Severe hyperbilirubinemia was used as a surrogate for possible chronic bilirubin encephalopathy (CBE), because no studies directly evaluated the latter as an outcome. Natus Medical Inc. ETCOc - An indicator of elevated hemolysis in neonatal hyperbilirubinemia. This Clinical Policy Bulletin may be updated and therefore is subject to change. The code is valid for the year 2023 for the submission of HIPAA-covered transactions. } TcB measurements obtained on the forehead, sternum, abdomen and covered lower abdomen were statistically compared with the corresponding TSB. Weisiger RA. 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. Phototherapy in the home setting. RM Kliegman, BF Stanton, JW St. Geme, et al., eds. Atotal of 686 healthy newborns needing measurement of their bilirubin were enrolled over a 4-month period. 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. 2018;31(10):1311-1317. 2021;34(21):3580-3585. 2011;128(4):e1046-e1052. 66920 Removal of lens material; intracapsular. J Pediatr. 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. On the pediatricians encounter, code P13.4 Fracture of clavicle due to birth injury because it involved medical decision-making. The pediatrician will wait watchfully and check the clavicle until its healed. 6. Several risk factors for hyperbilirubinemia are known, but in a large number of patients, a causal factor is never established. More commonly seen in the documentation are: Without a diagnosis, abnormal results of routine screenings should not be coded unless the pediatrician states the abnormal results have implications for future healthcare. Jaundice in healthy term neonates: Do we need new action levels or new approaches? Infants had been treated with DXM (0.25 mg/kg twice-daily at postnatal day 1 and 2) or with placebo (normal saline). Chu L, Xue X, Qiao J. Efficacy of intermittent phototherapy versus continuous phototherapy for treatment of neonatal hyperbilirubinaemia: A systematic review and meta-analysis. list-style-type: lower-alpha; Comp arative Effectiveness of Fiberoptic Phototherapy for Hyperbilirubinemia in Term Infants. In preterm infants, phototherapy should be initiated at 50 to 70 % of the maximum indirect levels below: * Complications include but are not limited to prenatal asphyxia, acidosis, hypoxia, hypoalbuminemia, meningitis, intraventricular hemorrhage, hemolysis, hypoglycemia, or signs of kernicterus. Aetna considers management of physiologic hyperbilirubinemia medically necessary in preterm infants (defined as an infant born prior to 37 weeks gestation) according to guidelines published by the AAP. .strikeThrough { 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. American Academy of Pediatrics and American College of Obstetricians and Gynecologist. This study compared oral zinc with placebo. Utilization Mangement and Q uality Review Manual Nebraska M edicaid, 2014, Phototherapy equipment (471 N AC 18-004.45A) The extracted information of RCTs should include efficacy rate, serum total bilirubin level, time of jaundice fading, duration of phototherapy, duration of hospitalization, adverse reactions. 1991;91:483-489. 'New' bilirubin recommendations questioned. 1990;4(6):304-308. A condition does not need to be coded on the inpatient hospital encounter to be coded on the pediatricians hospital encounter. 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. Multiple treatments is coded 6A601ZZ Phototherapy of skin, multiple. 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. 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). width: 100%; 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. 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. text-decoration: underline; Aetna considersexchange transfusionmedically necessary forterm andnear-term infantsaccording to guidelines published by the American Academy of Pediatrics (AAP). Oral zinc for the prevention of hyperbilirubinaemia in neonates. Pediatrics. list-style-type: upper-roman; After maintenance phototherapy was discontinued, 7 patients (23% ) had a sustained disease-free interval lasting more than 58 months (median of greater than 90 months). Seidman DS, Stevenson DK, Ergaz Z, et al. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. 2002;3(1). UpToDate[online serial]. Sometimes, a parent declines prophylactic services such as the eye ointment and vaccinations. 2023 ICD-10-PCS Procedure Code 6A600ZZ Phototherapy of Skin, Single 2016 2017 2018 2019 2020 2021 2022 2023 Billable/Specific Code ICD-10-PCS 6A600ZZ is a specific/billable code that can be used to indicate a procedure. Furthermore, an UpToDate review on "Treatment of unconjugated hyperbilirubinemia in term and late preterm infants" (Wong and Bhutani, 2016) does not mention zinc supplementation as a management tool. 1993;32:264-267. Reference Number: CP.MP.150 Coding Implications Date of Last Revision: 10/22 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Gholitabar M, McGuire H, Rennie J, et al. 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. Sacral dimples without diagnostic services, such as diagnostic imaging, are not coded on inpatient records. But unless the breech presentation or other malpresentation caused a significant finding for the newborn, do not code it on the inpatient hospital record. Guidelines for Perinatal Care. Saunders Co.; 2000:513-519. 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). Do not percuss over the backbone, breastbone, or lower two ribs. list-style-type: upper-alpha; Probiotics supplementation therapy for pathological neonatal jaundice: A systematic review and meta-analysis. Total serum bilirubin concentrations peaked 30 hours earlier in the DXM group (p 0.05). Severe neonatal hyperbilirubinemia and UGT1A1 promoter polymorphism. Paediatrics Child Health. 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. 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. 2009;124(4):1172-1177. 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 In general, serum bilirubin levels . 2012;1:CD007966. None of the included studies reported any side effects. Ch. The dose of zinc varied from 5 to 20mg/day and duration from 5 to 7 days. Most of the included studies only mentioned the use of random allocation, but they did not describe the specific random allocation method. PLoS One. 2020;59(6):588-595. 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. Cochrane Database Syst Rev. The authors concluded that phototherapy significantly interfered with the accuracy of transcutaneous bilirubinometry; TcB measurements performed 2 hours after stopping phototherapy were not reliable, even if they were performed on the unexposed body area. 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. Clin Pediatr (Phila). Morris BH, Oh W, Tyson JE, et al; NICHD Neonatal Research Network. For more information about blocked lacrimal ducts, visit: aao.org/eye-health/diseases/treatment-blocked-tear-duct. Data sources included PubMed, Embase, Cochrane library, China National Knowledge Infrastructure, China Biology Medicine, VIP Database, and Wanfang Database. Understanding why a pediatrician documents a finding enables you to determine if it should be coded. 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. Gu J, Zhu Y, Zhao J. Cochrane Database Syst Rev. Pediatrics. The SLCO1B1 521 T>C mutation showed a low risk of neonatal hyperbilirubinemia in Chinese neonates, while no significant associations were found in Brazilian, white, Asian, Thai, and Malaysian neonates. } 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. Analysis of rebound and indications for discontinuing phototherapy. In a Cochrane review, Gholitabar et al (2012) examined the safety and effectiveness of clofibrate in combination with phototherapy versus phototherapy alone in unconjugated neonatal hyperbilirubinemia. 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. 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. The authors concluded that the role of zinc in the prevention of neonatal hyperbilirubinemia is not supported by the current evidence. A total of 9 RCTs (prophylactic: 6 trials, n=1,761; therapeutic: 3 trials, n=279) with low- to high-risk of bias were included. As a family physician, you may also address needs of the mother during a newborn's encounter (e.g., lactation problems). 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 Only 1 study met the criteria of inclusion in the review. J Matern Fetal Neonatal Med. 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. San Carlos, CA: Natus Medical Inc.; 2002. Hayes Directory. Santa Barbara, CA: Elsevier Saunders; 2011. 1994;61(5):424-428. Can Nurse. Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 . Both trials in preterm neonates and most of the trials in term neonates (5 trials) reported increased stool frequencies. Meta-analysis was performed using random- or fixed-effect models. Curr Opin Pediatr. 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. --> Two reviewers screened papers and extracted data from selected papers. The order of use of the instruments was randomized. Guidelines from the American Academy of Pediatrics (AAP, 2004)on management of hyperbilirubinemia in thenewborn infantstate that "Measurement of the glucose-6-phosphate dehydrogenase (G6PD) level is recommended for a jaundiced infant who is receiving phototherapy and whose family history or ethnic or geographic origin suggest the likelihood of G6PD deficiency or for an infant in whom the response to phototherapy is poor(evidence quality C: benefits exceed harms)". Policy Home phototherapy is considered reasonable and necessary for a full-term The UGT1A1*28 allele was assessed in a case-control study of 231 white infants who had extreme hyperbilirubinemia in Denmark from 2000 to 2007 and 432 white controls. Screening is usually done as close as possible to inpatient discharge for this reason. The USPSTF and the Agency for Healthcare Research and Quality (2009) reported on the effectiveness of various screening strategies for preventing the development of CBE. Newman TB, Maisels MJ. Published March 24, 2016 (updated June 1 2, 2018). 2019;32(1):154-163. Chen and co-workers (2017) stated that probiotics supplementation therapy could assist to improve the recovery of neonatal jaundice, through enhancing immunity mainly by regulating bacterial colonies. A total of 10 articles were included in the study. Philadelphia, PA: W.B. 1998;101(6):995-998. Evaluation and management (E/M) services provided to normal newborns in the first days of life prior to hospital discharge are reported with Newborn Care Services codes. 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. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis. If time is not significant, and it does not impact medical decision-making, it does not meet the definition of an additional professional encounter diagnosis. Although inflammation occurs less frequently now than in the past because the medication used has changed, it may occur. The literature search was done for various RCTs by searching the Cochrane Library, PubMed, and Embase. In: Nelson Textbook of Pediatrics. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. OL OL OL LI { Usually, clicking hips lead to no findings but are noted so other providers know there is not issue. Additionally, no serious adverse reaction was reported. J Fam Pract. Morris and colleagues (2008) compared aggressive versus conservative phototherapy for infants with extremely low birth weight. 2008;358(9):920-928. None of the studies reported on bilirubin encephalopathy rates, neonatal mortality rates, or the levels of parental or staff satisfactions with the interventions. Support teaching, research, and patient care. 2016;36(10):858-861. 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). Stevenson DK, Fanaroff AA, Maisels MJ, et al. For most newborns, the transition from fetal to newborn blood simply involves watchful waiting. Malpresentations are almost always noted on the inpatient record. 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). 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. The authors concluded that this meta-analysis showed that probiotics supplementation therapy was an effective and safe treatment for pathological neonatal jaundice. TcB measurements were inaccurate, regardless of phototherapy technique (Bilibed, conventional phototherapy). 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). However, the results remain controversial. Yang L, Wu, Wang B, et al. Mt Sinai J Med. If done right, you will hear a popping sound. 2019;55(9):1077-1083. [glucose-6-phosphate dehydrogenase (G6PD), uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1), and. These investigators reviewed the current literature to examine if home-based phototherapy is more effective than hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. Home Phototherapy for Neonatal Jaundice (07.06.02) COVERED: ACCORDING TO CERTAIN CRITERIA Phototherapy is often used to treat neonatal jaundice and involves the continuous application of ultraviolet light via a lamp or a beroptic system to a newborn for a prescribed period of time. The smallest but significant difference between TSB and TcB was found on the lower abdomen. Revision Log See Important Reminder . ICD-10 Restricts Same-day Sick and Well Visits. Diagnosis code Z00.121 (encounter for routine child health examination with abnormal findings) and the appropriate problem diagnosis would be used. Metalloporphyrins for treatment of unconjugated hyperbilirubinemia in neonates. Cochrane Database Syst Rev. 92586 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, limited Spontaneous descent after one year is uncommon. 2017;30(16):1953-1962. 2010;15(3):169-175. Both case and control subjects were full term newborns. 2008;359(18):1885-1896. Less than 30 minutes of hands-on care during transport would not be separately reported. Intensive phototherapy in form of double light is used worldwide in the treatment of severe neonatal hyperbilirubinemia. The fetal blood is designed to attract oxygen from the mothers blood. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. The ICD-10-PCS code for light treatment of the skin is 6A600ZZ Phototherapy of skin, single for a single treatment. 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. Swelling in such a hydrocele is uniform, over time, until the fluid is absorbed by the body. 96.4. If approved, tin-mesoporphyrin could find immediate application in preventing the need for exchange transfusion in infants who are not responding to phototherapy." The ointment is administered by the hospital staff, so there is no professional component to the service. Pediatrics. CETS 99-6 RE. Clofibrate in combination with phototherapy for neonatal hyperbilirubinemia is considered experimental and investigational. 2011;100(2):170-174. Tin-mesoporphyrin is not approved by the U.S. Food and Drug Administration. Lacrimal ducts are the drainage system for fluid that lubricates the eye. 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. 1992;89:827-828. Valaes T. Problems with prediction of neonatal hyperbilirubinemia. list-style-type: decimal; 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. Do not subtract direct (conjugated) bilirubin. Watchko and Lin (2010) noted that the potential for genetic variation to modulate neonatal hyperbilirubinemia risk is increasingly being recognized. Also, no association was found for AB0 incompatible cases. All but 1 of the included studies were conducted in Iran. 2001;108(1):175-177. Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. 2005;17(2):167-169. 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. Mothers typically are counseled on newborn jaundice signs and when to bring the newborn in. Prediction of hyperbilirubinemia in near-term and term infants. at the end of this policy for important regulatory and legal information. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. These investigators searched CENTRAL (The Cochrane Library 2014, Issue 1), MEDLINE (1966 to November 30, 2014), and EMBASE (1990 to November 30, 2014). For instance, abnormal findings on screenings for example, newborn hearing screening or lab screenings are not coded in the inpatient record, unless: Here are several watchful waiting findings to consider. (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.) All the studies used zinc sulfate, only 1 study used zinc gluconate. If this is your first visit, be sure to check out the. Liu J, Long J, Zhang S, et al. You must log in or register to reply here. Although generally seen as safe, there is rising concern regarding phototherapy and its potentially damaging effects on DNA and increased side effects particularly for pre-term infants. However, there was insufficient evidence to recommend their use because of inadequate data on safety and long-term outcomes. French S. Phototherapy in the home for jaundiced neonates. Exchange transfusion involves taking small aliquots of blood from the infant and replacing them with donor red cells until the infants blood volume has been replaced twice to remove bilirubin and antibodies that may be causing hemolysis. 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). Available at: http://www.natus.com/information/breath_analysis/. 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. 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. 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. 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. Do not report Q10.3 Q10.6 or any of the H04 Disorders of lacrimal system for immaturity of the lacrimal ducts. 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. J Perinatol. Stevenson DK, Fanaroff AA, Maisels MJ, et al. OL LI { An UpToDate review on "Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants" (Wong and Bhutani, 2015) does not mention genotyping of SLCO1B1 and UGT1A1 as management tools. } J Perinatol. 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. Wong RJ, Bhutani VK. Evans D. Neonatal jaundice. 2019;68(1):E4-E11. 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. The infant is otherwise ready to be discharged from the hospital; The infant is feeding well, is active, appears well; TSBis less than 20 to 22 mg/dL in term infants, or less than 18 mg/dL in preterm infants; Arrangements have been made to evaluate the infant within 48 hours after discharge by an early office/clinic visit to the pediatrician, or by a home visit by a well-trained home health care nurse who should be able to: Be available for follow-up clinical assessments and blood drawing as determined to be necessary by the responsible physician based on changes in bilirubin levels, Clinically assess the initial level of jaundice, Explain all aspects of the phototherapy system to the parents, Oversee set-up of the phototherapy system.
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