Lacrimal ducts are the drainage system for fluid that lubricates the eye. A total of 14 studies were identified. TcB should not be used in patients undergoing phototherapy.". Diagnosis code Z00.121 (encounter for routine child health examination with abnormal findings) and the appropriate problem diagnosis would be used. They considered all RCTs that studied neonates comparing enteral feeding supplementation with prebiotics versus distilled water/placebo or no supplementation. The ointment is administered by the hospital staff, so there is no professional component to the service. 2016;109(3):203-212. 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. Accessed July 16, 2002. .fixedHeaderWrap { OL OL OL LI { 65. Utilization Mangement and Q uality Review Manual Nebraska M edicaid, 2014, Phototherapy equipment (471 N AC 18-004.45A) } 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. Morris BH, Oh W, Tyson JE, et al; NICHD Neonatal Research Network. 2006;117(2):474-485. Treating providers are solely responsible for medical advice and treatment of members. The following are general age-in-hours specificTSBthreshold values forexchange transfusionbased 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 ofless 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. Coding Guidelines 18, 19 The third trimester is the time of rapid weight gain, development of muscle mass and fat stores for the newborn. 2019;68(1):E4-E11. 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. 2019;55(9):1077-1083. 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. 2006;(4):CD004592. Travan et al (2014) examined if UGT1A1 promoter polymorphisms associated with Gilbert Syndrome (GS) occur with a greater frequency in neonates with severe hyperbilirubinemia. These investigators assessed the safety and efficacy of probiotics in reducing the need for phototherapy and its duration in NNH. These are not additional resources. Blood testing done as a diagnostic test, however, meets the requirements for coding the jaundice. 2010;15(3):169-175. 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). 2003;(1):CD004207. These investigators conducted a systematic review and meta-analysis to examine the safety and efficacy of zinc sulfate on hyperbilirubinemia among neonates. Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. 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. . Copyright 2023 American Academy of Family Physicians. 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. 1998;101(1 Pt 1):25-31. There were no significant differences in SLCO1B1 463 C>A between the hyperbilirubinemia and the control group. Care of newborns who are not normal but do not require intensive services may be reported with codes for initial hospital care (99221-99223). Percussion should not cause red marks on your child. Description J Pediatr. 2011;12:CD007969. 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. Sharma D, Farahbakhsh N, Sharma P, Shastri S. Role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia: A systematic review of current evidence. Clin Pediatr (Phila). 1992;89:827-828. Zhang M , Tang J, He Y, et al. 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 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. Neonatal hyperbilirubinemia: An evidence-based approach. Cochrane Database Syst Rev. Copyright Aetna Inc. All rights reserved. TcB measurements obtained on the forehead, sternum, abdomen and covered lower abdomen were statistically compared with the corresponding TSB. Cochrane Database Syst Rev. Only one physician may report this code. Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. 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. Poland RL. 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. RM Kliegman, BF Stanton, JW St. Geme, et al., eds. Sometimes, a parent declines prophylactic services such as the eye ointment and vaccinations. list-style-type : square !important; J Matern Fetal Neonatal Med. Usually, the time spent teaching parents how to care for the newborns eyes until the lacrimal ducts mature is not significant. 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. 2002;65(4):599-606. Savinetti-Rose B, Kempfer-Kline RE, Mabry CM. 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. A total of 416 records were identified through database searching; 4 studies (3 randomized studies and 1 retrospective study) meet the final inclusion criteria. In a systematic review and meta-analysis, Chu and colleagues (2021) examined if intermittent phototherapy is more effective than continuous phototherapy in the treatment of neonatal hyperbilirubinemia. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis. In search of a 'gold standard' for bilirubin toxicity. According to available guidelines, no further measurement of bilirubin is necessary in most cases. The primary outcomes were TSB on 3 days and 7 days, the incidence of hyperbilirubinemia. A total of 3 small studies evaluating 154 infants were included in this review. Correlation between neonatal hyperbilirubinemia and vitamin D levels: A meta-analysis. Clayton,VIC: Centre for Clinical Effectiveness (CCE); 2003. Otherwise healthy newborn infants with hyperbilirubinemia without signs of hemolytic disease; gestational age 33 weeks; birth weight . Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. Ch. Santa Barbara, CA: Elsevier Saunders; 2011. There are 4 chief Current Procedural Terminology (CPT) codes for reporting phototherapy services: (1) 96900: actinotherapy (UV light treatment); (2) 96910: photochemotherapy, tar, and UVB (Goeckerman treatment) or petrolatum and UVB; (3) 96912: photochemotherapy and PUVA; and (4) 96913: photochemotherapy (Goeckerman and/or PUVA) for severe Am Fam Physician. The ball at the proximal end of the femur is supposed to fit snuggly into the acetabulum (the cup-shaped depression in the pelvis). Clin Pediatr. 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. Pace EJ, Brown CM, DeGeorge KC. 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). } Hyperbilirubinemia in the term newborn. 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). Infants had been treated with DXM (0.25 mg/kg twice-daily at postnatal day 1 and 2) or with placebo (normal saline). Place the thermometer in your newborn's armpit while the phototherapy lights are on. 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). Coding for this service depends on the provider of the service and whether the visit is in follow-up to an already identified problem or screening for problems. These researchers used the standard methods of the Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. } 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. --> Yang L, Wu, Wang B, et al. Although an undescended testicle usually is described as palpable or impalpable, also get the location, if you can. 96.4. These investigatorscalculated the sensitivity and specificity of early TSB, TcB measurements, or risk scores in detecting hyperbilirubinemia. The meta-analyses of 2 studies demonstrated a significant reduction in the length of hospital stay (MD -10.57 days, 95 % CI: -17.81 to -3.33; 2 studies, 78 infants; I = 0 %, p = 0.004; low-quality evidence). 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. Maisels MJ, Watchko JF. None of the studies showed any effect on the duration of phototherapy, incidence of phototherapy, age of starting of phototherapy and any serious adverse effect. Randomized controlled trials were identified by searching MEDLINE (1950 to April 2012) before being translated for use in The Cochrane Library, EMBASE 1980 to April 2012 and CINAHL databases. 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. Since then, many hundred thousand infants have been treated with light. These researchers conducted a systematic review of studies comparing TcB devices with TSB in infants receiving phototherapy or in the post-phototherapy phase. These researchers examined whether the UGT1A1*28 allele is associated with extreme hyperbilirubinemia. The beroptic system consists of a pad of 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. Behrman RE, ed. Privacy Policy | Terms & Conditions | Contact Us. These researchers identified studies through Medline searches, perusing reference lists and by consulting with United States Preventive Services Task Force(USPSTF) lead experts. Description This policy details medical necessity criteria for home phototherapy for the treatment of neonatal . Mt Sinai J Med. 2. 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. With the sleeve pinned to the t-shirt, the newborn has restricted arm movement, and the clavicle heals without intervention. Codes for initial care of the normal newborn include: After the newborn has been discharged to home, it is common practice to see the infant to assess for jaundice or any feeding problems. .headerBar { top: 0px; Liu J, Long J, Zhang S, et al. Phototherapy to prevent severe neonatal hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. 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 pediatrician notes the abnormal results have implications for future healthcare. 1992;31(6):345-352. Clinical Information. The authors concluded that the role of zinc in the prevention of neonatal hyperbilirubinemia is not supported by the current evidence. 2012;12:CD009017. 2021;16(5):e0251584. (For the definition of critically ill or injured see the Critical Care Services subsection of CPT before codes 99291-99292.) 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. 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 extracted information of RCTs should include efficacy rate, serum total bilirubin level, time of jaundice fading, duration of phototherapy, duration of hospitalization, adverse reactions. One infant (1.6%) met all three AAP guideline criteria of being DAT-positive, bilirubin within 3 of exchange level, and rising bilirubin despite intensive phototherapy. 2019;32(1):154-163. Once the skin is clear or alm Prebiotics for the prevention of hyperbilirubinaemia in neonates. UpToDate [online serial]. But unless the breech presentation or other malpresentation caused a significant finding for the newborn, do not code it on the inpatient hospital record. Policy Home phototherapy is considered reasonable and necessary for a full-term 7. Digestive System Disorders. 3. 2001;108:31-39. Petersen JP, Henriksen TB, Hollegaard MV, et al. A heterozygous group was also equally distributed between cases (44.3 %) and controls (42.9 %). Some watchful waiting issues require continued outpatient evaluation until resolution. PICOS eligibility criteria were used to select original studies published from 1984 through 2019. Spontaneous descent after one year is uncommon. This is not a reportable inpatient condition. The Cochrane tool was applied to assessing the risk of bias of the trials. 1992;89:821-822. Intensive phototherapy in form of double light is used worldwide in the treatment of severe neonatal hyperbilirubinemia. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. 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 with the fiberoptic blanket. Incidence is as high as 30 percent in premature male neonates. CETS 99-6 RE. Furthermore, an UpToDate review on "Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants" (Wong and Bhutani, 2017) states that "TcB measurements are not reliable in infants undergoing phototherapy. Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia. 1994;61(5):424-428. 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). Earn CEUs and the respect of your peers. Nelson Textbook of Pediatrics. Support teaching, research, and patient care. 2014;134(3):510-515. Clinical evaluation (e.g., specialty consult during the hospitalization); Therapeutic treatment (e.g., bili lights for clinically significant neonatal jaundice); Diagnostic procedures (e.g., ultrasound due to sacral dimple); Extended length of hospital stay (e.g., beyond the average for the MS-DRG); Increased nursing care and/or monitoring (e.g., neonatal intensive care unit); or. 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. 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). Associations between G6PD, OATP1B1 and BLVRA variants and susceptibility to neonatal hyperbilirubinaemia in a Chinese Han population. Do not code this condition for the newborn inpatient encounter, unless additional resources are used. Conseil de valuation des Technologies de la Sant du Qubec (CETS).