The order of use of the instruments was randomized. An alternative to prolonged hospitalization of the full-term, well newborn. In a Cochrane review on early (less than8 days) postnatal corticosteroid treatmentfor preventing chronic lung disease in preterm infants, Halliday et al(2010) concluded that the benefits of early postnatal corticosteroid treatment, especially DXM, may not out-weigh the known or potential adverse effects of this treatment. Acta Paediatr. Since then, many hundred thousand infants have been treated with light. Reference Number: CP.MP.150 Coding Implications Date of Last Revision: 10/22 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. OL OL OL OL LI { These researchers systematically evaluated the safety and efficacy of probiotics supplement therapy for pathological neonatal jaundice. It may not display this or other websites correctly. Semin Fetal Neonatal Med. If no feeding or other health problem has been previously noted, this visit may be the first well-child visit when provided by a physician, nurse practitioner, or physician assistant. 1986;25(6):291-294. OL LI { If the screening must be done during the well-baby check, possible CPT codes to collect the screening are: Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. No significant difference in mortality during hospital stay after enteral supplementation with prebiotics was reported (typical RR 0.94, 95 % CI: 0.14 to 6.19; I = 6 %, p = 0.95; 2 studies; 78 infants; low-quality evidence). Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. A total of 10 articles were included in the study. Aggressive phototherapy, as compared with conservative phototherapy, significantly reduced the mean peak serum bilirubin level (7.0 versus 9.8 mg/dL [120 versus 168 micromol/L], p < 0.01) but not the rate of the primary outcome (52 % versus 55 %; relative risk, 0.94; 95 % confidence interval [CI]: 0.87 to 1.02; p = 0.15). Okwundu CI, Okoromah CA, Shah PS. The USPSTF concluded that the evidence is insufficient to assess the balance of benefits and harms of screening for hyperbilirubinemia to prevent CBE. The correlation between TSB and TcB was found to be moderately close (r = 0.4 to 0.5). Li and colleagues (2019) examined the associations between G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512 variants and the risk of neonatal hyperbilirubinemia in a Chinese neonate population. For most newborns, hematomas from the birth process resolve spontaneously. 1992;89:809-818. Each payer can develop its own diagnosis-related group. The genotype of Gilbert syndrome, the UGT1A1*28 allele, causes markedly reduced activity of this enzyme, but its association with neonatal hyperbilirubinemia is uncertain and its relationship with extreme hyperbilirubinemia has not been studied. display: block; There are implications for future healthcare needs (e.g., having a specialty consult ordered prior to discharge). Ch. Arch Dis Child Fetal Neonatal Ed. Pediatrics. Exchange transfusion should be performed in a neonatal intensive care unit (NICU) due to significant risks. The authors concluded that the findings of this study demonstrated that the 388 G>A mutation of the SLCO1B1 gene is a risk factor for developing neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations; the SLCO1B1 521 T>C mutation provides protection for neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations. Prophylactic probiotics did not reduce the incidence of jaundice significantly [n=1,582, RR: 0.56 (0.25 to 1.27); p=0.16; LOE: low]. 66850 Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration. For a better experience, please enable JavaScript in your browser before proceeding. Accessed July 16, 2002. Garg and colleagues (2017) stated that neonatal hyperbilirubinemia (NNH) is one of the leading causes of admissions in nursery throughout the world. 2019;8:CD012731. It affects approximately 2.4 to 15 % of neonates during the first 2 weeks of life. When newborns are discharged with the Pavlik harness, code for the placement of an immobilization device, external, limiting the movement of the upper right leg with 2W3NXYZ Immobilization of right upper leg using other device and upper left leg with 2W3PXYZ Immobilization of left upper leg using other device. Guidelines for Perinatal Care. These findings seem compatible with the concept that factors other than bilirubin conjugation capacity are important for the pathophysiology of neonatal jaundice in ELBW preterm infants. Torres-Torres M, Tayaba R, Weintraub A, et al. Clinical Information. After maintenance phototherapy was discontinued, 7 patients (23% ) had a sustained disease-free interval lasting more than 58 months (median of greater than 90 months). Earn CEUs and the respect of your peers. Evaluation and treatment of jaundice in the term infant: A kinder, gentler approach. Randomized and quasi-randomized controlled trials of pregnant women established to have red cell isoimmunization in the current pregnancy during their antenatal testing and given phenobarbital alone or in combination with other drugs before birth were selected for review. Pediatrics. There were no probiotic-related adverse effects. Behrman RE, ed. Effects of Gly71Arg mutation in UGT1A1 gene on neonatal hyperbilirubinemia: A systematic review and meta-analysis. At the well-baby check, report K42.9 Umbilical hernia without obstruction or gangrene if the condition is addressed (not merely noted in the documentation). Data sources included PubMed, Embase, Cochrane library, China National Knowledge Infrastructure, China Biology Medicine, VIP Database, and Wanfang Database. Aetna considers home phototherapy for physiologic jaundice in healthy infants with a gestational age of 35 weeks or more medically necessary if all of the following criteria are met: Note: If levels do not respond by stabilizing (+/- 1 mg/dL) or declining, more intensive phototherapy may be warranted. During an initial newborn evaluation, watchful waiting conditions are findings that usually resolve without medical intervention in a few weeks to a few years. (Codes may be selected based on time spent in counseling and coordination of care when documentation indicates more than 50% of face-to-face time was spent in these activities.) In search of a 'gold standard' for bilirubin toxicity. The SLCO1B1 521 T>C mutation showed a low risk of neonatal hyperbilirubinemia in Chinese neonates, while no significant associations were found in Brazilian, white, Asian, Thai, and Malaysian neonates. .newText { Cochrane Database Syst Rev. Moreover, they stated that as the quality of included studies and the limitations of samples, the long-term safety and efficacy still need to be confirmed by long-term and high-quality research. A total of 5 RCTs involving 645 patients were included in the meta-analysis. 1992;89:822-823. 16th ed. Normal newborn care services are reported with these codes: 99460 Initial hospital or birthing center care, per day, for E/M of normal newborn infant 99462 Subsequent hospital care, per day, for E/M of normal newborn The Coding for Pediatrics manual defines a normal newborn as the following: Transitions to life in the usual manner. Cochrane Database Syst Rev. These investigators evaluated the effects of antenatal phenobarbital in red cell isoimmunized pregnancies in reducing the incidence of phototherapy and exchange transfusion for the neonate. If the nurse visit results in a visit with the physician, only the physician services would be reported. J Pediatr (Rio J). For well infants 35 - 37 6/7 wk, can adjust TSB levels for intervention around the medium risk line. All searches were re-run on April 2, 2012. 2001;108(1):175-177. Cochrane Database Syst Rev. TcB should not be used in patients undergoing phototherapy.". } Randomized controlled trials were identified by searching MEDLINE (1950 to April 2012) before being translated for use in The Cochrane Library, EMBASE 1980 to April 2012 and CINAHL databases. None of the included studies reported any side effects. For harms associated with phototherapy, case reports or case series were also included. In a Cochrane review, these investigators examined if administration of prebiotics reduces the incidence of hyperbilirubinemia among term and pre-term infants compared with enteral supplementation of milk with distilled water/placebo or no supplementation. These researchers identified studies through Medline searches, perusing reference lists and by consulting with United States Preventive Services Task Force(USPSTF) lead experts. Approximately 2 ml of peripheral venous blood was taken from all subjects. Pediatrics. All Rights Reserved. These services include intensive cardiac and respiratory monitoring, continuous and/or frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, and constant observation by the health care team under direct physician supervision. Pediatrics. Notes: Prophylactic phototherapy is considered medically necessary for infants showing a rapid rise in bilirubin (greater than 1 mg/dL/hour) and as a temporary measure when one is contemplating exchange transfusion. Maisels MJ, Watchko JF. According to available guidelines, no further measurement of bilirubin is necessary in most cases. These researchers evaluated the role of massage therapy for reduction of NNH in both term and preterm neonates. Until the lacrimal ducts drain spontaneously, the pediatrician can show the parents a massage technique to use between the bridge of the nose and the inside corner of the affected eye. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis. The fetal blood is designed to attract oxygen from the mothers blood. The dose of zinc varied from 5 to 20mg/day and duration from 5 to 7 days. A total of 716 neonates were included in the meta-analysis. 1992;89:823-824. Support teaching, research, and patient care. li.bullet { Aetna considers measurement of glucose-6-phosphate dehydrogenase (G6PD) levelsmedically necessary for jaundiced infants who are receiving phototherapy, where response to phototherapy is poor, or where the infant is at an increased risk of G6PD deficiency due to family history, ethnic or geographic origin. Montreal, QC: CETS; October 2000. Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants. The authors found a moderate correlation between TcB and TSB during phototherapy with a marginal improvement in the post-phototherapy phase. @media print { However, they stated that due to limitations of the trials, current evidence is in sufficient regarding the use of massage therapy for the management of NNH in routine practice. Although early corticosteroid treatment facilitates extubation and reduces the risk of chronic lung disease and patent ductus arteriosus, it causes short-term adverse effects including gastro-intestinal bleeding, intestinal perforation, hyperglycaemia, hypertension, hypertrophic cardiomyopathy and growth failure. The authors stated that this study had several drawbacks. Last Review04/29/2022. Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. Incidence of hyperbilirubinaemia, defined as serum total bilirubin (STB) greater than or equal to 15 mg/dL, was similar between groups (n = 286; risk ratio (RR) 0.94, 95 % CI: 0.58 to 1.52). As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. phototherapy in the home, applied by a . Lets review which conditions should be reported and when. Use total bilirubin. There were no reports of the need for exchange transfusion and incidence of acute bilirubin encephalopathy, chronic bilirubin encephalopathy, and major neurodevelopmental disability in the included studies. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Pediatrics. Eye issues due to immaturity or from the ointment applied to the newborns eyes. Maisels MJ, McDonagh AF. Saunders Co.; 2000:513-519. Primary outcome was the duration of phototherapy. These investigators included trials where neonates with hyperbilirubinemia received either clofibrate in combination with phototherapy or phototherapy alone or placebo in combination with phototherapy. Meta-analysis was performed using random- or fixed-effect models. The pediatrician will wait watchfully and check the clavicle until its healed. Aggressive vs. conservative phototherapy for infants with extremely low birth weight. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Wong RJ, Bhutani VK. MMWR Morb Mortal Wkly Rep. 2001;50(23):491-494. Newborn/neonate - Age ranges from birth to 28 days Anomaly - Developmental deformity Congenital - Condition present at birth, however, may not manifest until later in life 5 Neonatal Coding Guidelines Newborn/perinatal conditions are never reported on the mother's record, and likewise, pregnancy Data were statistically extracted and evaluated by RevMan 5.3 software. These include vascular access procedures, airway and ventilation management services, oral or nasogastric tube placement, bladder aspiration or catheterization, and lumbar puncture among others. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Comp arative Effectiveness of Fiberoptic Phototherapy for Hyperbilirubinemia in Term Infants. Report code 99466 for 30-74 minutes of hands-on care and code 99467 for each additional 30 minutes of hands-on care. There are 4 chief Current Procedural Terminology (CPT) codes for reporting phototherapy services: (1) 96900: actinotherapy (UV light treatment); (2) 96910: photochemotherapy, tar, and UVB (Goeckerman treatment) or petrolatum and UVB; (3) 96912: photochemotherapy and PUVA; and (4) 96913: photochemotherapy (Goeckerman and/or PUVA) for severe J Perinatol. Pediatrics. solute carrier organic anion transporter polypeptide 1B1 (SLCO1B1)] may interact with each other and/or environmental contributors to produce significant hyperbilirubinemia. This risk increased significantly in the CC genotype carriers at the rs4149056 locus of the SLCO1B1 gene (OR=2.17, 95 % CI: 1.87 to 2.33), whereas it decreased significantly in individuals carrying the G-allele at the rs699512 locus of the BLVRA gene (adjusted OR=0.84, p= 0.01, 95 % CI: 0.75 to 0.95). Aggressive phototherapy did reduce rates of neurodevelopmental impairment (26 %, versus 30 %for conservative phototherapy; relative risk, 0.86; 95 % CI: 0.74 to 0.99). The authors concluded that genetic variants of bilirubin metabolism genes, including G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512, were associated with the risk of neonatal hyperbilirubinemia, and are potential markers for predicting the disorder. J Pediatr Health Care. Early corticosteroid treatment does not affect severity of unconjugated hyperbilirubinemia in extreme low birth weight preterm infants. Home Phototherapy for Neonatal Jaundice (07.06.02) COVERED: ACCORDING TO CERTAIN CRITERIA Phototherapy is often used to treat neonatal jaundice and involves the continuous application of ultraviolet light via a lamp or a beroptic system to a newborn for a prescribed period of time. When the newborn jaundice requires additional resources, the correct diagnosis is usually found under P58 Neonatal jaundice due to other excessive hemolysis or P59 Neonatal jaundice from other and unspecified causes codes. Description This policy details medical necessity criteria for home phototherapy for the treatment of neonatal . The lining of the abdomen pouches into the scrotum to surround the testicle. One study reported a significant reduction in the risk of hyperbilirubinemia and rate of treatment with phototherapy associated with enteral supplementation with prebiotics (RR 0.75, 95 % CI: 0.58 to 0.97; 1 study, 50 infants; low-quality evidence). The authors concluded that limited low-quality evidence indicated that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. The China National Knowledge Infrastructure and MEDLINE databases were searched. Yang L, Wu, Wang B, et al. The authors concluded that the limited evidence available has not shown that oral zinc supplementation given to infants up to 1 week old reduces the incidence of hyperbilirubinaemia or need for phototherapy. 2013;89(5):434-443. The smallest but significant difference between TSB and TcB was found on the lower abdomen. An example is hemangiomas (e.g., strawberry hemangiomas), which do not impinge on vital structures and are not located in the periorbital area, lip, neck, or sacral region. Watchful waiting conditions usually are not coded by hospital inpatient coders because the conditions do not use significant hospital resources and do not affect newborn hospitalization. Because this is a normal condition, there is no code for it. Consistent with available guidelines, continued phototherapy is not medically necessary for healthy term infants when the following criteria for discontinuation of phototherapy are met: A delay in discharge from the hospital in order to observe the infant for rebound once the bilirubin has decreased is not considered medically necessary. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. Two reviewers independently assessed studies for inclusion, and discrepancies were resolved with consensus. Treatment of jaundice in low birthweight infants. For the term neonates, there were significantly lower bilirubin levels in the clofibrate group compared to the control group after both 24 and 48 hours of treatment with a weighted mean difference of -2.14 mg/dL (95 % CI: -2.53 mg/dL to -1.75 mg/dL) (-37 mol/L; 95 % CI: -43 mol/L to -30 mol/L] and -1.82 mg/dL (95 % CI: -2.25 mg/dL to -1.38 mg/dL) (-31 mol/L; 95 % CI: -38 mol/L to -24 mol/L), respectively. When the depression is too shallow, the femoral head may move around in the depression and sometimes move out of the acetabulum. list-style-type : square !important; Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. This is not the same as for professional services coding, where the first-listed diagnosis is the reason for the encounter. Mothers typically are counseled on newborn jaundice signs and when to bring the newborn in. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks gestation). This study compared oral zinc with placebo. 2019;32(1):154-163. The ICD-10-PCS code for light treatment of the skin is 6A600ZZ Phototherapy of skin, single for a single treatment. TcB measurements obtained on the forehead, sternum, abdomen and covered lower abdomen were statistically compared with the corresponding TSB. 2012;12:CD009017. A total of 259 neonates were included in the meta-analysis. Liu J, Long J, Zhang S, et al. A condition does not need to be coded on the inpatient hospital encounter to be coded on the pediatricians hospital encounter. 2010;(1):CD001146. A systematic evidence review prepared for the Cochrane Collaboration (Suresh et al, 2003) concluded that, based upon limitations of the evidence, "[r]outine treatment of neonatal unconjugated hyperbilirubinemia with a metalloporphyrin cannot be recommended at present.". In some cases, phototherapy will only be needed for 24 hours or less, in some cases, it may be required for 5 to 7 days. Ip S, Glicken S, Kulig J, et al. Ludwig MA. Normal Newborn visit, initial service 1. A heterozygous group was also equally distributed between cases (44.3 %) and controls (42.9 %). The studies were included if they compared TcB results with TSB in term and near-term infants during phototherapy or after discontinuation of phototherapy. For the same reason, subcutaneous vaccine administration (3E0134Z Introduction of serum, toxoid and vaccine into subcutaneous tissue, percutaneous approach) usually is not coded. } Depending on the study, 2 to 10 percent of newborns have inconclusive results at discharge (e.g., there may be fluid in the middle ear; the newborn may be fussy; one ear might pass, but the other does not). According to available guidelines, inpatient treatment may be considered medically necessary for healthy full-term infants who present with aTSB greater than or equal to 20 mg/dL in the first post-natal week. These are not additional resources. Blood testing done as a diagnostic test, however, meets the requirements for coding the jaundice. .newText { Once the skin is clear or alm These investigators searched CENTRAL (The Cochrane Library 2014, Issue 1), MEDLINE (1966 to November 30, 2014), and EMBASE (1990 to November 30, 2014). Use a cupped hand or percussor cup. Liu et al (2013) examined if 3 variants (388 G>A, 521 T>C, and 463 C>A) of SLCO1B1 are associated with neonatal hyperbilirubinemia. There was no evidence of a significant difference in duration of phototherapy between the prebiotic and control groups, which was only reported by 1 study (MD 0.10 days, 95 % CI: -2.00 to 2.20; 1 study, 50 infants; low-quality evidence). Furthermore, an UpToDate review on "Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants" (Wong and Bhutani, 2017) states that "TcB measurements are not reliable in infants undergoing phototherapy. Watchko and Lin (2010) noted that the potential for genetic variation to modulate neonatal hyperbilirubinemia risk is increasingly being recognized. Stevenson DK, Fanaroff AA, Maisels MJ, et al. PubMed, Scopus, Embase, Cochrane library, CBM, CNKI, and Wanfang Data were searched to collect the comparative study of home-based phototherapy versus hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. 65. 2002;3(1). The authors concluded that intermittent phototherapy appeared to be as effective as continuous phototherapy for the treatment of neonatal hyperbilirubinemia and was safer than continuous phototherapy.
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