> Ask a coder what the difference is between a primary and secondary ankle ligament repair and many will refer you back to the Coder's Desk Reference which indicates a secondary repair occurs a period of time after the initial injury and for the most part, this is true. The information provided should be utilized for educational purposes only. <>/Metadata 533 0 R/ViewerPreferences 534 0 R>> %PDF-1.4 endobj This ligament is rarely injured in isolation and is often accompanied by a lateral malleolus fracture. Let's take a look at the two codes in question: 27696 Repair, primary, disrupted ligament, ankle; both collateral ligaments. of shoulders, please visit If both the ATFL and CFL are repaired in an end-to-end fashion then 27696 both collateral ligaments would be reported. All Rights Reserved. Dislocation and sprain of joints and ligaments at ankle, foot and toe level (S93) Sprain of deltoid ligament (S93.42) S93.419S. IHO? "The injured worker twisted his right shoulder while moving boxes. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 8qKb8*^B IHBW; |%$! It typically takes place as an outpatient procedure.