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Modifier 78 may apply when a patient returns for related procedural care within the global period (though 20610 has a zero-day global)

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Melatonin may promote the secretion of gastric bicarbonate, protect the gut barrier from NSAIDS, and improve the activity of the lower esophageal sphincter by inhibiting nitric oxide.[62][63][64] Given that endogenous melatonin peaks in the evening, this may be one way that ones innate physiology help to minimize gravity-dependent reflux