chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov

EX MAL LES FACE 4.0 0 CM 0
DEBRIDE SUB Q EA ADD 0 20 0
DEBRIDE SUB Q MUS/FAC 0 20 0
DEB SUB Q MUS/FAC/BONE 0 20 0
BILAT ABI UPR LOWR 21-2 LV 2
UNILAT ABI UPR LWR 01-2 LV 0
BILAT ABI UPR LWR 2ND 0 PRO 0
MLCW RT LWR EXTREMITY 0 0
MLCW LT LWR EXTREMITY 1 1
MLCW BILAT 8 8
UNNA BOOT RT LWR 0EXTREM
0
UNNA BOOT LT LWR 0EXTREM
0
UNNA BOOT BILAT 0 0
EXC BENIGN LES TRUNK 0 2.1 0
EXC BENIGN LES TRUNK 0 3.1 0
EXC BENIGN LES TRUNK>4.0 0 0
EXC BENIGN LES SCALP 0 2.1- 0
EXC BENIGN LES SCALP 0 3.1 0
EXC BENIGN LES SCALP 0 >4.0 0
EXC BENIGN LES FACE4.0CM 0 0
EXC MAL LES TRK/ARM 0 1.1-2 0
CUT SINGLE BENIGN LESION 1 1
RMV TUN CVA CATH 0W/O SUBQ 0
EXC NAIL, MATRIX, PAR/COM 0 0
APPLY RIGID CONTACT 0 LEG 0
OPTILOCK 5 X 5 DRESSING 7 7
PROMOGRAM MATRIX 2 DRESSING2
PRISMA MATRIX W/SILVER 0 0
INTERDRY AG SHEET 0 0
DUODERM XTRA THIN 0 4 X 4 0
DUODERM GCF 4 X 40 0
MEPILEX FOAM 4 X 839 39
MEPLIEX AG 4 X 4 SLVR 11 FM 11
MEPLIEX BORDER 314 X 3 14
MEPILEX BORDER 417 X 4 17
MEPILEX BORDER 6 X 16
1
MELGISORB ROPE 1.12 X 12.5 2