Gholitabar M, McGuire H, Rennie J, et al. 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. 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). [Phototherapy of newborn infants] The effect of light treatment on neonates with jaundice was discovered in 1958. Ambalavanan N, Carlo WA. Phototherapy is the use of visible light to treat severe jaundice in the neonatal period. } This indicated that cure may have been achieved in a minority of patients. text-decoration: line-through; They included English-language publications evaluating the effects of screening for bilirubin encephalopathy using early TSB, TcB measurements, or risk scores. The ointment is administered by the hospital staff, so there is no professional component to the service. Evidence Centre Evidence Report. Coding Guidelines 18, 19 The third trimester is the time of rapid weight gain, development of muscle mass and fat stores for the newborn. Do not percuss over the backbone, breastbone, or lower two ribs. Search All ICD-10 Toggle Dropdown. .fixedHeaderWrap { Reporting of codes for the services requires careful attention to CPT instructions and when more than one physician is caring for the infant, attention to which physician reports which codes. Subgroup analysis was done for AB0 incompatible cases. The main outcomes of the trials were analyzed by Review Manager 5.3 software. Clofibrate in combination with phototherapy for neonatal hyperbilirubinemia is considered experimental and investigational. Travan et al (2014) examined if UGT1A1 promoter polymorphisms associated with Gilbert Syndrome (GS) occur with a greater frequency in neonates with severe hyperbilirubinemia. Because it is a screening (not diagnostic), the test does not meet the definition of a diagnostic procedure or therapeutic treatment for a clinically significant condition. Stevenson DK, Wong RJ. None of the studies showed any effect on the duration of phototherapy, incidence of phototherapy, age of starting of phototherapy and any serious adverse effect. Codes 99478-99480 each are described as, "Subsequent intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant" with the code selected based upon the present body weight of the infant as below. If your newborn is too warm, remove the curtains or cover from around the light set. For most newborns, the transition from fetal to newborn blood simply involves watchful waiting. Although declining the inpatient prophylactic services is not reportable by inpatient hospital coders (because it does not affect the hospitalization), outpatient physician office coders can and should use Z28 Immunization not carried out and under immunization status codes when provider-recommended immunizations are not administered. In: Nelson Textbook of Pediatrics. This is not the same as for professional services coding, where the first-listed diagnosis is the reason for the encounter. 2001;108:31-39. Cochrane Database Syst Rev. The correlation between TSB and TcB was found to be moderately close (r = 0.4 to 0.5). Seven (2 prospective) studies evaluated the ability of risk factors (n = 3), early TSB (n = 3), TcB (n = 2), or combinations of risk factors and early TSB (n = 1) to predict hyperbilirubinemia (typically TSBgreater than 95th hour-specific percentile 24 hours to 30 days post-partum). OL OL OL OL LI { Diagnosis code Z00.121 (encounter for routine child health examination with abnormal findings) and the appropriate problem diagnosis would be used. Murki S, Dutta S, Narang A, et al. 2019;8:CD012731. 2018;31(10):1311-1317. Metalloporphyrins for treatment of unconjugated hyperbilirubinemia in neonates. www.hkjpaed.org/pdf/2007%3B12%3B93-95.pdf sacral dimple This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Earn CEUs and the respect of your peers. Although screening can predict hyperbilirubinemia, there is no robust evidence to suggest that screening is associated with favorable clinical outcomes. The literature search was done for various randomized control trial (RCT) by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, Scopus, Index Copernicus, African Index Medicus (AIM), Thomson Reuters (ESCI), Chemical Abstracts Service (CAS) and other data base. Two hundred years ago, newborns would have been placed on blankets in the sun for newborn jaundice. J Matern Fetal Neonatal Med. 2014;165(1):42-45. Jaundice, Coombs, and Phototherapy AAP Clinical Practice Guideline - Summary Bhutani Nomogram Guidelines for Phototherapy FAQs About Phototherapy 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. In a prospective study, Casnocha and colleagues (2016) tested the accuracy of TcB measure in newborns undergoing phototherapy. 7. 2017;8:432. Hospital readmission due to neonatal hyperbilirubinemia. Merenstein GB. The authors concluded that early DXM treatment does not affect the severity of neonatal hyperbilirubinemia in ELBW preterm infants. 16th ed. } The primary outcome was a composite of death or neurodevelopmental impairment determined for 91 % of the infants by investigators who were unaware of the treatment assignments. 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. 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. For additional language assistance: SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), gene analysis, common variant(s) (eg, *5), UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, irinotecan metabolism), gene analysis, common variants (eg, *28, *36, *37), Molecular pathology procedure, Level 1(eg, identification of single germline variant [eg, SNP] by techniques such as restriction enzyme digestion or melt curve analysis) [for assessing risk of neonatal hyperbilirubinemia], Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion), G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis, Phototherapy (bilirubin) light with photometer, Home visit, phototherapy services (e.g., Bili-lite), including equipment rental, nursing services, blood draw, supplies, and other services, per diem, Injection, phenobarbital sodium, up to 120 mg, Neonatal jaundice due to other excessive hemolysis, Neonatal jaundice from other and unspecified causes, Maternal care for other isoimmunization [not covered for the use of antenatal phenobarbital in red cell isoimmunized pregnant women], Glucose-6-phosphate dehydrogenase (G6PD); quantitative, Glucose-6-phosphate dehydrogenase (G6PD); screen, Genetic susceptibility to other disease [G6PD deficiency], Family history of other endocrine, nutritional and metabolic diseases [G6PD deficiency], Family history of carrier of genetic disease [G6PD deficiency]. These researchers identified studies through Medline searches, perusing reference lists and by consulting with United States Preventive Services Task Force(USPSTF) lead experts. All of the outcome measures should be monitored by a standardized effective report system in clinical trials and rare serious adverse reaction could be observed through epidemiological studies. display: block; Thayyil S, Milligan DW. UpToDate [online serial]. Aetna considers massage therapy experimental and investigational for the treatment ofneonatal hyperbilirubinemia because its effectiveness has not been established. Infants had been treated with DXM (0.25 mg/kg twice-daily at postnatal day 1 and 2) or with placebo (normal saline). Paediatrics Child Health. Wennberg RP. Cochrane Database Syst Rev. Starting Feb. 1, 2022, five new CPT codes will require preauthorization. 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. 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. If another physician provides critical care services to the neonate on the same date, that physician must report the services with critical care service codes 99291-99292. Semin Fetal Neonatal Med. Although inflammation occurs less frequently now than in the past because the medication used has changed, it may occur. The authors concluded that home-based phototherapy was more effective than hospital-based phototherapy in treatment for neonatal hyperbilirubinemia; home-based phototherapy was an effective, feasible, safe, and alternative to hospital-based phototherapy for neonatal hyperbilirubinemia. 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. The authors concluded that in this study population, GS polymorphism alone did not appear to play a major role in severe neonatal hyperbilirubinemia in neonates without signs of hemolysis. In 54 ELBW preterm infants, TSB and phototherapy (PT) data during the first 10 days were evaluated retrospectively. 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. The authors concluded that zinc sulfate could not reduce the TSB on 3 days and 7 days, the incidence of hyperbilirubinemia and phototherapy requirement, but resulted in significantly decreased duration of phototherapy. Pediatrics. cpt code for phototherapy of newbornhippo attacks human video. This review included total of 10 RCTs (2 in preterm neonates and 8in term neonates) that fulfilled inclusion criteria. list-style-type: decimal; Both case and control subjects were full term newborns. 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. Aetna considersphototherapy medically necessary forterm andnear-term infantsaccording to guidelines published by the American Academy of Pediatrics (AAP). Cochrane Database Syst Rev. 2016;109(3):203-212. The presumed mechanism of effect is photo-excitation of bilirubin extravascularly in the skin with the formation of bilirubin isomers which can be e Evaluation and treatment of jaundice in the term infant: A kinder, gentler approach. Inpatient coders do not code immature lacrimal ducts because the condition does not use additional resources. Primary outcome was the duration of phototherapy. 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. Canadian Paediatric Society, Fetus and Newborn Committee. Schuman AJ, Karush G. Fiberoptic vs conventional home phototherapy for neonatal hyperbilirubinemia. Each payer can develop its own diagnosis-related group. --> French S. Phototherapy in the home for jaundiced neonates. BiliCheck variability (+/- 2 SD of the mean bias from serum bilirubin) was within -87.2 to 63.3 micromol/L, while BiliMed variability was within -97.5 to 121.4 micromol/L. } 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. 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). 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. Once the skin is clear or alm Discharge normal newborn day 3 _____ 2. Meta-analysis (random-effects model) showed probiotic supplementation reduced duration of phototherapy [n=415, MD: -11.80 (-17.47 to -6.13); p<0.0001; level of evidence (LOE): low]; TSB was significantly reduced at 96hours [MD: -1.74 (-2.92 to -0.57); p=0.004] and 7 days [MD: -1.71 (-2.25 to -1.17); p<0.00001; LOE: low] after probiotic treatment. UGT1A1 is the rate-limiting enzyme in bilirubin's metabolism. 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. So, it was hard for these investigators to determine whether the allocation scheme was appropriate and whether blinding of participants and personnel was implemented. J Perinatol. J Matern Fetal Neonatal Med. Second, according to Cochrane risk of bias estimation, randomized allocation of participants was mentioned in 9 trials. The China National Knowledge Infrastructure and MEDLINE databases were searched. Neonatal hyperbilirubinemia: An evidence-based approach. For these hydroceles, the swelling will become greater and decrease. /* aetna.com standards styles for templates */ Phototherapy in the home setting. 2002;65(4):599-606. Cochrane Database Syst Rev. The correlation coefficient improved marginally in the post-phototherapy phase (r = 0.72, 95 % CI: 0.64 to 0.78, 4 studies). Toggle navigation. } In those (uncommon) circumstances, report P83.5 Congenital hydrocele. 2001;21(Suppl 1):S63-S87. Correlation between neonatal hyperbilirubinemia and vitamin D levels: A meta-analysis. However, that is not always the case. (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.) The authors concluded that the role of massage therapy in the management of NNH was supported by the current evidence. This study compared oral zinc with placebo. phototherapy in the home, applied by a . 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 %). Clinical evaluation (e.g., specialty consult during the hospitalization); Therapeutic treatment (e.g., bili lights for clinically significant neonatal jaundice); Diagnostic procedures (e.g., ultrasound due to sacral dimple); Extended length of hospital stay (e.g., beyond the average for the MS-DRG); Increased nursing care and/or monitoring (e.g., neonatal intensive care unit); or. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Pediatrics. Testicles develop in the abdomen. 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 In a prospective double-blind study, De Lucaet al (2008) compared the accuracy of a new transcutaneous bilirubinometer, BiliMed (Medick SA, Paris, France) with BiliCheck (Respironics, Marietta, GA), a widely available instrument, and with total serum bilirubin (TSB) measurement. Bhutani VK; Committee on Fetus and Newborn; American Academy of Pediatrics. Stevenson DK, Fanaroff AA, Maisels MJ, et al. 2004;114(1):297-316. Some infants may require intensive care services but do not meet the CPT definition of critically ill or injured required for reporting of critical care services. solute carrier organic anion transporter polypeptide 1B1 (SLCO1B1)] may interact with each other and/or environmental contributors to produce significant hyperbilirubinemia. 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. Nagar G, Vandermeer B, Campbell S, Kumar M. Effect of phototherapy on the reliability of transcutaneous bilirubin devices in term and near-term infants: A systematic review and meta-analysis. 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. 6. Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. 2019;32(1):154-163. Arch Dis Child Fetal Neonatal Ed. Inpatient coders dont collect watchful waiting conditions. JavaScript is disabled. Rates of death in the aggressive-phototherapy and conservative-phototherapy groups were 24 % and 23 %, respectively (relative risk, 1.05; 95 % CI: 0.90 to 1.22). There was no difference in the treatment efficacy and TSB, while there was a significant difference in phototherapy duration and side effects after treatment of intermittent phototherapy and continuous phototherapy for neonatal hyperbilirubinemia. FN07-02. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for reporting methods and results of synthesis with meta-analysis. 2015;7:CD008432. All Rights Reserved. Seidman DS, Stevenson DK, Ergaz Z, et al. Assign codes for conditions that have been specified by the provider as having implications for future healthcare needs. If separately documented in the mother's chart, you may report these services in addition to the services provided to the infant. Cochrane Database Syst Rev. 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. Maisels MJ, Watchko JF. Pediatrics. J Pediatr (Rio J). But unless the breech presentation or other malpresentation caused a significant finding for the newborn, do not code it on the inpatient hospital record. Comp arative Effectiveness of Fiberoptic Phototherapy for Hyperbilirubinemia in Term Infants. It not only decreased the total serum bilirubin level after 3 days [MD: -18.05, 95 % CI: -25.51 to -10.58), p < 0.00001], 5 days [MD: -23.49, 95 % CI: -32.80 to -14.18), p < 0.00001], 7 days [MD: -33.01, 95 % CI: -37.31 to -28.70), p < 0.00001] treatment, but also decreased time of jaundice fading [MD: -1.91, 95 % CI: -2.06 to -1.75), p < 0.00001], as well as the duration of phototherapy [MD: -0.64, 95 % CI: -0.84 to -0.44), p < 0.00001] and hospitalization [MD: -2.68, 95 % CI: -3.18 to -2.17), p < 0.00001], when compared with the control group. Bilirubin recommendations present problems: New guidelines simplistic and untested. This code may be reported only once per day and by only one physician. 2021;16(5):e0251584. NY State J Med. The G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512 SNPs had a significant impact on STB levels. 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]. In a Cochrane review, Thomas et al (2007) stated that neonates from isoimmunized pregnancies have increased morbidity from neonatal jaundice. This review included 6 RCTs that fulfilled inclusion criteria. Curr Opin Pediatr. It has been debated if there is an upper limit on the efficiency of phototherapy. This is caused by a small opening in the abdominal muscles that abdominal contents (e.g., fluid, abdominal lining) spill through. J Perinatol. Wong RJ, Bhutani VK. For the same reason, subcutaneous vaccine administration (3E0134Z Introduction of serum, toxoid and vaccine into subcutaneous tissue, percutaneous approach) usually is not coded. text-decoration: underline; 202;11(1):e040182. Torres-Torres M, Tayaba R, Weintraub A, et al. Ludwig MA. 1994;94(4 Pt 1):558-565 (reviewed 2000). Also, no association was found for AB0 incompatible cases. This service includes time spent addressing routine feeding issues. cursor: pointer; 2017:1-10. A total of 25 infants had been randomized into the DXM group; 29 into the placebo group. Bhutani VK, Stark AR, Lazzeroni LC, et al; Initial Clinical Testing Evaluation and Risk Assessment for Universal Screening for Hyperbilirubinemia Study Group. Guidelines from the Canadian Paediatric Society (2007) found that phenobarbitol, studied as a means of preventing severe hyperbilirubinemia in infants with G6PD deficiency, did not improve clinically important outcomes in a randomized controlled clinical study (Murki et al, 2005). Severe neonatal hyperbilirubinemia and UGT1A1 promoter polymorphism. The authors concluded that the use of antenatal phenobarbital to reduce neonatal jaundice in red cell isoimmunized pregnant women has not been evaluated in randomized controlled trials. On the pediatricians encounter, code P13.4 Fracture of clavicle due to birth injury because it involved medical decision-making. The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. color: red Reference No. Pediatrics. A total of 416 records were identified through database searching; 4 studies (3 randomized studies and 1 retrospective study) meet the final inclusion criteria. The longer the newborn has before an auditory function screening, the greater the chance of a successful screening. newborn, known as hyperbilirubenemia. No association was found between the UGT1A1*28 allele and extreme hyperbilirubinemia. Various trials in pregnant women who were not isoimmunized but had other risk factors for neonatal jaundice have shown a reduction in need for phototherapy and exchange transfusion by the use of antenatal phenobarbital. Am Fam Physician. The nurses role in caring for newborns and their caregivers. Philadelphia, PA: W.B. When the pediatrician spends additional time explaining the skin condition, and the findings affect the episode of care, it should be coded on professional encounters. Armanian AM, Jahanfar S, Feizi A, et al. Pace EJ, Brown CM, DeGeorge KC. A total of 3 small studies evaluating 154 infants were included in this review. The authors concluded that there is a compelling need for the long-term follow-up and reporting of late outcomes, especially neurological and developmental outcomes, among surviving infants who participated in all randomized trials of early postnatal corticosteroid treatment. Hyperbilirubinemia in the term newborn. 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. top: 0px; Digestive System Disorders. 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. These researchers stated that healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinemia. Aetna considers prebiotics / probiotics experimental and investigational for the treatment ofneonatal hyperbilirubinemia becausetheir effectiveness for this indication has not been established. Codes for initial care of the normal newborn include: After the newborn has been discharged to home, it is common practice to see the infant to assess for jaundice or any feeding problems. If the screening must be done during the well-baby check, possible CPT codes to collect the screening are: So why would you not use one of the codes from 99221-99223 for the first day? 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.