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. Home-based phototherapy versus hospital-based phototherapy for treatment of neonatal hyperbilirubinemia: A systematic review and meta-analysis. The SLCO1B1 521 T>C mutation showed a low risk of neonatal hyperbilirubinemia in Chinese neonates, while no significant associations were found in Brazilian, white, Asian, Thai, and Malaysian neonates. 2017;30(16):1953-1962. They included English-language publications evaluating the effects of screening for bilirubin encephalopathy using early TSB, TcB measurements, or risk scores. 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. registered for member area and forum access. J Perinatol. Clin Pediatr. 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). Ambalavanan N, Carlo WA. Data were extracted and analyzed independently by 2 review authors (MG and HM). They stated that there is a need for larger trials to determine how effective clofibrate is in reducing the need for, and duration of, phototherapy in term and preterm infants with hyperbilirubinemia. 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. 2005;17(2):167-169. 2001;108(1):175-177. Results were summarized as per GRADE guidelines. An example is hemangiomas (e.g., strawberry hemangiomas), which do not impinge on vital structures and are not located in the periorbital area, lip, neck, or sacral region. 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. Effects of Gly71Arg mutation in UGT1A1 gene on neonatal hyperbilirubinemia: A systematic review and meta-analysis. Utilization Mangement and Q uality Review Manual Nebraska M edicaid, 2014, Phototherapy equipment (471 N AC 18-004.45A) If the condition involves a diagnostic study, however, it is coded. Maisels MJ, McDonagh AF. OL OL OL OL OL LI { 5 star restaurants st louis. Oral zinc was administered in a dose of 5 ml twice-daily from day 2 to day 7 post-partum. Only 1 study met the criteria of inclusion in the review. A total of 3 small studies evaluating 154 infants were included in this review. 2005;25(5):325-330. Toggle navigation. 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). 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. 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. 6. They stated that further research is needed before the use of TcB devices can be recommended for these settings. Normal Newborn visit, initial service 1. Wong RJ, Bhutani VK. Casnocha Lucanova L, Matasova K, Zibolen M, Krcho P. Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy. 19th ed. } Savinetti-Rose B, Kempfer-Kline RE, Mabry CM. The authors concluded that the role of zinc in the prevention of neonatal hyperbilirubinemia is not supported by the current evidence. /*margin-bottom: 43px;*/ 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. Moreover, these investigators stated that infants with bilirubin levels greater than 25 mg/dL, those who are not responding to phototherapy, and those with evidence of acute bilirubin encephalopathy should be treated with exchange transfusion, with initiation based on an infants age in hours and neurotoxicity risk factors. In utero, the fetus requires larger amounts of hemoglobin for oxygenation. Cases were identified in the Danish Extreme Hyperbilirubinemia Database that covers the entire population. Per the ICD-10-PCS Official Guidelines for Coding and Reporting, only clinically significant conditions are reported. 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. The main outcomes of the trials were analyzed by Review Manager 5.3 software. 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. This is not the same as for professional services coding, where the first-listed diagnosis is the reason for the encounter. However, if significant time beyond that typical of the infant preventive service is spent in counseling, physicians may also report a problem-oriented service (99212-99215) with modifier -25 to indicate the significant and separately identifiable services provided on the same date. Understanding why a pediatrician documents a finding enables you to determine if it should be coded. Also, no association was found for AB0 incompatible cases. 2003;(1):CD004207. 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). Garg BD, Kabra NS, Balasubramanian H. Role of massage therapy on reduction of neonatal hyperbilirubinemia in term and preterm neonates: A review of clinical trials. If done right, you will hear a popping sound. list-style-type: decimal; The influence of zinc sulfate on neonatal jaundice: A systematic review and meta-analysis. Metalloporphyrins for treatment of unconjugated hyperbilirubinemia in neonates. list-style-type: decimal; Only one physician may report this code. Home phototherapy with the fiberoptic blanket. Aetna considers prebiotics / probiotics experimental and investigational for the treatment ofneonatal hyperbilirubinemia becausetheir effectiveness for this indication has not been established. Canadian Paediatric Society, Fetus and Newborn Committee. Clin Pediatr (Phila). Meta-analysis of the 3 studies showed a significant increase in stool frequency in the prebiotic groups (MD 1.18, 95 % CI: 0.90 to 1.46, I = 90 %; 3 studies, 154 infants; high-quality evidence). This is caused by a small opening in the abdominal muscles that abdominal contents (e.g., fluid, abdominal lining) spill through. These investigators also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for RCTs and quasi-randomized trials. 2011;12:CD007969. 96.4. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Am Fam Physician. 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. As with the initial critical care, only one physician may report code 99469 on a given date. London, UK: BMJ Publishing Group;November 2006. Seven (2 prospective) studies evaluated the ability of risk factors (n = 3), early TSB (n = 3), TcB (n = 2), or combinations of risk factors and early TSB (n = 1) to predict hyperbilirubinemia (typically TSBgreater than 95th hour-specific percentile 24 hours to 30 days post-partum). Policy Home phototherapy is considered reasonable and necessary for a full-term 2016;109(3):203-212. BMJ Open. 2019;32(1):154-163. The increased bilirubin from hemolysis often needs phototherapy, exchange transfusion or both after birth. His or her temperature should be between 97F and 100F (36.1C and 37.8C). Semin Fetal Neonatal Med. 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. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis. All searches were re-run on April 2, 2012. In an evidence-based review on "Neonatal hyperbilirubinemia", Pace and colleagues (2019) stated that clofibrate, metalloporphyrins, and ursodiol have been examined in the management of unconjugated hyperbilirubinemia as augmentation to phototherapy. 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 9 RCTs (prophylactic: 6 trials, n=1,761; therapeutic: 3 trials, n=279) with low- to high-risk of bias were included. These investigators evaluated the effects of antenatal phenobarbital in red cell isoimmunized pregnancies in reducing the incidence of phototherapy and exchange transfusion for the neonate. 16th ed. 2007;(2):CD005541. When the depression is too shallow, the femoral head may move around in the depression and sometimes move out of the acetabulum. 1990;10(4):435-438. www.hkjpaed.org/pdf/2007%3B12%3B93-95.pdf sacral dimple Moreover, they stated that routine use of probiotics to prevent or treat neonatal jaundice cannot be recommended; large well-designed trials are needed to confirm these findings. 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. 1993;32:264-267. Treatment of unconjugated hyperbilirubinemia in term and late preterm infants. 2010;15(3):169-175. More commonly seen in the documentation are: Without a diagnosis, abnormal results of routine screenings should not be coded unless the pediatrician states the abnormal results have implications for future healthcare. Phototherapy was started at an average of 7 h of age, and the first IVIG dose was administered at an average of 13 h of life; nearly 25% received a second IVIG dose. Report an inclusive screening finding (R94.120 Abnormal auditory function study) in the professional record so the newborn can be retested at the well-baby checks. 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. TcB should not be used in patients undergoing phototherapy.". A randomized, triple-blind, placebo-controlled trial of prophylactic oral phenobarbital to reduce the need for phototherapy in G6PD-deficient neonates. color: #FFF; The beroptic system consists of a pad of Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia. 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. The authors concluded that the use of antenatal phenobarbital to reduce neonatal jaundice in red cell isoimmunized pregnant women has not been evaluated in randomized controlled trials. 1986;25(6):291-294. The ICD-10-PCS code for light treatment of the skin is 6A600ZZ Phototherapy of skin, single for a single treatment. The authors concluded that genetic variants of bilirubin metabolism genes, including G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512, were associated with the risk of neonatal hyperbilirubinemia, and are potential markers for predicting the disorder. Aetna considersexchange transfusionmedically necessary forterm andnear-term infantsaccording to guidelines published by the American Academy of Pediatrics (AAP). In: BMJ Clinical Evidence. Home Phototherapy for Neonatal Jaundice (07.06.02) COVERED: ACCORDING TO CERTAIN CRITERIA Phototherapy is often used to treat neonatal jaundice and involves the continuous application of ultraviolet light via a lamp or a beroptic system to a newborn for a prescribed period of time. Bhutani VK; Committee on Fetus and Newborn; American Academy of Pediatrics. 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. In most of the trials, Field massage was given; 6 out of 8 trials reported reduction in bilirubin levels in term neonates. The need for PT as well as the duration of PT were similar in both groups. Resources The single nucleotide polymorphisms (SNPs) of G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512 loci were examined by the polymerase chain reaction (PCR) and Sanger sequencing technique in the peripheral blood of all subjects. 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. Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. As a family physician, you may also address needs of the mother during a newborn's encounter (e.g., lactation problems). text-decoration: line-through; Primary outcome was the duration of phototherapy. 1990;4(6):304-308. .fixedHeaderWrap { J Perinatol. 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. Studies were analyzed for methodological quality in a "Risk of bias" table. Aggressive vs. conservative phototherapy for infants with extremely low birth weight. Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia. Pediatrics. 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 Code History 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-PCS) 2017 (effective 10/1/2016): No change 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.
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