How to Adjust Procedure Coding to Abnormal Findings

Adjust Your Procedure Coding to Abnormal Findings

If the physician finds a lesion during a screening exam, you should no longer rely either G0105 or G0121 to describe the procedure. Instead, you would select the diagnostic colonoscopy (CPT Category I) code that properly identifies the resulting biopsy or removal.

For instance, if the physician discovers and biopsies a polyp during the exam for our 62-year-old, high risk patient described above, you would turn away from G0105 and instead report 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple).

Likewise, if the physician finds and removes by snare technique two colonic tumors during the exam of our 50-year-old patient, you would select 45383 (…with ablation of tumor[s], polyp[s] or other lesion[s] not amendable to removal by hot biopsy forceps, bipolar cautery or snare technique) over G0121.

Medicare Colonoscopy Screenings - Age and frequency limit

Watch Age and Frequency Limits for Medicare Colonoscopy Screenings

Medicare benefits allow a covered screening colonoscopy once every 24 months for those patients defined as “high risk” for colorectal cancer, or once every ten years — but not within 48 months of a screening sigmoidoscopy — for those patient’s who do not qualify as “high risk.”

In addition, Medicare guidelines generally require that a screening exam is a covered benefit for those beneficiaries at low risk for colorectal cancer who are 50 years of age or older. This can vary, however, and some carriers specify medical-necessity requirements that allow low-risk beneficiaries under age 50 to receive a covered screening exam.

For beneficiaries at high risk for colorectal cancer, national Medicare policy does not set a minimum age requirement. CMS MedLearn Matters article SE0613 states, “For beneficiaries considered to be at high risk for developing colorectal cancer, Medicare covers one screening colonoscopy every two years, regardless of age.”


Turn to ABN When Exceeding Frequency Limits

How to Adjust Procedure Coding to Abnormal Findings

 Adjust Your Procedure Coding to Abnormal Findings

If the physician finds a lesion during a screening exam, you should no longer rely either G0105 or G0121 to describe the procedure. Instead, you would select the diagnostic colonoscopy (CPT Category I) code that properly identifies the resulting biopsy or removal.

For instance, if the physician discovers and biopsies a polyp during the exam for our 62-year-old, high risk patient described above, you would turn away from G0105 and instead report 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple).

Likewise, if the physician finds and removes by snare technique two colonic tumors during the exam of our 50-year-old patient, you would select 45383 (…with ablation of tumor[s], polyp[s] or other lesion[s] not amendable to removal by hot biopsy forceps, bipolar cautery or snare technique) over G0121.


Screening-Turned-Diagnostic Requires Second Diagnosis

Medicare billing CPT G0105,G0121 and covered diagnosis

Colonoscopy Coding - What Happens when a screening becomes diagnostic

Rely on G-Code for Medicare Screenings

Medicare requires that you report colonoscopy screening for eligible patients using either G0105 (Colorectal cancer screening;colonoscopy on individual at high risk) or G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk). These codes define a patient as either “high risk” for colorectal cancer, or “not meeting criteria for high risk.”

Medicare will allow only select diagnoses to support a high risk classification. These may include:

• V10.05 — Personal history of malignant neoplasm; gastrointestinal tract; large intestine

Screening colonscopy - CPT G0104, G0105,G0106 AND G0121

A Medicare beneficiary undergoing a screening colonoscopy (no symptoms and no abnormal findings prior to the procedure) will be responsible for the deductible if a polyp is identified and either biopsied or removed.

When there is no need for a therapeutic procedure, the appropriate HCPCS G-code is reported with the ICD-9-CM code reflecting the indication. Effective January 1, 2007, CMS began waiving the annual Medicare Part B deductible for colorectal cancer screening tests billed with the HCPCS G-codes listed in the following table:

HCPCS Screening Code	Description
G0104	Colorectal cancer screening: Flexible sigmoidoscopy
G0105	Colorectal cancer screening: Colonoscopy on individual at high risk;
G0121	Colorectal cancer screening:

Billing CPT 76001 WITH 47500, 78400, 49427

Include Fluoroscopy with Several GI Injection Procedures

CCI bundles fluoroscopy codes 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy])

76001 (Fluoroscopy, physician time more than 1 hour,assisting a nonradiologic physician [e.g.,
nephrostolithotomy,ERCP, bronchoscopy, transbronchial biopsy]) with several injection procedures your gastroenterologist might perform. You will find both codes bundled
with the following codes:

Billing CPT 45385,45383, 45384 and multiple polyps

Don’t Become Ensnared in Polyp-Removal Codes

Choose the right code by pinning down the removal method.

If you don’t correctly code your gastroenterologist’s polyp-removals methods, you could be risking denials on your claims. But how do you choose between the codes? Look to the polyp removal technique for the answer.

Here’s how.

Use 45385 for Total Polypectomies

Gastroenterologists usually perform a total or entire polypectomy with an electrocautery snare — a heated wire loop that shaves off the polyp. When the physician uses the snare technique during a total polypectomy, you should report 45385 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique).

For Polyp Ablation, Use 45383

Ablation usually refers to the cauterization of a polyp during a colonoscopy when the polyp cannot be removed by other techniques or during follow-up colonoscopy when your gastroenterologist discovers remnants of previously removed polyps. 

The physician uses an argon plasma coagulator, heater probe, or other device to destroy any remaining polyp cells after an earlier colonoscopy in which the physician removed a larger polyp using a snare.

When your gastroenterologist uses any of these methods for an ablation of either a non-bleeding angiodysplasia or polyp tissue from a site where tissue was not removed during the same procedure, you should report 45383 (… not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique).

Hot Biopsy, Bipolar Cautery Forceps Require 45384

If your gastroenterologist uses bipolar forceps to both remove and cauterize a polyp simultaneously, you should report 45384 (… with removal by hot biopsy forceps or bipolar cautery). You can also apply this code when the physician uses either monopolar hot biopsy forceps or bipolar cautery forceps.

Multiple Polyps, 1 Technique Means 1 Code

If your gastroenterologist uses the same technique to remove both polyps, you would report it with one code.

For instance, you would report 45384 if your doctor used hot biopsy forceps to perform polyp removals at different sites at the same time.

Rule of thumb: No matter how many tumors, polyps, or lesions the doctor treats by the similar techniques, remember that the words “tumor(s), polyp(s), or other lesion(s)” in the descriptions of 45383, 45384, and 45385 signal that you’re also restricted to reporting only one of these codes per colonoscopy.

Example: A patient came in to the ambulatory surgical center (ASC) for a screening colonoscopy. The gastroenterologist found two polyps in the sigmoid colon and another two polyps in the ascending colon. She removed them all with hot forceps. Even though your gastroenterologist removed four polyps, she used the same technique for all four. Therefore, you can only report 45384 once, not four times.

Exception: When the surgeon uses different techniques, however, you can bill multiple tumor, polyp, or lesion removals, as long as you report each code only once per technique.

Two polyps, two techniques:

Your gastroenterologist used the snare technique to remove the first polyp and hot biopsy forceps to remove and control bleeding during the second polyp removal. As long as documentation supports the need for using different techniques on different polyps, you should report both 45385 and 45384.

CY 2014 CPT Code CY 2015 HCPCS Code Long Descriptor

45339 G6022 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s) or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

45345 G6023 Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)

45383 G6024 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s) or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

45387 G6025 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)

CPT Code Short Description Summary of Changes

45388 Ablation Code 45383 has been deleted. New code 45388 includes balloon dilation, guide wire insertion and ablation. Not

separately reportable with dilation code 45386 for the same lesion.

45389 Stent placement Code 45387 has been deleted. New code 45389 includes pre- and post-dilation and guide wire passage. Not

separately reportable with dilation code 45386. Use 74360 if fluoroscopic guidance is performed.

45391 Endoscopic ultrasound Now specifies exam limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures. Report only once per session. Not separately reportable with EUS FNA code 45392 or radiologic ultrasound codes 76872, 76975.

COLONOSCOPY

Changes in colonoscopy guidelines section

New definition: Colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine proximal to an anastomosis. 

45355 45399 Transabdominal colonoscopy via colotomy

Code 45355 has been deleted. Report with new code for unlisted colon procedure, 45399. Code

45399 does not include moderate sedation.

45378 45378 Colonoscopy Colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine proximal to an anastomosis.

45379 45379 Foreign body “Foreign body(s)” replaces “foreign body.” Use 76000 if fluoroscopic guidance is performed.

45380 45380 Biopsy Not separately reportable with EMR code 45390 for the same lesion.

45381 45381 Submucosal injection Not separately reportable with control of bleeding or endoscopic mucosal resection described by 45382, 45390.

45382 45382 Control of bleeding “Any method” replaces previous examples. Not separately reportable with injection or banding of hemorrhoids described by 45381, 45398 for same lesion.

45383 45388 Ablation Code 45383 has been deleted. New code 45388 includes balloon dilation, guide wire insertion and ablation. Not separately reportable with dilation code 45386 for the same lesion.

45384 45384 Hot biopsy Bipolar cautery was deleted as an example. 

45385 45385 Snare Not separately reportable with endoscopic mucosal resection described by 45390 for the same lesion.

45386 45386 Dilation New language specifies use of transendoscopic balloon. Dilation of multiple strictures can be reported with the 59 modifier for each additional stricture dilated. Not separately reportable with ablation or stent placement described by 45388, 45389. Use 74360 if fluoroscopic guidance is performed.

45387 45389 Stent placement Code 45387 has been deleted. New code 45389 includes pre and post dilation and guide wire passage.

Not separately reportable with dilation code 45386. Use 74360 if fluoroscopic guidance is performed. 

Appendix DD: Inclusions PC 6

Brief description DD.1 (CPT) DD.2 (LOINC)

Sigmoidoscopy 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45339, 45340, 45341, 45342, 45345

Barium enema 74270, 74280

Colonoscopy 44388, 44389, 44390, 44391, 44392,

44393, 44394, 44397, 45355, 45378,

45379, 45380, 45381, 45382, 45383,

45384, 45385, 45386, 45387

45378 X Flexible Colonoscopy Proximal to Splenic Flexure

45379 X Flexible Colonoscopy Proximal to Splenic Flexur...

45380 X Flexible Colonoscopy Proximal to Splenic Flexur...

45381 Colonoscopy, Flexible, Proximal to Splenic Flex...

45382 Colonoscopy, Flexible, Proximal to Splenic Flex...

45383 Flexible Colonoscopy Proximal to Splenic Flexur...

45384 Flexible Colonoscopy Proximal to Splenic Flexur...

45385 Flexible Colonoscopy Proximal to Splenic Flexur...

45386 Colonoscopy, Flexible, Proximal to Splenic Flex...

45387 Colonoscopy, Flexible, Proximal to Splenic Flex

Cholesterol screening (dyslipidemia): children at risk due to known family history, when family history is unknown, or with personal risk factors such as obesity, high blood pressure or diabetes, after age two but by age 10 (periodicity schedule/Bright Futures) Screening is covered as preventive once every 5 years ICD10: Z76.2, Z13.220 80061, 82172, 82465, 83695, 83718, 83719, 83721, 84478 Cholesterol screening (dyslipidemia  in adults: 

• Men age 35 and older: or age 20–35 if risk factors for coronary heart disease are present 

• Women age 45 and older: or age 20–45 if

risk factors for coronary heart disease are present Screening is covered as preventive once every 5 years ICD10: Z00.00, Z00.01, Z13.220 80061, 82172, 82465, 83695, 83718, 83719, 83721, 84478 Colorectal cancer screening: beginning at age 50 by any of the following ethods: 

• Fecal occult blood testing (FOBT)/fecal immunochemical test (FIT), annually

• Sigmoidoscopy every five years • Colonoscopy every 10 years • Double contrast barium enema (DCBE) ICD10: Z00.00, Z00.01, Z12.10, Z12.11, Z12.12, Z12.13, Z80.0, Z83.71, Z83.79

Furthermore, we refined the total time values as follows: 238 minutes for CPT code 36831, 266 minutes for CPT code 36832, and 296 minutes for CPT code 36833.

(7) Illeoscopy, Pouchoscopy, Colonoscopy through Stoma, Flexible Sigmoidoscopy and Colonoscopy (CPT Codes 44380, 44381, 44382, 44383, 44384, 44385, 44386, 44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 44799, 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45346, 45340, 45341, 45342, 45345, 45347, 45349, 45350, 45378, 45379, 45380, 45381, 45382, 45383, 45388, 45384, 45385, 45386, 45387, 45389, 45390, 45391, 45392, 45393, 45398, 45399, 0226T, 46601, 0227T, and 46607 and HCPCS Codes G6018, G6019, G6020, G6021, G6022, G6023, G6024, G6025, G6027, G6028) 

TABLE 26: Lower Gastrointestinal Endoscopy G-Codes Replacing CY 2015 CPT Codes CY 2014 CPT Code1 CY 2015 HCPCS Code

Long Descriptor

44383 G6018 Ileoscopy,through stoma;with transendoscopic stent placement (includes predilation ) 

44393 G6019 Colonoscopy through stoma;with ablation of tumor(s),polp(s),or other lesion(s)not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

44397 G6020 Colonoscopy through stoma;with transendoscopic stent placement (includes predilation)

44799 G6021 Unlisted procedure,intestine

45339 G6022 Sigmoidoscopy, flexible; with ablation of tumor(s),polyp(s),or other lesions(s)notamenable to removal by hot biopsy forceps, bipolar cautery or snare technique

45345 G6023 Sigmoidoscopy, flexible; with transenoscopic stent placement (includes predilation) 

45383 G6024 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

45387 G6025 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)

0226T G6027 

Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed 0227T G6028 

Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); with biopsy(ies).

CPT Code   Description

45384  : Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery (add modifier PT for Medicare or modifier 33 for commercial payers when screening was indication or finding was discovered during screening procedure)

Appendix DD: Inclusions PC 6

Brief description        DD.1 (CPT)         DD.2 (LOINC) 

Colonoscopy 

44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 45355, 45378, 45379, 45380, 45381, 45382, 45383, 45384, 45385, 45386, 45387

APPENDIX H: BUNDLED SURGICAL TRAY CROSSWALK

Procedure      Component Code     Procedure Code       Procedure Code Type      Effective Date       Termination Date STRY3 45384 CPT4 1/1/2007

Coding System: CPT-4

Code INACT UID Description

45378 X Flexible Colonoscopy Proximal to Splenic Flexure
45379 X Flexible Colonoscopy Proximal to Splenic Flexur...
45380 X Flexible Colonoscopy Proximal to Splenic Flexur...
45381 Colonoscopy, Flexible, Proximal to Splenic Flex...
45382 Colonoscopy, Flexible, Proximal to Splenic Flex...
45383 Flexible Colonoscopy Proximal to Splenic Flexur...
45384 Flexible Colonoscopy Proximal to Splenic Flexur...
45385 Flexible Colonoscopy Proximal to Splenic Flexur...
45386 Colonoscopy, Flexible, Proximal to Splenic Flex...
45387 Colonoscopy, Flexible, Proximal to Splenic Flex

Anesthesia services - Gastrointestinal endoscopy - CPT 00740 , 00810

 Use of Anesthesia Services for Routine Gastrointestinal Endoscopy

As a general rule, benefits are payable under Blue Cross and Blue Shield of Alabama health plans only in cases of medical necessity and only if services or supplies are not investigational, provided the customer group contracts have such coverage.

The following Association Technology Evaluation Criteria must be met for a service/supply to be

considered for coverage:

1. The technology must have final approval from the appropriate government regulatory bodies;

2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes;

3. The technology must improve the net health outcome;

4. The technology must be as beneficial as any established alternatives;

5. The improvement must be attainable outside the investigational setting.

Coding:

CPT Codes:

00740 Anesthesia for upper gastrointestinal endoscopic procedures,

endoscope introduced proximal to duodenum

00810 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum.

Description of Procedure or Service:

Intravenous sedation and analgesia is routinely administered for gastrointestinal endoscopic examinations to help alleviate patient anxiety and discomfort. Provision of sedation and analgesia for endoscopy procedures is standard practice. 

In the United States, licensed registered nurse or physician assistant administration of intravenous opiate narcotic, usually meperidine (Demerol®), in combination with a benzodiazepine, usually midazolam (Versed®), under the direct supervision of a licensed physician endoscopist is the traditional method for achieving sedation.

Recently propofol (Diprivan) has been used as an alternative method of sedation for patients undergoing endoscopy procedures. Propofol is a short-acting anesthetic agent. 

The advantages of propofol are its rapid induction of sedation, quicker patient recovery time, and anti-emetic effect. The use of propofol requires monitoring for respiratory and/or cardiac collapse by trained personnel.

Appendix D – Requested Professional CPT and HCPCS

Procedure Codes

Code         Description        Modifiers to Report 

00740        Anesthesia           NONE 

Subset: West TN counties no MHSA

Time Period: Incurred YTD          Jan - Oct, 2014       In Network? (Yes =1, No=0)

Provider Name    Provider NPI ID    Provider City    Provider Zip   Provider State Code    Visits Provider Prof

Kimberlin, Gibson D. 1932100740 PARIS 38242 TN 1

PID segment definition

SEQ    LEN     DT      OPT   RP/#  TBL#      ITEM#    ELEMENT NAME

29 26 TS O 00740 Patient Death Date and Time

PWX-00740 codepage_name is not a recognized codepage.

Explanation: The code page name on the PowerExchange configuration file was not recognized.

System Action: PowerExchange returns an error code and message, and abends.

User Response: The codepage name should be one of the standard codepages such as, IBM-037 or a user codepage name such as USRCP01. Correct the codepage name in the PowerExchange configuration file and resubmit.

Average risk screening: Lack of symptoms and abnormalities

X Screening, by definition, is a service performed on a patient in the absence of signs and symptoms.

X Medicare’s definition of average risk is no personal history of adenomatous polyps, colorectal cancer or inflammatory bowel disease, including Crohn’s disease and ulcerative colitis; no family history of colorectal cancers or an adenomatous polyp, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

X For most payors, a patient is eligible for screening colonoscopy on or after age 50. Some payors allow for screening to begin at age 45 for patients of certain gender and/or ethnic origin. If there are questions, check the summary of plan documents (SPD) and/or the plan’s coverage policies.

X Since Jan. 1, 2011, Medicare waives the co-pay and deductible for the professional and facility fees for screening colonoscopy at 100 percent with no patient financial responsibility.

X In the final rule for 2015, Medicare expanded the waiver of co-pay and deductible to include anesthesia for screening colonoscopy. A -33 modifier should be added to the 00810 anesthesia code to indicate the circumstance was preventive. 

This coverage “trumps” local contractor medical necessity policies now in existence in a screening circumstance. In the circumstance when a screening procedure becomes therapeutic (see next bullet), the PT modifier should be applied to the anesthesia service. A copay will still apply, but the deductible should be waived.

X If the screening colonoscopy is negative, a follow-up procedure is allowed every 10 years by Medicare. The frequency for follow-up for commercial payors is dependent upon the patient coverage/plan, but most follow either CMS policy or the U.S. Multi-Specialty Task Force (MSTF) recommendations.

X Billing for a screening colonoscopy in an average risk patient:

• Medicare: G0121


HCPCS/CPT Codes

00810 – Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum

81528 – Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or
negative result

82270 – Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided 3 cards or single triple card for
consecutive collection)

G0104 – Flexible Sigmoidoscopy

G0105 – Colonoscopy (high risk)

G0106 – Barium Enema (alternative to G0104)

G0120 – Barium Enema (alternative to G0105)

G0121 – Colonoscopy (not high risk)

G0328 – Fecal Occult Blood Test (FOBT), immunoassay, 1–3 simultaneous

G0464 – Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin
(e.g., KRAS, NDRG4 and BMP3)

Medicare Beneficiary Pays

81528, 82270, G0104, G0105, G0121, G0328, and G0464:

* Copayment/coinsurance waived

* Deductible waived

Append modifier -33 to the anesthesia CPT code 00810 when you furnish a separately payable anesthesia service in conjunction with a screening colonoscopy (G0105 and G0121) to waive Medicare beneficiary copayment/coinsurance and deductible.

Appendix D – Requested Professional CPT and HCPCS

Procedure Codes

Code Description Modifiers to Report

00170 Anesthesia NONE

00400 Anesthesia NONE

00740 Anesthesia NONE

00790 Anesthesia NONE

00810 Anesthesia NONE

00840 Anesthesia NONE

01400 Anesthesia NONE

01480 Anesthesia NONE

01961 Maternity-Csection NONE

01967 Maternity-Normal NONE

11100 Biopsy, skin lesion 50, 51, 52, AS, AN, ZZ 

00785 ALCAINE       

00790 ALCOHOL

00800 ALCOHOL ISOPROPYL

00805 ALCOHOL RUBBING

00810 ALCON

00825 ALDACTAZIDE

00830 ALDACTONE

00845 ALDOMET

00850 ALDORIL

00866 ALFENTA

00903 ALKALINIZING AGENT

00915 ALKERAN

00960 ALLEREST

00976 ALLERGAN

00980 ALLERGY RELIEF OR SHOTS

00982 ALLERHIST

01000 ALLERPHED C EXPECTORANT

01001 CLARITIN D

01002 NEXIUM

01003 ANAPROX DS

01004 ATUSS EX

01005 ALLERPHED SYRUP

01006 FERRIMIN

01007 TIKOSYN

01008 ZONEGRAN

01012 BUDESONIDE

01014 CORVERT

01016 ADVIL MIGRAINE

01017 BACTRIM DS

01018 MONSEL'S SOLUTION

01019 NIFEDICAL XL

01020 OPTIVAR

01021 BUTORPHANO

d00805 METHAMPHETAMINE

d00806 PHENTERMINE

d00809 PHENDIMETRAZINE

d00810 DIETHYLPROPION

d00813 BENZOCAINE TOPICAL

d00817 HYDROXYCHLOROQUINE

d00824 OPIUM

d00825 LEVORPHANOL

d00833 OXYMORPHONE

d00838 BUTORPHANOL

d00839 NALBUPHINE

d00840 BUPRENORPHINE

d00842 SALSALATE

d00843 SODIUM SALICYLATE

d00844 SODIUM THIOSALICYLATE

d00846 MAGNESIUM SALICYLATE

d00848 DICLOFENAC 

00805 ALCOHOL RUBBING

00810 ALCON

00825 ALDACTAZIDE

00830 ALDACTONE

00835 ALDOCLOR

00845 ALDOMET

00850 ALDORIL

00866 ALFENTA

00880 ALKA-SELTZER

00960 ALLEREST

00976 ALLERGAN 

0780 NORMAL(1l)=AN0*BN0-CNO*DNO

00790 NORMAL(2,1)=CNO*FNO-ENO*8N0

00800 NJRMAL(3,1)=ENO*DNO-ANO*FNO

00810 TYPE 9900,NORMAL

00820 CALL MArMUL(3lV3,DIRCOSNORMAL,NGRMA)

00830 TYE 930tNORMA

00840 9900 FJRMAI(!X,3F10.3)

00850 C

0086V CONST=57.29577951


00870 C

00880NORk4AG=SQRT(NORKA(11f)**2+NOPMA(2t1)**2+NORMA(3,1)**2)

0890 C

00900 DIP=ACOS(ABS(NORMA(3,1)/NORMAG))*CONST

00910 lF(NORMA(1,1).EQ.0.U)STRDIR='N'

00920 IF(NORMA(2,1).E.0.0 )STRDIR='E'

00930 IF(NORMA(2,1)+N0RMA(ll).NE.0.C)GO TO 35