Phototherapy was well-tolerated without evidence of significant photo-damage or photo-carcinogenicity. J Matern Fetal Neonatal Med. An alternative to prolonged hospitalization of the full-term, well newborn. For more information about blocked lacrimal ducts, visit: aao.org/eye-health/diseases/treatment-blocked-tear-duct. Accessed July 16, 2002. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. The RR or MD with a 95 % CI was used to measure the effect. These researchers used the standard methods of the Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. 2021;34(21):3580-3585. Ambalavanan N, Carlo WA. Chu and colleagues (2020) stated that phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. These researchers systematically evaluated the safety and efficacy of probiotics supplement therapy for pathological neonatal jaundice. OL OL LI { Cochrane Database Syst Rev. 2016;109(3):203-212. Associations between G6PD, OATP1B1 and BLVRA variants and susceptibility to neonatal hyperbilirubinaemia in a Chinese Han population. Use a cupped hand or percussor cup. This generally refers to an undescended or maldescended testis. Do not subtract direct (conjugated) bilirubin. PubMed, Embase, Web of science, EBSCO, Cochrane library databases, Ovid, BMJ database, and CINAHL were systematically searched; RCTs evaluating the effect of zinc sulfate versus placebo on the prevention of jaundice in neonates were included. } Pediatrics. Do not confuse light treatment with ultraviolet light therapy, which is usually used for skin conditions such as psoriasis. In a systematic review and meta-analysis, Chu and colleagues (2021) examined if intermittent phototherapy is more effective than continuous phototherapy in the treatment of neonatal hyperbilirubinemia. Genotypes were obtained through the Danish Neonatal Screening Biobank. A total of 447 Chinese neonates with hyperbilirubinemia were selected as the study group and 544 healthy subjects were recruited as the control group matched by baseline sex, age, feeding pattern and delivery mode. 6A650ZZ - Phototherapy, Circulatory, Single Version 2023 Billable Code ICD-10-PCS Details 6A650ZZ is a billable procedure code used to specify the performance of phototherapy, circulatory, single. Resources TcB measurements obtained on the forehead, sternum, abdomen and covered lower abdomen were statistically compared with the corresponding TSB. Casnocha Lucanova L, Matasova K, Zibolen M, Krcho P. Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy. 04/29/2022 No study assessed harms of screening. Search All ICD-10; ICD-10-CM Diagnosis Codes; ICD-10-PCS Procedure Codes So, it was hard for these investigators to determine whether the allocation scheme was appropriate and whether blinding of participants and personnel was implemented. Aetna considers prebiotics / probiotics experimental and investigational for the treatment ofneonatal hyperbilirubinemia becausetheir effectiveness for this indication has not been established. The impact of SLCO1B1 genetic polymorphisms on neonatal hyperbilirubinemia: A systematic review with meta-analysis. Centers for Disease Control and Prevention (CDC). Code 99477 represents initial hospital care of the neonate (28 days or younger) who is not critically ill but requires intensive observation, frequent interventions, and other intensive care services. Available at: http://www.natus.com/information/breath_analysis/. Sometimes issues heal without interventions, such as minor hematomas from the birth process and laceration from the fetal monitoring electrode. J Pediatr (Rio J). Pace EJ, Brown CM, DeGeorge KC. Mishra S, Cheema A, Agarwal R, et al. It involves the exposure of the newborn to an ultraviolet light source (bili-light) in the home for a prescribed period of time. Inpatient treatment is generally not medically necessary for healthy full-term infants with aTSB less than 20 mg/dL, as these infants can usually be treated with expectant observation or home phototherapy. Copyright 2023 American Academy of Family Physicians. .strikeThrough { } Family physicians who perform newborn circumcision should separately report this service. Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia. The authors concluded that the UGT1A1*28 allele was not associated with risk for extreme hyperbilirubinemia in this study. } Petersen and colleagues (2014) stated that extreme hyperbilirubinemia (plasma bilirubin greater than or equal to 24.5 mg/dL) is an important risk factor for severe bilirubin encephalopathy. list-style-type: lower-roman; } Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. The dose of zinc varied from 5 to 20mg/day and duration from 5 to 7 days. However, the results remain controversial. OL OL OL OL OL LI { 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. Usually, the nurses pin the sleeve of the affected arm to the body of the newborns t-shirt. Ch. To determine if the administration of the anti-infective (e.g., erythromycin) externally to the eye (3E0CX2 Introduction of oxazolidinones into eye, external approach) is coded, check if your hospital has a policy on inpatient procedure collection. foam closure strips for metal roofing | keokuk, iowa arrests newington high school football coach 0 Additional citations were identified from the bibliography of selected articles and from the abstracts of conference proceedings. The pediatrician will wait watchfully and check the clavicle until its healed. Coding for this service depends on the provider of the service and whether the visit is in follow-up to an already identified problem or screening for problems. 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. The studies were included if they compared TcB results with TSB in term and near-term infants during phototherapy or after discontinuation of phototherapy. Jaundice in healthy term neonates: Do we need new action levels or new approaches? Cases were identified in the Danish Extreme Hyperbilirubinemia Database that covers the entire population. 2006;(4):CD004592. The authors concluded that early DXM treatment does not affect the severity of neonatal hyperbilirubinemia in ELBW preterm infants. Everything I am finding indicates this code is used for dermatological treatment not for jaundice. .newText { 2019;8:CD012731. NY State J Med. Understanding why a pediatrician documents a finding enables you to determine if it should be coded. Do not code this condition for the newborn inpatient encounter, unless additional resources are used. Guidelines for Perinatal Care. 2011;128(4):e1046-e1052. Clin Pediatr (Phila). 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 provider should document whether the testis is ectopic (e.g., in the superficial inguinal pouch) or abdominal. Liu J, Long J, Zhang S, et al. In 54 ELBW preterm infants, TSB and phototherapy (PT) data during the first 10 days were evaluated retrospectively. Clinical Policy: Phototherapy for Neonatal Hyperbilirubinemia Reference Number: CP.MP.150 Coding Implications . color: red French S. Phototherapy in the home for jaundiced neonates. Evidence Centre Evidence Report. However, if significant time beyond that typical of the infant preventive service is spent in counseling, physicians may also report a problem-oriented service (99212-99215) with modifier -25 to indicate the significant and separately identifiable services provided on the same date. Nagar and associates (2016) noted that TcB devices are commonly used for screening of hyperbilirubinemia in term and near-term infants not exposed to phototherapy. For the G6PD 1388 G>A SNP, individuals carrying the A-allele were associated with a significantly increased risk of neonatal hyperbilirubinemia (adjusted OR=1.49, p< 0.001, 95 % CI: 1.31 to 1.67). Malpresentations are almost always noted on the inpatient record. 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. The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. 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. Inpatient treatment is not generally medically necessary for preterm infants who present with a TSB less than 18 mg/dL, as these infants can usually be treated with expectant observation or home phototherapy. Eye issues due to immaturity or from the ointment applied to the newborns eyes. Support Lucile Packard Children's Hospital Stanford and child and maternal health, AAP Clinical Practice Guideline -- Full Version, Assessing Risk Based on Bilirubin Level -- "BiliTool", Infants who have not latched-on or nursed effectively for 12 hours, Infants supplemented more than once in 24 hours, Mothers with a history of breastfeeding failure, Antepartum mothers at risk of preterm delivery, AAP Clinical Practice Guideline - Summary. Unless there are issues, congenital hydroceles also are not coded on the well-baby checks. eMedicine J. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks gestation). 3. Indirect evidence from 3 descriptive uncontrolled studies suggested favorable associations between initiation of screening and decrease in hyperbilirubinemia rates, and rates of treatment or re-admissions for hyperbilirubinemia compared with the baseline of no screening. Pediatrics. Per the ICD-10-PCS Official Guidelines for Coding and Reporting, only clinically significant conditions are reported. Garg and colleagues (2017) stated that neonatal hyperbilirubinemia (NNH) is one of the leading causes of admissions in nursery throughout the world. Meta-analyses of 2 studies showed no significant difference in maximum plasma unconjugated bilirubin levels in infants with prebiotic supplementation (MD 0.14 mg/dL, 95 % CI: -0.91 to 1.20, I = 81 %, p = 0.79; 2 studies, 78 infants; low-quality evidence). map of m6 motorway junctions. J Fam Pract. J Perinatol. Can Nurse. This study compared oral zinc with placebo. Treating providers are solely responsible for medical advice and treatment of members. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. 1994;61(5):424-428. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis. Deshmukh and associates (2017) noted that neonatal jaundice requiring phototherapy is associated with significant socioeconomic burden including hospital re-admission, prolonged hospital stay, and separation of the baby from mother. CPT-4 codes: 59400: Antepartum, intrapartum, and postpartum patient care 59400: SG facility fees for the birth center 99460 or 99463: Initial newborn care in a birth center 99461: Second home visit for newborn care Hospital transfer during labor with no postpartum or newborn services Menu penelope loyalty quotes. If done right, you will hear a popping sound. J Matern Fetal Neonatal Med. Pediatrics. 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. www.hkjpaed.org/pdf/2007%3B12%3B93-95.pdf sacral dimple It has been debated if there is an upper limit on the efficiency of phototherapy. Hamelin K, Seshia M. Home phototherapy for uncomplicated neonatal jaundice. Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia. When the hematoma is extensive or combined with other issues that cause excessive hemolysis, involving additional resources, look to P58 Neonatal jaundice due to other excessive hemolysis. When the depression is too shallow, the femoral head may move around in the depression and sometimes move out of the acetabulum. Evaluation and treatment of jaundice in the term infant: A kinder, gentler approach. J Matern Fetal Neonatal Med. 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. Savinetti-Rose B, Kempfer-Kline RE, Mabry CM. 2019;32(10):1575-1585. American Academy of Pediatrics and American College of Obstetricians and Gynecologist. Montreal, QC: CETS; October 2000. 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. Sacral dimples without diagnostic services, such as diagnostic imaging, are not coded on inpatient records. Evans D. Neonatal jaundice. These investigators randomly assigned 1,974 infants with extremely low birth weight at 12 to 36 hours of age to undergo either aggressive or conservative phototherapy. Copyright Aetna Inc. All rights reserved. Testicles develop in the abdomen. In pre-planned subgroup analyses, the rates of death were 13 % with aggressive phototherapy and 14 % with conservative phototherapy for infants with a birth weight of 751 to 1,000 g and 39 % and 34 %, respectively (relative risk, 1.13; 95 % CI: 0.96 to 1.34), for infants with a birth weight of 501 to 750 g. The authors concluded that aggressive phototherapy did not significantly reduce the rate of death or neurodevelopmental impairment. This service includes time spent addressing routine feeding issues. TcB should not be used in patients undergoing phototherapy.". Medline, Embase, Cochrane Library, CINAHL and Scopus databases (from inception to May 8, 2014) were searched. I have a provider that ordered phototherapy for a newborn in the hospital with jaundice and he is wanting to bill 96900. Clinical Information. 2005;25(5):325-330. 1992;89:827-828. JavaScript is disabled. newborn, known as hyperbilirubenemia. This code may be reported only once per day and by only one physician. Watchko JF, Lin Z. For most newborns, the transition from fetal to newborn blood simply involves watchful waiting. Randomized controlled trials were eligible for inclusion if they enrolled neonates (term and pre-term) to whom oral zinc, in a dose of 10 to 20 mg/day, was initiated within the first 96 hours of life, for any duration until day 7, compared with no treatment or placebo. Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. PICOS eligibility criteria were used to select original studies published from 1984 through 2019. Aetna considersphototherapy medically necessary forterm andnear-term infantsaccording to guidelines published by the American Academy of Pediatrics (AAP). In those (uncommon) circumstances, report P83.5 Congenital hydrocele. When no additional resources are used, this is not coded on the inpatient record, and is part of the pediatricians well-baby check. 1992;31(6):345-352. Suresh GK, Martin CL, Soll RF. None of the included studies reported any side effects. 96.4. The results revealed that SLCO1B1 388 G>A is associated with an increased risk of neonatal hyperbilirubinemia (odds ratio [OR], 1.39; 95 % CI: 1.07 to 1.82) in Chinese neonates, but not in white, Thai, Latin American, or Malaysian neonates. If the screening must be done during the well-baby check, possible CPT codes to collect the screening are: Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2002. Pediatrics. Subsequent hospital care of infants who are not critically ill or injured as defined in CPT but who had a very low birth weight and continue to require intensive care services as described for code 99477 above may be reported with codes 99478-99480. Stevenson DK, Fanaroff AA, Maisels MJ, et al. Report an inclusive screening finding (R94.120 Abnormal auditory function study) in the professional record so the newborn can be retested at the well-baby checks. Approximately 60% of term babies and 85% preterm babies will develop clinically apparent jaundice, which classically becomes visible on day 3, peaks days 5-7 and resolves by 14 days of age in a term infant and by 21 days in the preterm infant. Diagnosis code Z00.121 (encounter for routine child health examination with abnormal findings) and the appropriate problem diagnosis would be used. There are implications for future healthcare needs (e.g., having a specialty consult ordered prior to discharge). Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. For preterm neonates, there was a significantly lower bilirubin level in the 100 mg/kg clofibrate group compared to the control group with a mean difference of -1.37 mg/dL (95 % CI: -2.19 mg/dL to -0.55 mg/dL) (-23 mol/L; 95 % CI: -36 mol/L to -9 mol/L) after 48 hours. For more information about congenital hydrocele, visit: www.webmd.com/parenting/baby/tc/congenital-hydrocele-topic-overview#1. 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.". The receiver operating characteristic analysis (for serum bilirubin levels greater than 205.2 micromol/L or greater than 239.4 micromol/L) showed significantly higher areas under the curve for BiliCheck than those for BiliMed (p < 0.001). 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). Although the duration of phototherapy in the zinc group was significantly shorter compared to the placebo group (n = 286; MD -12.80, 95 % CI: -16.93 to -8.67), the incidence of need for phototherapy was comparable across both the groups (n = 286; RR 1.20; 95 % CI: 0.66 to 2.18). Less than 30 minutes of hands-on care during transport would not be separately reported. Two reviewers independently assessed studies for inclusion, and discrepancies were resolved with consensus. If the fractured clavicle does not use additional resources during the hospitalization (a safety pin is not additional resources), do not code the condition on the hospital encounter. Pediatrics. Thirteen infants homozygous for (TA)7 polymorphism associated with GS were in the case group (18.6 %) and 14 in the control group (20.0 %). list-style-type: decimal; Halliday HL, Ehrenkranz RA, Doyle LW. 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). In an evidence-based review on "Neonatal hyperbilirubinemia", Pace and colleagues (2019) stated that clofibrate, metalloporphyrins, and ursodiol have been examined in the management of unconjugated hyperbilirubinemia as augmentation to phototherapy. Early corticosteroid treatment does not affect severity of unconjugated hyperbilirubinemia in extreme low birth weight preterm infants. Second, according to Cochrane risk of bias estimation, randomized allocation of participants was mentioned in 9 trials. For inpatient hospital coding, a condition is clinically significant if it requires: Note: These perinatal guidelines are the same as the general coding guidelines for additional diagnoses, except for the final point regarding implications for future healthcare needs. Cryptorchidism If a nurse visit is provided (e.g., weight screen only), code 99211 may be reported. Total serum bilirubin concentrations peaked 30 hours earlier in the DXM group (p 0.05). Assign codes for conditions that have been specified by the provider as having implications for future healthcare needs. Mean TSB (120 +/-19 mol/L versus 123 +/- 28 mol/L, DXM versus placebo, respectively) and maximum TSB (178 +/- 23 mol/L versus 176 +/- 48, DXM versus placebo, respectively) concentrations were similar. Available at: http://www.emedicine.com/med/topic1065.htm. Pediatrics. 2021;16(5):e0251584. .fixedHeaderWrap { [glucose-6-phosphate dehydrogenase (G6PD), uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1), and. For well infants 35 - 37 6/7 wk, can adjust TSB levels for intervention around the medium risk line. Analysis was performed on an intention-to-treat basis. 2015;7:CD008432. Cochrane Database Syst Rev. 2010;15(3):169-175. Therefore, well-designed, large randomized, double blind, placebo-controlled trials would be needed to further confirm the efficacy of probiotics. Since then, many hundred thousand infants have been treated with light. 1991;91:483-489. 1992;89:809-818. list-style-type: upper-alpha; This reduction may be offset by an increase in mortality among infants weighing 501 to 750 g at birth. Neonatology. Clin Pediatr. Phototherapy was started at an average of 7 h of age, and the first IVIG dose was administered at an average of 13 h of life; nearly 25% received a second IVIG dose. There is a new code for sacral dimples, Q82.6 Congenital sacral dimple, which can be coded in the professional encounter if they affect care, such as when an ultrasound is ordered and there is no finding of occult spina bifida. When the observation of hip click does not lead to diagnostic testing (e.g., ultrasound), therapeutic treatment (e.g., parental training in the use of, and discharged with, a Pavlik harness), an inpatient specialty consult, neonatal intensive care, or a scheduled outpatient specialty consult, it is not coded by inpatient coders. American Academy of Pediatrics, Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. The order of use of the instruments was randomized. Typically, no extra resources are required during the newborn hospitalization, so do not code the condition. list-style-type: lower-alpha; The condition affects 3 percent of term male infants, and 1 percent of male infants at one year. Secondary outcomes included incidence of jaundice, TSB level at 24, 48, 72, 96hours, and day 7, duration of hospital stay, and adverse effects (e.g., probiotic sepsis). 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis. Digestive System Disorders. In a case-control study performed at a single hospital center in Italy, 70 subjects with severe hyperbilirubinemia (defined as bilirubin level greater than or equal to 20 mg/dL or 340 mol/L) and 70 controls (bilirubin level less than 12 mg/dL or 210 mol/L) were enrolled. This document addresses the use of home phototherapy and the devices used for the treatment of neonatal jaundice that is physiologic (that is, non-pathologic) in nature. They used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), Medline via PubMed (1966 to June 14, 2018), Embase (1980 to June 14, 2018), and CINAHL (1982 to June 14, 2018). Cochrane Database Syst Rev. Additionally, no serious adverse reaction was reported. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. 2005;17(2):167-169. 2. . Poland RL. When there is a diagnostic study, such as an ultrasound with no diagnosis, the justification for the diagnostic study is coded with R29.4 Clicking hip. New perspectives on neonatal hyperbilirubinemia. These researchers performed a systematic review with meta-analysis including genetic studies, which assessed the association between neonatal hyperbilirubinemia and 388 G>A, 521 T>C, and 463 C>A variants of SLCO1B1 between January of 1980 and December of 2012. Subsequent days of critical care to the critically ill neonate are reported per day with code 99469. Report an inclusive screening finding (R94.120 Abnormal auditory function study) in the professional record so the newborn can be retested at the well-baby checks. UGT1A1 is the rate-limiting enzyme in bilirubin's metabolism. No association was found between the UGT1A1*28 allele and extreme hyperbilirubinemia. Inpatient treatment may be medically necessary for pre-term infants who present with a TSB greater than or equal to 18 mg/dL. list-style-type: decimal; It suggested that these researchers should use the same guideline to detect the time of jaundice fading in future study. Severe hyperbilirubinemia was used as a surrogate for possible chronic bilirubin encephalopathy (CBE), because no studies directly evaluated the latter as an outcome. Do not use S42.0- Fracture of clavicle for the initial encounter or subsequent professional encounters. Metalloporphyrins for treatment of unconjugated hyperbilirubinemia in neonates. Do not percuss over the backbone, breastbone, or lower two ribs. Mean STB levels, mg/dL, at 72 12 hours were comparable in both the groups (n = 286; mean difference (MD) -0.20; 95 % CI: -1.03 to 0.63). Data were statistically extracted and evaluated using RevMan 5.3 software.