Johnson LH. Data selection and extraction were performed independently by 2 reviewers. Copyright 2023 American Academy of Family Physicians. All studies were found to be of low-risk based on Cochrane Collaborative Risk of Bias Tool. list-style-type: upper-alpha; 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. Gartner LM, Gartner LM,. Prediction of hyperbilirubinemia in near-term and term infants. 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. @media print { 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. Typically, no extra resources are required during the newborn hospitalization, so do not code the condition. These investigators included trials where neonates with hyperbilirubinemia received either clofibrate in combination with phototherapy or phototherapy alone or placebo in combination with phototherapy. No statistical difference in the prevalence of UGTA1A1 gene variants was found between cases and controls (p = 1). Saunders Co.; 2000:513-519. 2023 ICD-10-PCS Procedure Code 6A600ZZ: Phototherapy of Skin, Single Cochrane Database Syst Rev. Guidelines for Perinatal Care. Stevenson DK, Fanaroff AA, Maisels MJ, et al. Immaturity is not congenital absence, agenesis, stenosis, stricture, or malformation. 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. color: red!important; Clicking hips may develop into dysplasia of the hip. 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. 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 Infants had been treated with DXM (0.25 mg/kg twice-daily at postnatal day 1 and 2) or with placebo (normal saline). Stevenson DK, Fanaroff AA, Maisels MJ, et al. The linear regression analysis showed a better correlation between BiliCheck and serum bilirubin (r = 0.75) than between BiliMed and serum bilirubin (r = 0.45). The authors concluded that the role of massage therapy in the management of NNH was supported by the current evidence. 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. These include vascular access procedures, airway and ventilation management services, oral or nasogastric tube placement, bladder aspiration or catheterization, and lumbar puncture among others. list-style-type: upper-roman; Home-based phototherapy versus hospital-based phototherapy for treatment of neonatal hyperbilirubinemia: A systematic review and meta-analysis. Phototherapy in the home setting. The genotype of Gilbert syndrome, the UGT1A1*28 allele, causes markedly reduced activity of this enzyme, but its association with neonatal hyperbilirubinemia is uncertain and its relationship with extreme hyperbilirubinemia has not been studied. To determine if the administration of the anti-infective (e.g., erythromycin) externally to the eye (3E0CX2 Introduction of oxazolidinones into eye, external approach) is coded, check if your hospital has a policy on inpatient procedure collection. 1986;25(6):291-294. TcB measurements obtained on the forehead, sternum, abdomen and covered lower abdomen were statistically compared with the corresponding TSB. Screening is usually done as close as possible to inpatient discharge for this reason. Discharge normal newborn day 3 _____ 2. 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. 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. Sharma D, Farahbakhsh N, Sharma P, Shastri S. Role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia: A systematic review of current evidence. } All that is needed is watchful waiting. The total number of neonates enrolled in these different RCT were 749. Lets review which conditions should be reported and when. Arch Dis Child Fetal Neonatal Ed. Cochrane Database Syst Rev. 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. display: block; J Pediatr. Hulzebos CV, Bos AF, Anttila E, et al. 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. A total of 25 infants had been randomized into the DXM group; 29 into the placebo group. Phototherapy was well-tolerated without evidence of significant photo-damage or photo-carcinogenicity. Both case and control subjects were full term newborns. The fetal blood is designed to attract oxygen from the mothers blood. 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). Single versus double volume exchange transfusion in jaundiced newborn infants. Description 16th ed. Sometimes issues heal without interventions, such as minor hematomas from the birth process and laceration from the fetal monitoring electrode. 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]. 2007;12(5):1B-12B. Mishra S, Cheema A, Agarwal R, et al. This is caused by a small opening in the abdominal muscles that abdominal contents (e.g., fluid, abdominal lining) spill through. 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. } 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. 1992;89:822-823. If the lining still has an opening into the abdomen, the fluid can move in and out of the lining surrounding the testicle. 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. These researchers stated that healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinemia. 1990;10(4):435-438. [Phototherapy of newborn infants] - PubMed padding: 10px; 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. Severe neonatal hyperbilirubinemia and UGT1A1 promoter polymorphism. 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. Wennberg RP, Ahlfors CE, Bhutani VK, et al. 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. Clin Pediatr. Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. These investigatorscalculated the sensitivity and specificity of early TSB, TcB measurements, or risk scores in detecting hyperbilirubinemia. Management of neonatal hyperbilirubinemia. 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. Newman TB, Maisels MJ. Li Y, Wu T, Chen L, Zhu Y. 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. 2017:1-10. Only 1 study was able to show reduction in the mean TSB level and requirement of phototherapy with zinc, and the remaining studies did not report any positive effect. Aetna considers genotyping of BLVRA, SLCO1B1 and UGT1A1 experimental and investigational for assessing risk of neonatal hyperbilirubinemia because the clinical value of this approach has not been established. Data were extracted and analyzed independently by 2 review authors (MG and HM). Pediatrics. 2014;165(1):42-45. Metalloporphyrins in the management of neonatal hyperbilirubinemia. With the sleeve pinned to the t-shirt, the newborn has restricted arm movement, and the clavicle heals without intervention. If done right, you will hear a popping sound. 2012;12:CD009017. Everything I am finding indicates this code is used for dermatological treatment not for jaundice. phototherapy in the home, applied by a . herman's coleslaw recipe. When the depression is too shallow, the femoral head may move around in the depression and sometimes move out of the acetabulum. In utero, the fetus requires larger amounts of hemoglobin for oxygenation. So, it was hard for these investigators to determine whether the allocation scheme was appropriate and whether blinding of participants and personnel was implemented. Some watchful waiting conditions include: Some conditions happen more frequently in premature newborns such as cryptorchidism and umbilical hernias. These researchers stated that additional large, well-designed RCTs are needed in neonates that compare effects of enteral supplementation with prebiotics on neonatal hyperbilirubinemia with supplementation of milk with any other placebo (particularly distilled water) or no supplementation. Do not confuse light treatment with ultraviolet light therapy, which is usually used for skin conditions such as psoriasis. Chu L, Xue X, Qiao J. Efficacy of intermittent phototherapy versus continuous phototherapy for treatment of neonatal hyperbilirubinaemia: A systematic review and meta-analysis. Although an undescended testicle usually is described as palpable or impalpable, also get the location, if you can. Aetna's policy on treatment of hyperbilirubinemia in infants is adapted from guidelines from the American Academy of Pediatrics. Acta Paediatr. 6A650ZZ - Phototherapy, Circulatory, Single - ICD List 2023 Poland RL. In some cases, phototherapy will only be needed for 24 hours or less, in some cases, it may be required for 5 to 7 days. Pediatrics. This code may be reported only once per day and by only one physician. 2004;114(1):297-316. Trikalinos TA, Chung M, Lau J, Ip S. Systematic review of screening for bilirubin encephalopathy in neonates. 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. Mehrad-Majd H, Haerian MS, Akhtari J, et al. 2019;68(1):E4-E11. 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis. This document addresses the use of home phototherapy and the devices used for the treatment of neonatal jaundice that is physiologic (that is, non-pathologic) in nature. Understanding why a pediatrician documents a finding enables you to determine if it should be coded. 2019;55(9):1077-1083. Secondary outcomes included incidence of jaundice, TSB level at 24, 48, 72, 96hours, and day 7, duration of hospital stay, and adverse effects (e.g., probiotic sepsis). Available at: http://www.emedicine.com/med/topic1065.htm. 7. CPT Code for Cataract Removal without Implant 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. 1992;89:821-822. Analysis was performed on an intention-to-treat basis. Chu and colleagues (2020) stated that phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: US Preventive Services Task Force recommendation statement. The increased bilirubin from hemolysis often needs phototherapy, exchange transfusion or both after birth. Oral zinc was administered in a dose of 5 ml twice-daily from day 2 to day 7 post-partum. 2003;88(6):F459-F463. 1994;94(4 Pt 1):558-565 (reviewed 2000). When the newborn jaundice requires additional resources, the correct diagnosis is usually found under P58 Neonatal jaundice due to other excessive hemolysis or P59 Neonatal jaundice from other and unspecified causes codes. Support teaching, research, and patient care. #closethis { 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. 2003;(1):CD004207. The nurses role in caring for newborns and their caregivers. 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. Do I Use 25 or 59 for Same-day Assessment and E/M? PDF Clinical Policy: Phototherapy for Neonatal Hyperbilirubinemia Petersen JP, Henriksen TB, Hollegaard MV, et al. 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. li.bullet { tradicne jedla na vychodnom slovensku . These investigators also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for RCTs and quasi-randomized trials. Porter ML, Dennis BL. FN07-02. color: #FFF; Cochrane Database Syst Rev. The impact of SLCO1B1 genetic polymorphisms on neonatal hyperbilirubinemia: A systematic review with meta-analysis. There are implications for future healthcare needs (e.g., having a specialty consult ordered prior to discharge). There was a significantly lower duration of phototherapy in the clofibrate group compared to the control group for both preterm and term neonates with a weighted mean difference of -23.82 hours (95 % CI: -30.46 hours to -17.18 hours) and -25.40 hours (95 % CI: -28.94 hours to -21.86 hours), respectively. 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. Otherwise, at 3 to 4 years of age, the hernia will be surgically repaired. Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. Toggle navigation. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. 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. 2001;108(1):175-177. With time, the lacrimal ducts mature and the membrane covering the nasolacrimal ducts open. Utilization Mangement and Q uality Review Manual Nebraska M edicaid, 2014, Phototherapy equipment (471 N AC 18-004.45A) Pediatrics. According to available guidelines, no further measurement of bilirubin is necessary in most cases. Paediatrics Child Health. For a better experience, please enable JavaScript in your browser before proceeding. 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. Data were statistically extracted and evaluated by RevMan 5.3 software. Ambalavanan N, Carlo WA. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks gestation). However, the accuracy of TcB devices in infants exposed to phototherapy is unclear. However, the methodological quality of the studies determining long-term outcomes is limited in some cases; the surviving children have been assessed predominantly before school age, and no study has been sufficiently powered to detect important adverse long-term neurosensory outcomes. The beroptic system consists of a pad of Waltham, MA: UpToDate;reviewed January 2016. None of the included studies reported any side effects. Pediatrics. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis. 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.