Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. There is insufficient evidence to support the use of metalloporphyrins (e.g., stannsoporfin (tin mesoporphyrin), Stanate, WellSpring Pharmaceutical Corporation, Neptune, NJ) for the treatment of neonatal jaundice. 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. Casnocha Lucanova L, Matasova K, Zibolen M, Krcho P. Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy. Home Phototherapy Clicking hips may develop into dysplasia of the hip. Resources Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24-months of age or less, are reported based on the time of face-to-face care beginning when the physician assumes primary responsibility at the referring hospital/facility and ending when the receiving hospital/facility accepts responsibility for the patient's care. Long-term follow-up studies reported an increased risk of abnormal neurological examination and cerebral palsy. Jaundice in healthy term neonates: Do we need new action levels or new approaches? If separately documented in the mother's chart, you may report these services in addition to the services provided to the infant. Hayes Directory. In most of the trials, Field massage was given; 6 out of 8 trials reported reduction in bilirubin levels in term neonates. Lacrimal ducts are the drainage system for fluid that lubricates the eye. The USPSTF reviewed experimental and observational studies that included comparison groups. The presumed mechanism of effect is photo-excitation of bilirubin extravascularly in the skin with the formation of bilirubin isomers which can be e Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. Sacral dimples without diagnostic services, such as diagnostic imaging, are not coded on inpatient records. The ball at the proximal end of the femur is supposed to fit snuggly into the acetabulum (the cup-shaped depression in the pelvis). London, UK: BMJ Publishing Group;November 2006. New perspectives on neonatal hyperbilirubinemia. 2011;12:CD007969. /*margin-bottom: 43px;*/ 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. For most newborns, the transition from fetal to newborn blood simply involves watchful waiting. 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. list-style-type: decimal; J Pediatr. Privacy Policy | Terms & Conditions | Contact Us. Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. 2019;68(1):E4-E11. These investigators conducted a systematic review and meta-analysis to examine the safety and efficacy of zinc sulfate on hyperbilirubinemia among neonates. Evans D. Neonatal jaundice. J Matern Fetal Neonatal Med. Data were extracted and analyzed independently by 2 review authors (MG and HM). Attempt to improve transcutaneous bilirubinometry: A double-blind study of Medick BiliMed versus Respironics BiliCheck. These investigators assessed the safety and efficacy of probiotics in reducing the need for phototherapy and its duration in NNH. Total serum bilirubin concentrations peaked 30 hours earlier in the DXM group (p 0.05). Hyperbilirubinemia in the term newborn. Sometimes, a parent declines prophylactic services such as the eye ointment and vaccinations. Aetna considersexchange transfusionmedically necessary forterm andnear-term infantsaccording to guidelines published by the American Academy of Pediatrics (AAP). The influence of zinc sulfate on neonatal jaundice: A systematic review and meta-analysis. 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. 99462 3. Am Fam Physician. This reduction may be offset by an increase in mortality among infants weighing 501 to 750 g at birth. OL LI { 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. Studies were analyzed for methodological quality in a "Risk of bias" table. Care of newborns who are not normal but do not require intensive services may be reported with codes for initial hospital care (99221-99223). 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. OL OL OL OL OL LI { Copyright Aetna Inc. All rights reserved. You are using an out of date browser. 1994;94(4 Pt 1):558-565 (reviewed 2000). Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia. 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. } Medline, Embase, Cochrane Library, CINAHL and Scopus databases (from inception to May 8, 2014) were searched. Petersen JP, Henriksen TB, Hollegaard MV, et al. Search All ICD-10; ICD-10-CM Diagnosis Codes; ICD-10-PCS Procedure Codes JavaScript is disabled. 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 %). As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. Also, no association was found for AB0 incompatible cases. Testicles develop in the abdomen. 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). So why would you not use one of the codes from 99221-99223 for the first day? 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. Analysis was performed on an intention-to-treat basis. } 1993;32:264-267. Utilization Mangement and Q uality Review Manual Nebraska M edicaid, 2014, Phototherapy equipment (471 N AC 18-004.45A) Data sources included PubMed, Embase, Cochrane library, China National Knowledge Infrastructure, China Biology Medicine, VIP Database, and Wanfang Database. Usually, hip clicks involve watchful waiting, with the tendons and muscles continuing to develop until the click is no longer felt. Intensive phototherapy in form of double light is used worldwide in the treatment of severe neonatal hyperbilirubinemia. 19th ed. 2007;(2):CD005541. 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. The therapy may be in the form of a lamp, light panel, or special light blanket. Genotypes were obtained through the Danish Neonatal Screening Biobank. Numerous skin findings may be noted, but are not coded in the inpatient record unless they are clinically significant. Conseil de valuation des Technologies de la Sant du Qubec (CETS). J Paediatr Child Health. The China National Knowledge Infrastructure and MEDLINE databases were searched. Philadelphia, PA: W.B. In general, serum bilirubin levels . @media print { Subgroup analysis was done for AB0 incompatible cases. Clinical Information. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Copyright 2023 American Academy of Family Physicians. 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). Lets review which conditions should be reported and when. Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. On the pediatricians encounter, code P13.4 Fracture of clavicle due to birth injury because it involved medical decision-making. The beroptic system consists of a pad of The authors concluded that the role of zinc in the prevention of neonatal hyperbilirubinemia is not supported by the current evidence. The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia: A meta-analysis of randomized controlled studies. 2021;34(21):3580-3585. Available at: http://www.emedicine.com/med/topic1065.htm. In particular, polymorphisms across 3 genes involved in bilirubin production and metabolism: Variant gene co-expression including compound and synergistic heterozygosity enhances hyperbilirubinemia risk, contributing to the etiologic heterogeneity and complex nature of neonatal jaundice. 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. Clinical Policy: Phototherapy for Neonatal Hyperbilirubinemia Reference Number: CP.MP.150 Coding Implications . J Fam Pract. 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. 2015;7:CD008432. J Pediatr Health Care. Neonatal hyperbilirubinemia: An evidence-based approach. Do not subtract direct (conjugated) bilirubin. A total of 10 articles were included in the study. [Phototherapy of newborn infants] The effect of light treatment on neonates with jaundice was discovered in 1958. A total of 14 studies were identified. Last Review Data were statistically extracted and evaluated by RevMan 5.3 software. 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. But unless the breech presentation or other malpresentation caused a significant finding for the newborn, do not code it on the inpatient hospital record. Do not use S42.0- Fracture of clavicle for the initial encounter or subsequent professional encounters. Published March 24, 2016 (updated June 1 2, 2018). Typically, no extra resources are required during the newborn hospitalization, so do not code the condition. Cryptorchidism However, there was insufficient evidence to recommend their use because of inadequate data on safety and long-term outcomes. Transcutaneous bilirubinometry in the context of early postnatal discharge. Atotal of 686 healthy newborns needing measurement of their bilirubin were enrolled over a 4-month period. None of the studies reported on bilirubin encephalopathy rates, neonatal mortality rates, or the levels of parental or staff satisfactions with the interventions. 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). Second, according to Cochrane risk of bias estimation, randomized allocation of participants was mentioned in 9 trials. Maisels MJ, Watchko JF. The pediatrician will spend time evaluating the condition, and at some point, a code in the Q53 Undescended and ectopic testicle range will be used. Travan et al (2014) examined if UGT1A1 promoter polymorphisms associated with Gilbert Syndrome (GS) occur with a greater frequency in neonates with severe hyperbilirubinemia. 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 Approximately one in 1,000 children have congenital developmental dysplasia of the hip, which is coded Q65.89 Other specified congenital deformities of hip. Our providers amend their office note to indicate the patient was admitted due to results then charge an Initial Outpatient Care code (99218-99220) for the day of admission and then 99217 for discharge. color: red!important; Sharma D, Farahbakhsh N, Sharma P, Shastri S. Role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia: A systematic review of current evidence. The ICD-10-PCS code for light treatment of the skin is 6A600ZZ Phototherapy of skin, single for a single treatment. 2005;17(2):167-169. The condition affects 3 percent of term male infants, and 1 percent of male infants at one year. 2010;47(5):401-407. Sharma and colleagues (2017) examined the role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia in term and preterm infants. Morris and colleagues (2008) compared aggressive versus conservative phototherapy for infants with extremely low birth weight. A condition does not need to be coded on the inpatient hospital encounter to be coded on the pediatricians hospital encounter. In that case, other conditions can be coded if they were involved in medical decision-making, or otherwise affected the episode of care. Pediatrics. Tin-mesoporphyrin is not approved by the U.S. Food and Drug Administration. The order of use of the instruments was randomized. Thomas JT, Muller P, Wilkinson C. Antenatal phenobarbital for reducing neonatal jaundice after red cell isoimmunization. 2012;1:CD007966. Garg and colleagues (2017) stated that neonatal hyperbilirubinemia (NNH) is one of the leading causes of admissions in nursery throughout the world. Procedures included in the services represented by code 99477 include those listed for the Critical Care Services subsection of CPT (codes 99291 and 99292), as well as additional procedures listed in the Inpatient Neonatal and Pediatric Critical Care subsection (codes 99468-99476, 99466-99467). They stated that there is a need for larger trials to determine how effective clofibrate is in reducing the need for, and duration of, phototherapy in term and preterm infants with hyperbilirubinemia. For well infants 35 - 37 6/7 wk, can adjust TSB levels for intervention around the medium risk line. Evidence Centre Evidence Report. Aetna considers zinc supplementation for the prevention of hyperbilirubinaemia experimental and investigational because its effectiveness has not been established. 16th ed. Overall, compared with placebo, zinc sulfate supplementation failed to significantly reduce TSB on 3 days (MD=0.09mg/dL; 95 % CI:-0.49 to 0.67; p=0.77), TSB on 7 days (MD=-0.37mg/dL; 95 % CI:-98 to 0.25; p=0.25) as well as the incidence of hyperbilirubinemia (OR=1.14; 95 % CI:0.74 to 1.76; p=0.56). Two reviewers independently assessed studies for inclusion, and discrepancies were resolved with consensus. 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. 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. 2001;21(Suppl 1):S63-S87. cpt code for phototherapy of newborn TcB should not be used in patients undergoing phototherapy.". Evidence Report/Technology Assessment No. Phototherapy to prevent severe neonatal hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. With the sleeve pinned to the t-shirt, the newborn has restricted arm movement, and the clavicle heals without intervention. background: #5e9732; Pediatrics. The nurses role in caring for newborns and their caregivers. 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. The single nucleotide polymorphisms (SNPs) of G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512 loci were examined by the polymerase chain reaction (PCR) and Sanger sequencing technique in the peripheral blood of all subjects. 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. Clin Pediatr (Phila). Wong RJ, Bhutani VK. Treating providers are solely responsible for medical advice and treatment of members. Multiple treatments is coded 6A601ZZ Phototherapy of skin, multiple. 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. Sometimes, a newborns clavicle is fractured during a vaginal delivery. Spontaneous descent after one year is uncommon. 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. If the lining still has an opening into the abdomen, the fluid can move in and out of the lining surrounding the testicle. The authors concluded that limited low-quality evidence indicated that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. Assign codes for conditions that have been specified by the provider as having implications for future healthcare needs. Aetna considers measurement of end-tidal carbon monoxide (CO) corrected for ambient CO (ETCOc), used either alone or in combination with the simultaneous measurement of total serum bilirubin (TSB) concentration, experimental and investigational because measurement of ETCOc has not been proven to improve prediction of development of significant neonatal bilirubinemia over TSB alone. These researchers used the standard methods of the Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. These usually heal and resolve on their own. Pediatrics. Aetna considers massage therapy experimental and investigational for the treatment ofneonatal hyperbilirubinemia because its effectiveness has not been established. American Academy of Pediatrics, Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia. Okwundu CI, Okoromah CA, Shah PS. } Use a cupped hand or percussor cup. J Pediatr Gastroenterol Nutr. Schuman AJ, Karush G. Fiberoptic vs conventional home phototherapy for neonatal hyperbilirubinemia. 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). Li Y, Wu T, Chen L, Zhu Y. Subsequent days of critical care to the critically ill neonate are reported per day with code 99469. E0202 is the HCPC for phototherapy that would normally be billed by the hospital/dme provider. Approximately 2 ml of peripheral venous blood was taken from all subjects. Normal Newborn visit, day 2 3. One study evaluated the role of zinc in very low birth-weight (VLBW) infants and remaining enrolled neonates greater than or equal to 35 weeks of gestation. Garg BD, Kabra NS, Balasubramanian H. Role of massage therapy on reduction of neonatal hyperbilirubinemia in term and preterm neonates: A review of clinical trials. Guidelines from the AAP stated: "There is now evidence that hyperbilirubinemia can be effectively prevented or treated with tin-mesoporphyrin, a drug that inhibits the production of heme oxygenase. Pediatrics. Pediatrics. Expect to see this monitored; usually there is a consult/referral around six months of age for newborns with undescended testicle(s). For these hydroceles, the swelling will become greater and decrease. .newText { Nelson Textbook of Pediatrics. 202;11(1):e040182. ICD-10 Restricts Same-day Sick and Well Visits. Stigma (plural stigmata) is a finding that may indicate an abnormal condition, such as a sacral dimple without a visible floor being stigma for occult spina bifida. 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. 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. 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. The USPSTF concluded that the evidence is insufficient to assess the balance of benefits and harms of screening for hyperbilirubinemia to prevent CBE. Aetna considers the use of metalloporphyrins (e.g., stannsoporfin (tin mesoporphyrin), Stanate, WellSpring Pharmaceutical Corporation, Neptune, NJ) for the treatment of neonatal jaundice experimental and investigational because their safety and effectiveness for this indication has not been established. list-style-type: lower-roman; Code 99391 may be reported with diagnosis code Z00.129 (encounter for routine child health examination without abnormal findings) for this service. } J Pediatr (Rio J). All the studies used zinc sulfate, only 1 study used zinc gluconate. 2017:1-10. 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. } Meta-analysis was performed using random- or fixed-effect models. 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. Poland RL. 2016;36(10):858-861. The authors concluded that despite the potential practical advantages of BiliMed, its reduced diagnostic accuracy in comparison with BiliCheck does not justify its use in clinical practice. 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. 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. ol.numberedList LI { OL OL OL LI { Savinetti-Rose B, Kempfer-Kline RE, Mabry CM. Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. Brown AK, Seidman DS, Stevenson DK. Newborn jaundice happens when the newborns liver and sunshine on the newborns skin dont remove the fetal blood components in an efficient manner. Morris BH, Oh W, Tyson JE, et al; NICHD Neonatal Research Network. Moreover, individuals carrying the A-allele of G6PD 1388 G>A and BLVRA rs699512 had a significantly increased risk of developing neonatal hyperbilirubinemia (OR=5.01, p< 0.001, 95 % CI: 3.42 to 7.85). Exploring the genetic architecture of neonatal hyperbilirubinemia. Moreover, these investigators stated that infants with bilirubin levels greater than 25 mg/dL, those who are not responding to phototherapy, and those with evidence of acute bilirubin encephalopathy should be treated with exchange transfusion, with initiation based on an infants age in hours and neurotoxicity risk factors. 1992;31(6):345-352. Thayyil S, Milligan DW. Serum and transcutaneous bilirubin (TcB) measurements were taken with both devices within 15 mins. San Carlos, CA: Natus Medical Inc.; 2002. 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. Additionally, no serious adverse reaction was reported. } Accessed January 30, 2019 . The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for reporting methods and results of synthesis with meta-analysis. The authors concluded that effects of screening on the rates of bilirubin encephalopathy are unknown. 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].