| 59774-0 | Anesthesia | required |
| 55109-3 | Complications Doc | required |
| 10218-6 | Operative note post-op Dx | required |
| 10219-4 | Operative note pre-op Dx | required |
| 59770-8 | Estimated blood loss | required |
| 59776-5 | Findings | required |
| 59773-2 | Specimens taken | required |
| 29554-3 | Proc | required |
| 59771-6 | Implants | optional |
| 10216-0 | Operative note fluids | optional |
| 10223-6 | Operative note procedure | optional |
| 18776-5 | Plan of care note | optional |
| 59772-4 | Planned procedure | optional |
| 59775-7 | Disposition | optional |
| 59768-2 | Procedure indications Imp | optional |
| 11537-8 | Surgical drains | optional |
| 72227-2 | Surg Op C-CDA R1.1+2.0+2.1 Sections | |