It affects approximately 2.4 to 15 % of neonates during the first 2 weeks of life. 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. Clin Pediatr. This is usually associated with one of the codes from Q65 Congenital deformities of the hip. Cochrane Database Syst Rev. When no additional resources are used, this is not coded on the inpatient record, and is part of the pediatricians well-baby check. J Matern Fetal Neonatal Med. cpt code for phototherapy of newbornhippo attacks human video. 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. Pediatrics. They used a fixed-effect method in combining the effects of studies that were sufficiently similar; and then used the GRADE approach to assess the quality of the evidence. The following are general age-in-hours specifictotal serum bilirubin (TSB)threshold values for phototherapy based upon gestational age and the presence or absence of risk factors (isoimmune hemolytic disease, glucose-6-phosphate dehydrogenase [G6PD] deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis, or albumin of less than 3.0 g/dL [if measured]): Footnotes* Low Risk: 38 weeks gestation and without risk factors; Medium Risk: 38 weeks gestation with risk factors or 35 to 37 6/7 weeks gestation without risk factors; High Risk: 35 to 37 6/7 weeks gestation with risk factors. Curr Opin Pediatr. .strikeThrough { 16th ed. 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. Zhang M , Tang J, He Y, et al. MMWR Morb Mortal Wkly Rep. 2001;50(23):491-494. No significant difference in mortality during hospital stay after enteral supplementation with prebiotics was reported (typical RR 0.94, 95 % CI: 0.14 to 6.19; I = 6 %, p = 0.95; 2 studies; 78 infants; low-quality evidence). 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. list-style-type: lower-alpha; Data were statistically extracted and evaluated by RevMan 5.3 software. 2005;17(2):167-169. 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. 202;11(1):e040182. PDF Pediatric Coding - AAPC Analysis of rebound and indications for discontinuing phototherapy. list-style-type: upper-roman; Oral zinc for the prevention of hyperbilirubinaemia in neonates. Sharma D, Farahbakhsh N, Sharma P, Shastri S. Role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia: A systematic review of current evidence. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. J Matern Fetal Neonatal Med. 2001;108:31-39. J Perinatol. cpt code for phototherapy of newborn Elk Grove Village, IL: AAP; 1997. Aetna considers measurement of glucose-6-phosphate dehydrogenase (G6PD) levelsmedically necessary for jaundiced infants who are receiving phototherapy, where response to phototherapy is poor, or where the infant is at an increased risk of G6PD deficiency due to family history, ethnic or geographic origin. PICOS eligibility criteria were used to select original studies published from 1984 through 2019. Do not percuss over the backbone, breastbone, or lower two ribs. The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis. The fetal blood is designed to attract oxygen from the mothers blood. For the term neonates, there were significantly lower bilirubin levels in the clofibrate group compared to the control group after both 24 and 48 hours of treatment with a weighted mean difference of -2.14 mg/dL (95 % CI: -2.53 mg/dL to -1.75 mg/dL) (-37 mol/L; 95 % CI: -43 mol/L to -30 mol/L] and -1.82 mg/dL (95 % CI: -2.25 mg/dL to -1.38 mg/dL) (-31 mol/L; 95 % CI: -38 mol/L to -24 mol/L), respectively. TcB should not be used in patients undergoing phototherapy.". J Matern Fetal Neonatal Med. Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. There is no CPT code because these hospital screenings are usually done by hospital staff who are trained by an audiologist. Effects of Gly71Arg mutation in UGT1A1 gene on neonatal hyperbilirubinemia: A systematic review and meta-analysis. 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. Only 1 study met the criteria of inclusion in the review. Single versus double volume exchange transfusion in jaundiced newborn infants. 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. Liu J, Long J, Zhang S, et al. 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. These researchers used the standard methods of the Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. cpt code for phototherapy of newborn - malaikamediatv.com 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. Use a cupped hand or percussor cup. Cincinnati Childrens, umbilical hernia: www.cincinnatichildrens.org/health/u/umbilical-herni, Copyright 2023, AAPC Because this is a normal condition, there is no code for it. .newText { Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. J Matern Fetal Neonatal Med. Aetna's policy on treatment of hyperbilirubinemia in infants is adapted from guidelines from the American Academy of Pediatrics. 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. A fetus blood is different than an adults. CG-DME-12 Home Phototherapy Devices for Neonatal Hyperbilirubinemia } FAQs About Phototherapy | Newborn Nursery | Stanford Medicine 2008;358(9):920-928. No statistical difference in the prevalence of UGTA1A1 gene variants was found between cases and controls (p = 1). Place the thermometer in your newborn's armpit while the phototherapy lights are on. 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 ointment is administered by the hospital staff, so there is no professional component to the service. The smallest but significant difference between TSB and TcB was found on the lower abdomen. Inpatient treatment is generally not medically necessary for healthy full-term infants with aTSB less than 20 mg/dL, as these infants can usually be treated with expectant observation or home phototherapy. 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). Cochrane Database Syst Rev. 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. Compared with hospital-based phototherapy, home-based phototherapy appeared more effective for the treatment of neonatal hyperbilirubinemia in reducing the rate of total serum bilirubin (standard mean difference [SMD] = 0.32, 95 % CI: -0.22 to 0.86, p = 0.04); however, there was no signicant difference in duration of phototherapy (SMD = 0.59, 95 % CI: 0.28 to 0.90, p = 0.06) in the 2 groups. eMedicine J. Randomized controlled trials were eligible for inclusion if they enrolled neonates (term and pre-term) to whom oral zinc, in a dose of 10 to 20 mg/day, was initiated within the first 96 hours of life, for any duration until day 7, compared with no treatment or placebo. 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. This is not the same as for professional services coding, where the first-listed diagnosis is the reason for the encounter. Watchful Waiting: Collecting Newborn Information Johnson LH. .headerBar { Chen Z, Zhang L, Zeng L, et al. This is caused by a small opening in the abdominal muscles that abdominal contents (e.g., fluid, abdominal lining) spill through. 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. Nelson Textbook of Pediatrics. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. cpt code for phototherapy of newborn - mycyberplug.com } Subgroup analysis was done for AB0 incompatible cases. Wennberg RP. 2008;359(18):1885-1896. The order of use of the instruments was randomized. newborn, known as hyperbilirubenemia. 2001;21(Suppl 1):S63-S87. 2011;100(2):170-174. No (TA)8 repeat was found in the 2 groups. Cochrane Database Syst Rev. Approximately one in 1,000 children have congenital developmental dysplasia of the hip, which is coded Q65.89 Other specified congenital deformities of hip. Toward understanding kernicterus: A challenge to improve the management of jaundiced newborns. Yang L, Wu, Wang B, et al. OL OL LI { Although an undescended testicle usually is described as palpable or impalpable, also get the location, if you can. It is an option to provide conventional phototherapy in hospital or at home at TSB levels 2 - 3 mg/dL below those shown, but home phototherapy should not be used in any infant with risk factors. Per the ICD-10-PCS Official Guidelines for Coding and Reporting, only clinically significant conditions are reported. However, the results remain controversial. Therefore, well-designed, large randomized, double blind, placebo-controlled trials would be needed to further confirm the efficacy of probiotics. Codes for circumcision procedures include: When providing E/M services to other than normal newborns, choose the level of care based on the intensity of the service and status of the newborn. N Engl J Med. 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. 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. The Cochrane tool was applied to assessing the risk of bias of the trials. According to available guidelines, no further measurement of bilirubin is necessary in most cases. Dennery PA. Metalloporphyrins for the treatment of neonatal jaundice. Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: US Preventive Services Task Force recommendation statement. 2019;32(1):154-163. Treating providers are solely responsible for medical advice and treatment of members. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. Phototherapy in the home setting. Sharma and colleagues (2017) examined the role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia in term and preterm infants. 2013;89(5):434-443. When newborns are discharged with the Pavlik harness, code for the placement of an immobilization device, external, limiting the movement of the upper right leg with 2W3NXYZ Immobilization of right upper leg using other device and upper left leg with 2W3PXYZ Immobilization of left upper leg using other device. All that is needed is watchful waiting. Meta-analysis was performed using random- or fixed-effect models. Tin-mesoporphyrin is not approved by the U.S. Food and Drug Administration. 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. PLoS One. 1990;4(6):304-308. 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). Stevenson DK, Fanaroff AA, Maisels MJ, et al. .fixedHeaderWrap { Data were extracted and analyzed independently by 2 review authors (MG and HM). The nurses role in caring for newborns and their caregivers. High Intensity Phototherapy: Double vs. Single - Home - ClinicalTrials.gov Lets review which conditions should be reported and when. Now, newborns are checked with a transcutaneous bilirubinometer, and the pediatrician reviews standard laboratory blood screenings. The need for PT as well as the duration of PT were similar in both groups. There are implications for future healthcare needs (e.g., having a specialty consult ordered prior to discharge). In: BMJ Clinical Evidence. 2006;(4):CD004592. Bhutani VK, Stark AR, Lazzeroni LC, et al; Initial Clinical Testing Evaluation and Risk Assessment for Universal Screening for Hyperbilirubinemia Study Group. Pediatrics. Garg and colleagues (2017) stated that neonatal hyperbilirubinemia (NNH) is one of the leading causes of admissions in nursery throughout the world.