| CPT CODE | CPT MODIFIER 1 | CPT MODIFIER 2 | PRIMARY DIAGNOSIS | SECONDARY DIAGNOSIS 1 | SECONDARY DIAGNOSIS 2 | SECONDARY DIAGNOSIS 3 | TREATED FOR SC CONDITION | TREATED FOR AO CONDITION | TREATED FOR IR CONDITION | EXPOSED TO ENVIR CONTAMINANTS | TREATMENT FOR MST | TREATMENT FOR HEAD/NECK CA | COMBAT VET | CPT RECORD DATE/TIME | PTF | SOURCE | USER | QUANTITY | SECONDARY DIAGNOSIS 4 | SECONDARY DIAGNOSIS 5 | SECONDARY DIAGNOSIS 6 | SECONDARY DIAGNOSIS 7 | DELETE DATE |
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