Phototherapy is the use of visible light to treat severe jaundice in the neonatal period. Subsequent days of critical care to the critically ill neonate are reported per day with code 99469. 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. 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). 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 The studies were included if they compared TcB results with TSB in term and near-term infants during phototherapy or after discontinuation of phototherapy. Can Nurse. De Luca D, Zecca E, Corsello M, et al. 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. Screening had good ability to detect hyperbilirubinemia: reported area-under-the-curve values ranged between 0.69 and 0.84, and reported sensitivities and specificities suggested similar diagnostic ability. 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. 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). There were no probiotic-related adverse effects. 96.4. J Matern Fetal Neonatal Med. 1998;101(6):995-998. Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. Also, no association was found for AB0 incompatible cases. 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. Clin Pediatr. Search All ICD-10 Toggle Dropdown. 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. An alternative to prolonged hospitalization of the full-term, well newborn. 2019;32(1):154-163. Newborn jaundice happens when the newborns liver and sunshine on the newborns skin dont remove the fetal blood components in an efficient manner. 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. Huang J, Zhao Q, Li J, et al. However, there is limited evidence regarding the effect of probiotics on bilirubin level in neonates. 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. Hyperbilirubinemia in the term newborn. Malpresentations are almost always noted on the inpatient record. 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. A total of 3 small studies evaluating 154 infants were included in this review. 2020;59(6):588-595. J Matern Fetal Neonatal Med. These investigators searched CENTRAL (The Cochrane Library 2014, Issue 1), MEDLINE (1966 to November 30, 2014), and EMBASE (1990 to November 30, 2014). Atotal of 686 healthy newborns needing measurement of their bilirubin were enrolled over a 4-month period. 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. FN07-02. The China National Knowledge Infrastructure and MEDLINE databases were searched. Aetna considers transcutaneous bilirubin devices for evaluating hyperbilirubinemia in term and near-term infants while undergoing phototherapy experimental and investigational becasue this approach is not reliable in infantsin this setting. } Conseil de valuation des Technologies de la Sant du Qubec (CETS). 16th ed. Some studies showed that unclear random allocation and allocation plan might exaggerate the hidden effect of up to 30 to 41 %. Aetna's policy on treatment of hyperbilirubinemia in infants is adapted from guidelines from the American Academy of Pediatrics. J Matern Fetal Neonatal Med. Metalloporphyrins for treatment of unconjugated hyperbilirubinemia in neonates. Sacral dimples without diagnostic services, such as diagnostic imaging, are not coded on inpatient records. When the depression is too shallow, the femoral head may move around in the depression and sometimes move out of the acetabulum. 2010;15(3):169-175. Do not subtract direct (conjugated) bilirubin. Home Phototherapy PICOS eligibility criteria were used to select original studies published from 1984 through 2019. Digestive System Disorders. These researchers evaluated the role of massage therapy for reduction of NNH in both term and preterm neonates. 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 therapy may be in the form of a lamp, light panel, or special light blanket. list-style-type: decimal; Put a thin layer of clothing, such a T- shirt, on your child's chest. 2021;34(21):3580-3585. Hayes Directory. Numerous skin findings may be noted, but are not coded in the inpatient record unless they are clinically significant. Cincinnati Childrens, umbilical hernia: www.cincinnatichildrens.org/health/u/umbilical-herni, Copyright 2023, AAPC The authors concluded that there are insufficient data from different countries on the use of clofibrate in combination with phototherapy for hyperbilirubinemia to make recommendations for practice. Aggressive vs. conservative phototherapy for infants with extremely low birth weight. tradicne jedla na vychodnom slovensku . It has been debated if there is an upper limit on the efficiency of phototherapy. Pediatrics. Do not code the condition as part of the newborn hospitalization unless it requires a consult, diagnostic or therapeutic services, prolonged length of stay, increased nursing services, or there is documentation by the provider for future healthcare needs. [Phototherapy of newborn infants] The effect of light treatment on neonates with jaundice was discovered in 1958. li.bullet { Most newborns have ointment administered at birth, or soon after the initial bonding with the mother. } Treatment effects on the following outcomes were determined: mean change in bilirubin levels, mean duration of treatment with phototherapy, number of exchange transfusions needed, adverse effects of clofibrate, bilirubin encephalopathy and neonatal mortality. None of the included studies reported any side effects. Cases were identified in the Danish Extreme Hyperbilirubinemia Database that covers the entire population. Per the ICD-10-PCS Official Guidelines for Coding and Reporting, only clinically significant conditions are reported. 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. Genotypes were obtained through the Danish Neonatal Screening Biobank. 2012;12:CD009017. NY State J Med. They stated that a Cochrane review of clofibrate (2012) and metalloporphyrins (2003) found that when added to phototherapy, these medications significantly decreased serum bilirubin levels and duration of phototherapy. Santa Barbara, CA: Elsevier Saunders; 2011. cursor: pointer; 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis. Evidence Centre Evidence Report. Severe hyperbilirubinemia was used as a surrogate for possible chronic bilirubin encephalopathy (CBE), because no studies directly evaluated the latter as an outcome. Risk of bias was assessed using the QUADAS-2 tool. The authors stated that this study had several drawbacks. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. Meta-analysis was performed using random- or fixed-effect models. 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). The pediatrician notes the abnormal results have implications for future healthcare. Inpatient treatment may be medically necessary for pre-term infants who present with a TSB greater than or equal to 18 mg/dL. 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. Cochrane Database Syst Rev. Now, newborns are checked with a transcutaneous bilirubinometer, and the pediatrician reviews standard laboratory blood screenings. Schuman AJ, Karush G. Fiberoptic vs conventional home phototherapy for neonatal hyperbilirubinemia. A total of 5 RCTs involving 645 patients were included in the meta-analysis. TcB measurements obtained on the forehead, sternum, abdomen and covered lower abdomen were statistically compared with the corresponding TSB. Jaundice in healthy term neonates: Do we need new action levels or new approaches? Pediatrics. 2006;(4):CD004592. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis. OL OL OL OL OL LI { These researchers stated that healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinemia. 2014;134(3):510-515. Pediatrics. 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. On the pediatricians encounter, code P13.4 Fracture of clavicle due to birth injury because it involved medical decision-making. 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. Cochrane Database Syst Rev. 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. These researchers used the standard methods of the Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. at the end of this policy for important regulatory and legal information. color: #FFF; 2008;359(18):1885-1896. In a Cochrane review, Mishra and colleagues (2015) examined the effect of oral zinc supplementation compared to placebo or no treatment on the incidence of hyperbilirubinaemia in neonates during the first week of life and to evaluate the safety of oral zinc in enrolled neonates. Chu L, Qiao J, Xu C, et al. Some watchful waiting conditions include: Some conditions happen more frequently in premature newborns such as cryptorchidism and umbilical hernias. 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. Toward understanding kernicterus: A challenge to improve the management of jaundiced newborns. 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. Most of the included studies only mentioned the use of random allocation, but they did not describe the specific random allocation method. CPT CODE 96910, 96912, 96920 CPT/HCPCS Codes: 96910 Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B . After the newborn begins to breath on his own, the fetal blood is destroyed and replaced with blood that works with lungs. 2005;25(5):325-330. solute carrier organic anion transporter polypeptide 1B1 (SLCO1B1)] may interact with each other and/or environmental contributors to produce significant hyperbilirubinemia. The total number of neonates enrolled in these different RCT were 749. Kernicterus in full-term infants--United States, 1994-1998. .headerBar { Toggle navigation. padding: 10px; Other methods, such as enteral feeding supplementation with prebiotics, may have an effective use in the management of hyperbilirubinemia in neonates. Inpatient coders do not code immature lacrimal ducts because the condition does not use additional resources. 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. They stated that TSB assessment remains necessary, if treatment of hyperbilirubinemia is being considered. Home phototherapy. Data selection and extraction were performed independently by 2 reviewers. First, because the value of jaundice fading in each guideline was different, the heterogeneity was high in time of jaundice fading. French S. Phototherapy in the home for jaundiced neonates. display: block; In utero, the fetus requires larger amounts of hemoglobin for oxygenation. Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. Otherwise, at 3 to 4 years of age, the hernia will be surgically repaired. No (TA)8 repeat was found in the 2 groups. Suresh GK, Martin CL, Soll RF. J Matern Fetal Neonatal Med. 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. 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 Home-based phototherapy versus hospital-based phototherapy for treatment of neonatal hyperbilirubinemia: A systematic review and meta-analysis. UGT1A1 is the rate-limiting enzyme in bilirubin's metabolism.
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