list-style-type: lower-roman; Pediatrics. Metalloporphyrins for treatment of unconjugated hyperbilirubinemia in neonates. Petersen JP, Henriksen TB, Hollegaard MV, et al. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. 1993;32:264-267. When the newborn is critically ill or injured, codes exist for reporting of services provided during interfacility transport, initial critical care, and subsequent critical services. Casnocha Lucanova L, Matasova K, Zibolen M, Krcho P. Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy. Hamelin K, Seshia M. Home phototherapy for uncomplicated neonatal jaundice. Study authors were contacted for additional information. 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]. Sometimes issues heal without interventions, such as minor hematomas from the birth process and laceration from the fetal monitoring electrode. UGT1A1 is the rate-limiting enzyme in bilirubin's metabolism. Okwundu CI, Okoromah CA, Shah PS. In preterm infants, phototherapy should be initiated at 50 to 70 % of the maximum indirect levels below: Footnotes* Complications include but are not limited to prenatal asphyxia, acidosis, hypoxia, hypoalbuminemia, meningitis, intraventricular hemorrhage, hemolysis, hypoglycemia, or signs of kernicterus. Description This policy details medical necessity criteria for home phototherapy for the treatment of neonatal . 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. Murki S, Dutta S, Narang A, et al. 1998;101(1 Pt 1):25-31. Pediatrics. J Matern Fetal Neonatal Med. Do not confuse light treatment with ultraviolet light therapy, which is usually used for skin conditions such as psoriasis. Therefore, well-designed, large randomized, double blind, placebo-controlled trials would be needed to further confirm the efficacy of probiotics. Everything I am finding indicates this code is used for dermatological treatment not for jaundice. 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. Stevenson DK, Wong RJ. Available at: http://www.emedicine.com/med/topic1065.htm. 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. London, UK: BMJ Publishing Group;November 2006. at the end of this policy for important regulatory and legal information. 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. Typically, no extra resources are required during the newborn hospitalization, so do not code the condition. 6A650ZZ - Phototherapy, Circulatory, Single Version 2023 Billable Code ICD-10-PCS Details 6A650ZZ is a billable procedure code used to specify the performance of phototherapy, circulatory, single. The authors concluded that this meta-analysis showed that probiotics supplementation therapy was an effective and safe treatment for pathological neonatal jaundice. Gu J, Zhu Y, Zhao J. All searches were re-run on April 2, 2012. 1992;89:827-828. 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. 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. 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. UpToDate[online serial]. 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. Jaundice, Coombs, and Phototherapy AAP Clinical Practice Guideline - Summary Bhutani Nomogram Guidelines for Phototherapy FAQs About Phototherapy Cochrane Database Syst Rev. The authors concluded that the limited evidence available has not shown that oral zinc supplementation given to infants up to 1 week old reduces the incidence of hyperbilirubinaemia or need for phototherapy. If separately documented in the mother's chart, you may report these services in addition to the services provided to the infant. If the fractured clavicle does not use additional resources during the hospitalization (a safety pin is not additional resources), do not code the condition on the hospital encounter. Exchange transfusion should be performed in a neonatal intensive care unit (NICU) due to significant risks. 2021;16(5):e0251584. 2011;128(4):e1046-e1052. } Screening is usually done as close as possible to inpatient discharge for this reason. Ludwig MA. 92586 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system, limited 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. No (TA)8 repeat was found in the 2 groups. No association was found between the UGT1A1*28 allele and extreme hyperbilirubinemia. J Matern Fetal Neonatal Med. When the observation of hip click does not lead to diagnostic testing (e.g., ultrasound), therapeutic treatment (e.g., parental training in the use of, and discharged with, a Pavlik harness), an inpatient specialty consult, neonatal intensive care, or a scheduled outpatient specialty consult, it is not coded by inpatient coders. These investigators also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for RCTs and quasi-randomized trials. 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. 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]. 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. The receiver operating characteristic analysis (for serum bilirubin levels greater than 205.2 micromol/L or greater than 239.4 micromol/L) showed significantly higher areas under the curve for BiliCheck than those for BiliMed (p < 0.001). 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. Front Pharmacol. Centers for Disease Control and Prevention (CDC). Zinc sulfate showed no influence on phototherapy requirement (OR=0.90; 95 % CI:0.41 to 1.98; p=0.79), but resulted in significantly decreased duration of phototherapy (MD=-16.69hours; 95 % CI:-25.09 to -8.3hours; p<0.0001). Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. Meta-analyses of 2 studies showed no significant difference in maximum plasma unconjugated bilirubin levels in infants with prebiotic supplementation (MD 0.14 mg/dL, 95 % CI: -0.91 to 1.20, I = 81 %, p = 0.79; 2 studies, 78 infants; low-quality evidence). .strikeThrough { Mishra S, Cheema A, Agarwal R, et al. Arch Dis Child Fetal Neonatal Ed. The China National Knowledge Infrastructure and MEDLINE databases were searched. 2013;162(3):477-482. The pooled estimates of correlation coefficients (r) during phototherapy were: covered sites 0.71 (95 % CI: 0.64 to 0.77, 11 studies), uncovered sites 0.65 (95 % CI: 0.55 to 0.74), 8 studies), forehead 0.70 (95 % CI: 0.64 to 0.75, 12 studies) and sternum 0.64 (95 % CI: 0.43 to 0.77, 5 studies). These include vascular access procedures, airway and ventilation management services, oral or nasogastric tube placement, bladder aspiration or catheterization, and lumbar puncture among others. The authors concluded that limited low-quality evidence indicated that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. Sharma and colleagues (2017) examined the role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia in term and preterm infants. 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. Paediatrics Child Health. Clayton,VIC: Centre for Clinical Effectiveness (CCE); 2003. 6. 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. .fixedHeaderWrap { The authors concluded that the findings of this study demonstrated that the 388 G>A mutation of the SLCO1B1 gene is a risk factor for developing neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations; the SLCO1B1 521 T>C mutation provides protection for neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations. This risk increased significantly in the CC genotype carriers at the rs4149056 locus of the SLCO1B1 gene (OR=2.17, 95 % CI: 1.87 to 2.33), whereas it decreased significantly in individuals carrying the G-allele at the rs699512 locus of the BLVRA gene (adjusted OR=0.84, p= 0.01, 95 % CI: 0.75 to 0.95). 2017;8:432. /*margin-bottom: 43px;*/ 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. However, the accuracy of TcB devices in infants exposed to phototherapy is unclear. In those (uncommon) circumstances, report P83.5 Congenital hydrocele. 2008;359(18):1885-1896. 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. 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. OL OL OL OL OL LI { Percussion should not cause red marks on your child. . Gholitabar M, McGuire H, Rennie J, et al. The impact of SLCO1B1 genetic polymorphisms on neonatal hyperbilirubinemia: A systematic review with meta-analysis. This is caused by a small opening in the abdominal muscles that abdominal contents (e.g., fluid, abdominal lining) spill through. In a prospective double-blind study, De Lucaet al (2008) compared the accuracy of a new transcutaneous bilirubinometer, BiliMed (Medick SA, Paris, France) with BiliCheck (Respironics, Marietta, GA), a widely available instrument, and with total serum bilirubin (TSB) measurement. Home phototherapy. 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. 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. Wennberg RP, Ahlfors CE, Bhutani VK, et al. Treating providers are solely responsible for medical advice and treatment of members. Two studies also provided results as Bland-Altman difference plots (mean TcB-TSB differences -29.2 and 30 mol/L, respectively). Mehrad-Majd H, Haerian MS, Akhtari J, et al. RM Kliegman, BF Stanton, JW St. Geme, et al., eds. Kernicterus in full-term infants--United States, 1994-1998. 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. 2005;17(2):167-169. These findings seem compatible with the concept that factors other than bilirubin conjugation capacity are important for the pathophysiology of neonatal jaundice in ELBW preterm infants. Coding Guidelines 18, 19 The third trimester is the time of rapid weight gain, development of muscle mass and fat stores for the newborn. Inpatient coders dont collect watchful waiting conditions. Honar et al (2016) found that ursodiol added at the time of phototherapy initiation showed a significant reduction in peak bilirubin levels and duration of phototherapy in term infants with unconjugated hyperbilirubinemia without any adverse effects. Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants. 2012;1:CD007966. 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 Sometimes, a newborns clavicle is fractured during a vaginal delivery. Li Y, Wu T, Chen L, Zhu Y. Montreal, QC: CETS; October 2000. San Carlos, CA: Natus Medical Inc.; 2002. 2021;77(1):12-22. 2010;15(3):164-168. Home-based phototherapy versus hospital-based phototherapy for treatment of neonatal hyperbilirubinemia: A systematic review and meta-analysis. The longer the newborn has before an auditory function screening, the greater the chance of a successful screening. Additionally, no serious adverse reaction was reported. 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 Chu and colleagues (2020) stated that phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. 2018;31(10):1311-1317. 2016;109(3):203-212. on Watchful Waiting:Collecting Newborn Information, Watchful Waiting:Collecting Newborn Information, Tech & Innovation in Healthcare eNewsletter, Capture Active Duty Diagnoses with DoD Unique Codes, Finally Tobacco Use That Isn't a Mental Health Issue, Know Your Payer to Make the Most of Modifier 24, Modifier 25 for E/M on the Day of an Injection Procedure. They used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), Medline via PubMed (1966 to June 14, 2018), Embase (1980 to June 14, 2018), and CINAHL (1982 to June 14, 2018). In a Cochrane review, Thomas et al (2007) stated that neonates from isoimmunized pregnancies have increased morbidity from neonatal jaundice. J Perinatol. The presumed mechanism of effect is photo-excitation of bilirubin extravascularly in the skin with the formation of bilirubin isomers which can be e MMWR Morb Mortal Wkly Rep. 2001;50(23):491-494. Results were summarized as per GRADE guidelines. However, that is not always the case. Zhang M , Tang J, He Y, et al. ol.numberedList LI { Sometimes, a parent declines prophylactic services such as the eye ointment and vaccinations. The Cochrane tool was applied to assessing the risk of bias of the trials. NY State J Med. 19th ed. Pediatrics. It affects approximately 2.4 to 15 % of neonates during the first 2 weeks of life. The fetal blood is designed to attract oxygen from the mothers blood. Polymerase chain reaction analysis on blood spot was performed to determine the frequency of UGTA1A1 promoter polymorphisms in cases and controls. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. J Pediatr. FN07-02. Both trials in preterm neonates and most of the trials in term neonates (5 trials) reported increased stool frequencies. 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. 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).