display: block; /* aetna.com standards styles for templates */ Evaluation and treatment of jaundice in the term infant: A kinder, gentler approach. The Cochrane tool was applied to assessing the risk of bias of the trials. Read more Therefore, its functional efficiency is important for your market reputation. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. None of the studies reported on bilirubin encephalopathy rates, neonatal mortality rates, or the levels of parental or staff satisfactions with the interventions. They stated that further research is needed before the use of TcB devices can be recommended for these settings. Ambalavanan N, Carlo WA. Transcutaneous bilirubinometry in the context of early postnatal discharge. 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. Pediatrics. Swelling in such a hydrocele is uniform, over time, until the fluid is absorbed by the body. 2003;(1):CD004207. Description (For the definition of critically ill or injured see the Critical Care Services subsection of CPT before codes 99291-99292.) UpToDate [online serial]. The nurses role in caring for newborns and their caregivers. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. J Pediatr Health Care. 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. In utero, the fetus requires larger amounts of hemoglobin for oxygenation. Inpatient coders do not code immature lacrimal ducts because the condition does not use additional resources. In that case, other conditions can be coded if they were involved in medical decision-making, or otherwise affected the episode of care. Travan et al (2014) examined if UGT1A1 promoter polymorphisms associated with Gilbert Syndrome (GS) occur with a greater frequency in neonates with severe hyperbilirubinemia. The primary outcomes were TSB on 3 days and 7 days, the incidence of hyperbilirubinemia. cpt code for phototherapy of newborn Evidence Report/Technology Assessment No. 96.4. A randomized, triple-blind, placebo-controlled trial of prophylactic oral phenobarbital to reduce the need for phototherapy in G6PD-deficient neonates. Phototherapy in the home setting. 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). 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. Waltham, MA: UpToDate;reviewed January 2015; January 2017. Clayton,VIC: Centre for Clinical Effectiveness (CCE); 2003. 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. Approximately 2 ml of peripheral venous blood was taken from all subjects. Treating providers are solely responsible for medical advice and treatment of members. These ELBW infants had participated in a randomized controlled trial of early DXM therapy thataimed toevaluate effects on chronic lung disease. 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. 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. For a better experience, please enable JavaScript in your browser before proceeding. 2017:1-9. With the common genotype as reference, the odds ratio of extreme hyperbilirubinemia was 0.87 (range of 0.68 to 1.13) for UGT1A1*28 heterozygotes and 0.77 (range of 0.46 to 1.27) for homozygotes. Copyright Aetna Inc. All rights reserved. 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]. Date of Last Revision: 10/22 . 6. 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). 5 star restaurants st louis. 2010;(1):CD001146. The authors concluded that limited low-quality evidence indicated that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. The provider should document whether the testis is ectopic (e.g., in the superficial inguinal pouch) or abdominal. 2017:1-10. 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. 1995;96(4 Pt 1):727-729. cpt code for phototherapy of newborn. 1992;89:809-818. Two studies also provided results as Bland-Altman difference plots (mean TcB-TSB differences -29.2 and 30 mol/L, respectively). Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants. 2015;7:CD008432. li.bullet { 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. They performed a systematic review of RCTs of probiotic supplementation for prevention or treatment of jaundice in neonates (any gestation or weight) using the Cochrane methodology. A total of 10 publications (11 studies) were eligible. Third, since RCTs of included studies centered in a short observation period and did not follow-up the patients in long-term, the methodological quality of clinical trials with probiotics supplementation therapy for neonatal jaundice needed further improvement. Study authors were contacted for additional information. On the pediatricians encounter, code P13.4 Fracture of clavicle due to birth injury because it involved medical decision-making. Schuman AJ, Karush G. Fiberoptic vs conventional home phototherapy for neonatal hyperbilirubinemia. Cochrane Database Syst Rev. }. 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. 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. 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. 1986;25(6):291-294. In a prospective study, Casnocha and colleagues (2016) tested the accuracy of TcB measure in newborns undergoing phototherapy. 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. Policy Home phototherapy is considered reasonable and necessary for a full-term 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. Atotal of 686 healthy newborns needing measurement of their bilirubin were enrolled over a 4-month period. Cochrane Database Syst Rev. Curr Opin Pediatr. 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. There is no CPT code because these hospital screenings are usually done by hospital staff who are trained by an audiologist. Sharma and colleagues (2017) examined the role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia in term and preterm infants. 65. The ointment is administered by the hospital staff, so there is no professional component to the service. If done right, you will hear a popping sound. 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. Front Pharmacol. This is not a reportable inpatient condition. Data were statistically extracted and evaluated using RevMan 5.3 software. 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). His or her temperature should be between 97F and 100F (36.1C and 37.8C). Suresh GK, Martin CL, Soll RF. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. Sacral dimples without diagnostic services, such as diagnostic imaging, are not coded on inpatient records. The China National Knowledge Infrastructure and MEDLINE databases were searched. Coding Guidelines 18, 19 The third trimester is the time of rapid weight gain, development of muscle mass and fat stores for the newborn. Polymerase chain reaction analysis on blood spot was performed to determine the frequency of UGTA1A1 promoter polymorphisms in cases and controls. According to available guidelines, inpatient treatment may be considered medically necessary for healthy full-term infants who present with aTSB greater than or equal to 20 mg/dL in the first post-natal week. No statistical difference in the prevalence of UGTA1A1 gene variants was found between cases and controls (p = 1). 2006;117(2):474-485. According to available guidelines, no further measurement of bilirubin is necessary in most cases. J Perinatol. The authors found a moderate correlation between TcB and TSB during phototherapy with a marginal improvement in the post-phototherapy phase. 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 Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. A total of 259 neonates were included in the meta-analysis. Gartner LM, Gartner LM,. 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. It affects approximately 2.4 to 15 % of neonates during the first 2 weeks of life. 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. You are using an out of date browser. Phototherapy to prevent severe neonatal hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. An alternative to prolonged hospitalization of the full-term, well newborn. Toggle navigation. Subgroup analysis was done for AB0 incompatible cases. Gholitabar M, McGuire H, Rennie J, et al. Pediatrics. 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. 2007;12(5):1B-12B. These researchers stated that healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinemia. Rates of death in the aggressive-phototherapy and conservative-phototherapy groups were 24 % and 23 %, respectively (relative risk, 1.05; 95 % CI: 0.90 to 1.22). All Rights Reserved. Paediatrics Child Health. 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. www.hkjpaed.org/pdf/2007%3B12%3B93-95.pdf sacral dimple Aetna's policy on treatment of hyperbilirubinemia in infants is adapted from guidelines from the American Academy of Pediatrics. All but 1 of the included studies were conducted in Iran. 2009;124(4):1162-1171. 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. If a nurse visit is provided (e.g., weight screen only), code 99211 may be reported. 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. Newborn jaundice happens when the newborns liver and sunshine on the newborns skin dont remove the fetal blood components in an efficient manner. Aetna considers the use of antenatal phenobarbital to reduce neonatal jaundice in red cell isoimmunized pregnant women experimental and investigational because its effectiveness has not been established. Newborn Care 1. This indicated that cure may have been achieved in a minority of patients. This is caused by a small opening in the abdominal muscles that abdominal contents (e.g., fluid, abdominal lining) spill through. N Engl J Med. Some studies showed that unclear random allocation and allocation plan might exaggerate the hidden effect of up to 30 to 41 %. Huang J, Zhao Q, Li J, et al. Prediction of hyperbilirubinemia in near-term and term infants. It may not display this or other websites correctly. Pediatrics. Mehrad-Majd H, Haerian MS, Akhtari J, et al. For most newborns, the transition from fetal to newborn blood simply involves watchful waiting. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Meta-analysis (random-effects model) showed probiotic supplementation reduced duration of phototherapy [n=415, MD: -11.80 (-17.47 to -6.13); p<0.0001; level of evidence (LOE): low]; TSB was significantly reduced at 96hours [MD: -1.74 (-2.92 to -0.57); p=0.004] and 7 days [MD: -1.71 (-2.25 to -1.17); p<0.00001; LOE: low] after probiotic treatment.