If you are unable to justify the use of a modifier, you may only bill 52332. If you bill both, 52005 should receive the modifier. Either route you go coding this procedure; you may code 74420 with the -26 modifier (professional component) for the interpretation/reading of the xrays. Hope this gives you some direction on coding this …Medical Coding. Urology . Wiki Percutaneous cystolithotomy. Thread starter lshafer; Start date Sep 14, 2011; Create Wiki L. lshafer Guest. Messages 6 Best answers 0 ...Background: The treatment of large volume bladder stones by current equipments continues to be a management problem in both developing and developed countries. AH-1 Stone Removal System (SRS) invented by us is primarily used to crush and retrieve bladder stones. This study evaluated the safety and efficiency of transurethral …A cystolitholapaxy is a surgical procedure that treats bladder stones, which are hard deposits of minerals that can form inside your bladder. During a cystolitholapaxy, a surgeon inserts an instrument called a cystoscope into your bladder to locate the stone or stones. A cystoscope is a tube with a camera on the end.If this is removal but is not a simple grasping or basket extraction of the stone, CPT code 52315 may be more appropriate. Mark Painter If the physician elected to manipulate the stone into the bladder and then to laser the stone in the bladder, we would recommend one of the litholapaxy codes based upon size of the stone (CPT 52317 or …Cystolitholapaxy. What is Cystolitholapaxy? It is an operation to break up and remove stones in the urinary bladder. Such stones can lead to pain, blood in the urinary tract, infection, and in some cases kidney dysfunction if associated with urinary tract obstruction.Per the definition of CPT 52317: "Litholapaxy: crushing or fragmentation of calculus by any means..." The use of a grasper to manually crush the stone is still considered litholapaxy. You may also want to look at billing 52318 in this case, as the stones being encrusted on the stent makes it "complicated" for the purpose of coding.Cystolitholapaxy is a minimally invasive medical procedure used to treat bladder stones by breaking them into smaller fragments, which can then be easily removed or passed through the urinary tract. This procedure typically involves the use of a cystoscope, a thin tube with a camera and light, which is inserted into the urethra and guided into the bladder. Specialized tools are then used to ...Patients. From 1999 to 2012, in Korea, the overall incidence rates of kidney, bladder, and prostate cancer were 4.4%, 4.79%, and 7.75% [] and generally increase with aging [].Owing to a growing elderly population, there has been an increase in the number of urologic surgeries, such as nephrectomy, cystectomy, and prostatectomy [].Surgery has been …CPT is a registered trademark of the American Medical Association. CPT Codes (cont’d) CPT® . Code Description. PCNL. 50080. 50081. Percutaneous nephrostolithotomy or …In the world of medical billing and coding, accuracy is crucial. One small error in assigning a Current Procedural Terminology (CPT) code can lead to significant consequences, incl...Percutaneous cystolitholapaxy is a safe and effective approach for the removal of moderate-sized bladder calculi in adults with prior lower urinary tract reconstruction utilizing bowel. Its efficacy and minimally invasive nature make it …Cystolitholapaxy is a surgical procedure used to treat stones in the urinary bladder. The procedure is carried out with the help of a cystoscope and can be transurethral (through the urethra) or ...Jul 28, 2023 · CPT code 52356 is the code used to bill for cystolitholapaxy. This code was introduced in the 1990s and has undergone several changes since then. The current code, 52356, was established in 2003 and is used to bill for the entire procedure, including the use of equipment and any necessary anesthesia. Aug 1, 2023 · Percutaneous cystolitholapaxy is a safe and effective approach for the removal of moderate-sized bladder calculi in adults with prior lower urinary tract reconstruction utilizing bowel. Its efficacy and minimally invasive nature make it the approach of choice at our institution. Answer: "When a physician must use more than one procedure to accomplish successful surgery, you should only report the code for the procedure that accomplishes the intended surgery," Ferragamo says. "In this case, that would be the TURP." For Medicare patients, the coding policy from the NCCI is to bill only this procedure (52601).Page 2 of 18 * Indicates Inpatient only CPT Code/Procedure. SJH Procedures - Urology Service ... CYSTOLITHOLAPAXY CYSTOSCOPY LITHOPAXY 52317 Litholapaxy: crushing or ...Learn the difference between source code and object code within computer programming. Each term has its own use; deciphering them can be difficult at first, but with this easy-to-f...Prostate gland Enlarge image. Transurethral incision of the prostate (TUIP) is a procedure to treat urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). TUIP is generally used in younger men with a small prostate who are concerned about fertility. A combined visual and surgical instrument ...A transurethral cystolitholapaxy is the most common procedure used to treat adults with bladder stones. The surgeon inserts a small, rigid tube with a camera at the end (a cystoscope) into your urethra and up into your bladder. The camera is used to help locate the bladder stones. A crushing device, lasers or ultrasound waves transmitted from ...Trusted Urology & Prostate Cancer Physician providing a variety of services to Central Midtown, New York and East Hills, NY. Contact us by phone at 607-689-9383 or visit us at 485 Madison Avenue, 21 st floor , New York, NY 10022 | David B Samadi, MDAmerican Urological Association 1000 Corporate Boulevard Linthicum, MD 21090 Phone: 410-689-3700 Toll-Free: 1-800-828-7866Answer: You should report the following codes: Question: My urologist performed a cystolitholapaxy for a stone sized greater than 2.5cm. They also performed a channel TURP and a bilateral retrograde pyelogram. According to the medical documentation, a bladder stone was attached to the bladder mucosa and the circumferential fashion around the ...Objective: This report presents the results of a randomized prospective study comparing synchronous transurethral cystolitholapaxy and transurethral resection of the prostate (TURP) with transurethral cystolitholapaxy plus medical treatment for benign prostatic hyperplasia (BPH) in patients with concomitant vesical stone(s) and BPH. Patients and …As such, correct coding would indicate that the service should be reported to non-Medicare payers following CPT correct coding directives as: 52356–RT 52353–5952214. Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands. 52224. Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion (s) with or without biopsy.Medical Coding. Urology . Wiki Manual Cystolitholapaxy. Thread starter KaylaRieken; Start date Jan 21, 2019; Create Wiki K. KaylaRieken ... Wiki Manual Cystolitholapaxy. Thread starter KaylaRieken; Start date Jan 21, 2019; Create Wiki K. KaylaRieken True Blue. Messages 506 Location Waukee, IA Best answers 0. Jan 21, …Jan 1, 2016 · The most commonly used codes in which a holmium laser is specifically referenced are: 52214: Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands. 52317: Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of ... Percutaneous cystolitholapaxy is a safe and effective approach for the removal of moderate-sized bladder calculi in adults with prior lower urinary tract reconstruction utilizing bowel. Its efficacy and minimally invasive nature make it the approach of choice at our institution.On a common scale, physician work RVUs compare the work involved with performing a service to all other services and procedures. For example, removing a foreign body from an eye (CPT ® code 65205) is assigned 0.49 work RVUs. But performing a minor eye wound repair (65270) is valued at 1.95 work RVUs.Letter to the editor re: Percutaneous cystolitholapaxy: A safe and effective alternative to open stone surgery for the management of complex bladder stones in patients with no urethral access. Goldsmith et al., J Clin Urol, 4 March 2019OVERVIEW Stones occur within the urinary bladder due to incomplete bladder emptying, urinary stasis, and/or chronic bladder infections. With time, the urine that is not voided begins to harbor bacteria and contain higher amounts of mucus, sediment and urinary minerals, eventually resulting in a bladder calculus. Surgical options for patients with …To code the encounter, your options are as follows: 52224 – Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR (less than 0.5 cm) lesion (s) with or without biopsy. 52234 – Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder …CPT Code For Cystolitholapaxy is 52356, and it refers to a procedure commonly used to remove bladder stones. This minimally invasive technique uses a …Objective This report presents the results of a randomized prospective study comparing synchronous transurethral cystolitholapaxy and transurethral resection of the prostate (TURP) with transurethral cystolitholapaxy plus medical treatment for benign prostatic hyperplasia (BPH) in patients with concomitant vesical stone(s) and BPH. Patients and methods The study included 100 patients with ...Cystolitholapaxy. 2. Placement of right double-J ureteral stent. 3. Shockwave lithotripsy to right renal calculi. Cystourethroscopy was notable for finding several small stones within the bladder and these were broken up and manually removed using a manual grasper. We did this until the bladder was free of stones. UW MEDICINE | PATIENT EDUCATION. | | | | About Your Procedure. Cystolitholapaxy. This handout explains a cystolitholapaxy, a procedure that breaks up and removes bladder stones. What is cystolitholapaxy? Cystolitholapaxy is a procedure to break up bladder stones into smaller pieces and remove them. Dec 1, 2016 · Introduction. Bladder stones constitute around 5% of bladder stones in the developed countries [].Open surgery has the maximum effectiveness, but leads to more morbidity to the patient [2,3]. In the ever-evolving landscape of healthcare, accurate and efficient medical coding is crucial. One important aspect of medical coding is understanding and utilizing Current Proced...CPT Code 51065, Surgical Procedures on the Bladder, Incision Procedures on the Bladder - Codify by AAPC. Select. Code Sets; Indexes; Code Sets and Indexes; ... Percutaneous Cystolitholapaxy. I actually sent my op note into the AUA coding hotline. They recommended me using CPT code 51065.... [ Read More ] View All. Coding …Ureteroscopic Stone Management and Stent Insertion. 52005 Cystourethroscopy, with ureteral catheterization. $290 $138. 8.05 3.84. 52310 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple. $277 $158. 7.68 4.38. 52332 Cystourethroscopy, with insertion of indwelling ...Dec 10, 2022 · Dr. is wanting to charge for a Cystolitholapaxy for crushing the stone off of the catheter with a lithotripsy along with a replacement of or exchange of the supra-pubic catheter.. CPT codes: 52317- states removal of bladder stones.... to me this is not according do Dr. dictation removal of a bladder stone. Stones occur within the urinary bladder due to incomplete bladder emptying, urinary stasis, and/or chronic bladder infections. With time, the urine that is not voided begins to harbor bacteria and contain higher amounts of mucus, sediment and urinary minerals, eventually resulting in a bladder calculus. Surgical options for patients with symptomatic bladder stones include open…52214. Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands. 52224. Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion (s) with or without biopsy.M7361. Complex urethroplasty, eg revision surgery of the anterior urethra, posterior urethra, +/- grafting (including cystoscopy) 28/01/2016. M7362. Complex urethroplasty, i.e. posterior urethral repairs and second (or further) anterior repairs with …CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. CPT code information is copyright by the AMA. Access to this feature is available in the following products: Find-A-Code Essentials; Find-A-Code Professional; Find-A-Code Premium; Find-A-Code Elite52214. Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands. 52224. Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion (s) with or without biopsy.CPT Codes. Surgery. Surgical Procedures on the Urinary System. Surgical Procedures on the Bladder. Incision Procedures on the Bladder. 51050. 51045. 51050. 51060.Here are three examples of coding 52005 and 74420 together: Example 1: The physician performs a retrograde pyelogram in the hospital with only a radiology technician to operate the equipment. This should be billed 52005 and 74420-26. The -26 modifier (professional component) indicates that the urologist interpreted the radiology …Apr 1, 2002 · The indwelling stent is not bundled with the lithotripsy. For bladder stones treated by laser ablation or lithotripsy, use 52317 ( Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small [less than 2.5 cm]) and 52318 (... complicated or large [over 2.5 cm]) with 594.1 ( Other calculus ... Hello I have a Cystolitholapaxy stone size greater than 2.5cm along with per Dr. a Channel TURP 1). Cystolitholapaxy 2). Channel TURP 3). Bilateral retrograde pyelogram " Bladder stone attached to the bladder mucosa and the circumferential fashion around the bladder neck..Aug 5, 2021 · Looking for a code for this.. I've seen 52317/51040 for lithopaxy, but since the stone was removed in this case maybe 52315/51040? I've also been looking at 51065 but it's a bladder stone not a ureteral stone. Foley cather was placed into bladder to straight drain. Question: I’m looking for help coding for an excision of exposed urethral sling mesh via laser destruction.While the provider was performing cystolitholapaxy for a bladder stone he came across the mesh which “slung across from the 5 to the 7 o’clock position right at the bladder neck, probably about 1 cm to 1.5 cm bridge right there at the bladder neck.”Letter to the editor re: Percutaneous cystolitholapaxy: A safe and effective alternative to open stone surgery for the management of complex bladder stones in …If this is removal but is not a simple grasping or basket extraction of the stone, CPT code 52315 may be more appropriate. Mark Painter If the physician elected to manipulate the stone into the bladder and then to laser the stone in the bladder, we would recommend one of the litholapaxy codes based upon size of the stone (CPT 52317 or 52318 for ...On August 27, 2015, the FDA cleared for marketing the Rezum System to relieve lower urinary tract symptoms secondary to benign prostatic hyperplasia. This procedure involves the transurethral injection of steam into the prostate. Once injected, the steam condenses to water, imparting convective energy to the tissue, causing cell death …Aug 1, 2023 · Percutaneous cystolitholapaxy is a safe and effective approach for the removal of moderate-sized bladder calculi in adults with prior lower urinary tract reconstruction utilizing bowel. Its efficacy and minimally invasive nature make it the approach of choice at our institution. Cystolitholapaxy. 2. Placement of right double-J ureteral stent. 3. Shockwave lithotripsy to right renal calculi. Cystourethroscopy was notable for finding …PC cystolitholapaxy is our institution’s method of choice for management of bladder calculi in all adult patients. CONCLUSION. A percutaneous approach to bladder calculi is safe and effective for patients with prior CURs, bladder augmentation, or neobladder. Recurrence rates of stones remain elevated and further investigations are …AWS today launched Amazon Honeycode, a no-code environment built around a spreadsheet-like interface that is a bit of a detour for Amazon’s cloud service. Typically, after all, AWS...The indwelling stent is not bundled with the lithotripsy. For bladder stones treated by laser ablation or lithotripsy, use 52317 ( Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small [less than 2.5 cm]) and 52318 (... complicated or large [over 2.5 cm]) with 594.1 ( Other calculus ...Of the foreign bodies, 33 (67.3%) were retrieved by cystoscopy, while transurethral cystolitholapaxy was required in 10 patients (20.4%), percutaneous suprapubic cystolitholapaxy was performed in 4 patients (8.1%), and holmium laser lithotripsy was performed in 2 patients (4.08%). None of the cases required open …Introduction: Management of intravesical calculi is not uncommon at the time of bladder outlet surgery.1 With advancement of endourologic surgery and laser technology for lithotripsy, holmium laser cystolitholapaxy (HLC) was first reported in 1997 that helped transform a traditionally open procedure into an endoscopic one.2 HLC can be effectively …Cpt code cystolitholapaxy. Cpt code for cystolitholapaxy with holmium laser. Transurethral cystolitholapaxy cpt code. Cystolitholapaxy procedure cpt code. What is the cpt code for ureteroscopy. Cpt code for cystoscopy with cystolitholapaxy. Percutaneous cystolitholapaxy cpt code. Can cpt code 58661 and 58662 be billed together.Ureteroscopic Stone Management and Stent Insertion. 52332 Cystourethroscopy, with insertion of indwelling ureteral stent. $500 $162. 13.92 4.51. 52352 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus. See Note $368. See Note 10.25.CPT code 99214 is a Current Procedural Terminology (CPT) code that is used in the medical field. According to E/M University, CPT 99214 refers to a Level 4 established office patie...52315 - CPT® Code in category: Cystourethroscopy, with removal of foreign body, calculus, or ureteral... CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more.CPT is a registered trademark of the American Medical Association. CPT Codes (cont’d) CPT® . Code Description. PCNL. 50080. 50081. Percutaneous nephrostolithotomy or …This changed on Jan. 1, 2009 when CPT® updated the coding for a staged TURP. Official guidance: CPT® states the following: “For first stage transurethral partial resection of prostate, use 52601. For second stage partial resection of prostate, use 52601 with modifier 58.”. “Although, in general, one should still consider and follow this ...CPT® / HCPCS. Code. Code Description. Cystoscopy-based Procedures (continued) 52260. Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or …3 days ago · CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. CPT code information is copyright by the AMA. Access to this feature is available in the following products: Find-A-Code Essentials; Find-A-Code Professional; Find-A-Code Premium; Find-A-Code Elite Published on Mon Oct 01, 2001. When a patient's bladder has been removed and there is either a loop of intestine (ileal conduit) or an artificial bladder (intestinal continent pouch), the urologist is in a quandary when coding procedures that normally involve looking into the bladder, such as a cystourethroscopy (52000) and related procedures.–Cystolitholapaxy(2 cm bladder stone), ... CPT code •Fee is raised to 125% and reimbursement is split 50% Customized Coding Webinar 41 Modifier 80They help diagnose problems related to urine control. These can be incontinence, difficulty emptying the bladder, overactive bladder, obstructions or frequent infections. Cystometry is used to measure how much urine the bladder can hold. It also measures pressure inside the bladder, and how full it is when you have the urge to go.Answer: "When a physician must use more than one procedure to accomplish successful surgery, you should only report the code for the procedure that accomplishes the intended surgery," Ferragamo says. "In this case, that would be the TURP." For Medicare patients, the coding policy from the NCCI is to bill only this procedure (52601).Question: The urologist performed cystoscopy with bladder irrigation and urethral placement of cyberwand for cystolitholapaxy.How should we code this procedure? Kentucky Subscriber. Answer: The correct code choice is based on the size of the stone the urologist treated.Check for the stone’s size in the operative report, and then …A software program is typically written in a high-level programming language such as C or Visual Basic. This native code is then compiled into machine code that can be run on a com...May 1, 2008 · Therefore, code 52315-"Cysto- urethroscopy, with re- moval of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated"-is the correct code. We recommend this code based on the comment that you removed multiple stones, as opposed to code 52310-"Cystourethroscopy, with removal of foreign body, calculus ... Feb 7, 2006 · The problem is that the CPT code descriptors for 52224-52240 state "tumor(s)" or "lesions(s)," meaning that each code represents single or multiple tumors of the same size, Ferragamo says. Separately Report Some Biopsies. Often a urologist will perform a biopsy of a bladder tumor before its complete removal. UW MEDICINE | PATIENT EDUCATION. | | | | About Your Procedure. Cystolitholapaxy. This handout explains a cystolitholapaxy, a procedure that breaks up and removes bladder stones. What is cystolitholapaxy? Cystolitholapaxy is a procedure to break up bladder stones into smaller pieces and remove them. Background: The treatment of large volume bladder stones by current equipments continues to be a management problem in both developing and developed countries. AH-1 Stone Removal System (SRS) invented by us is primarily used to crush and retrieve bladder stones. This study evaluated the safety and efficiency of transurethral …Percutaneous suprapubic cystolitholapaxy (PSCL) is largely performed in the pediatric population for the treatment of bladder calculi in augmented and native bladders. It is rarely performed in adults, in whom open cystolithotomy or transurethral cystoscopic techniques are generally employed. However, a transurethral approach is precluded in patients born with bladder exstrophy who have had ...Feb 7, 2006 · The problem is that the CPT code descriptors for 52224-52240 state "tumor(s)" or "lesions(s)," meaning that each code represents single or multiple tumors of the same size, Ferragamo says. Separately Report Some Biopsies. Often a urologist will perform a biopsy of a bladder tumor before its complete removal.
Kidney stones affect 1 in 500 Americans each year, causing significant pain and healthcare expense. Surgical options for patients with symptomatic kidney stones include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL). Your renal anatomy, stone composition, and body habitus all …. Glacier bay vanity combo
Jun 7, 2016 · Various techniques have been used for the management of bladder calculi, such as open cystolithotomy, transurethral cystolitholapaxy (TUCL), SWL, and percutaneous cystolitholapaxy (PCCL) , . However, the ideal treatment option for bladder stones remains controversial [3] . Can you please advise the CPT code for "Cystolitholapaxy"? Your help is greatly appreciated. Thank you. 0 K. KaylaRieken True Blue. Messages 505 Location Waukee, IA Best answers 0. Mar 8, 2022 #2 52317 or 52318. Depends what the size is. 0 1. 1CodingTeam24 Networker. Messages 59 Location Bolingbrook, IL Best answers 0.The 2017 CPT® manual tells us that for change of a ureterostomy tube or externally accessible ureteral stent via an ileal conduit, you should report 50688 for unilateral or bilateral stents. Factor 2: Pay Attention to the Approach. Don’t miss that codes 50382-50389 are not just differentiated by whether the procedure included a stent removal ...Aug 1, 2023 · Percutaneous cystolitholapaxy is a safe and effective approach for the removal of moderate-sized bladder calculi in adults with prior lower urinary tract reconstruction utilizing bowel. Its efficacy and minimally invasive nature make it the approach of choice at our institution. Page 2 of 18 * Indicates Inpatient only CPT Code/Procedure. SJH Procedures - Urology Service ... CYSTOLITHOLAPAXY CYSTOSCOPY LITHOPAXY 52317 Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm)CPT is a registered trademark of the American Medical Association. CPT Codes (cont’d) CPT® . Code Description. PCNL. 50080. 50081. Percutaneous nephrostolithotomy or …Jun 7, 2023 · Let us look at the 4 CPT codes that have been proposed to describe this situation: • 52310: Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple. • 52315: Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate ... Percutaneous suprapubic cystolithotripsy is an effective and safe technique for treating large bladder calculi. It is minimally invasive, avoids urethral injury, and, in combination with the pneumatic Swiss Lithoclast, can be used to …Can you please advise the CPT code for "Cystolitholapaxy"? Your help is greatly appreciated. Thank you. 0 K. KaylaRieken True Blue. Messages 505 Location Waukee, IA Best answers 0. Mar 8, 2022 #2 52317 or 52318. Depends what the size is. 0 1. 1CodingTeam24 Networker. Messages 59 Location Bolingbrook, IL Best answers 0. Cystolitholapaxy is the most common surgical procedure to remove bladder stones without external incisions. It is an outpatient procedure where the patient can return home the same day. During a Cystolitholapaxy, the surgeon uses a cystoscope to locate the bladder stone. Somewhere in between getting started with programming and being job-ready competent, you might experience the "desert of despair." Viking Code School explains why this struggle hap...Feb 21, 2015 · Transurethral cystolitholapaxy is probably the most common way to manage cystolithiasis. But the transurethral methods by the current lithotriptoscope, nephroscope, cystoscope, resctoscope or ureteroscope are plagued by long operative times, trauma to the bladder mucosa, and still have several serious deficiencies [ 4 , 10 - 13 ]. .