cpt code for phototherapy of newborn

The authors concluded that effects of screening on the rates of bilirubin encephalopathy are unknown. Poland RL. 99238-99239 _____ 99463 Normal Newborn evaluated & discharged same day 9 Normal Newborn Care 99460 Initial hospital or birthing center care- normal newborn Results were summarized as per GRADE guidelines. Curr Opin Pediatr. Philadelphia, PA: W.B. A total of 14 studies were identified. color: #FFF; Do I Use 25 or 59 for Same-day Assessment and E/M? The order of use of the instruments was randomized. cpt code for phototherapy of newborn 1994;94(4 Pt 1):558-565 (reviewed 2000). The lining of the abdomen pouches into the scrotum to surround the testicle. Newman TB, Maisels MJ. Data selection and extraction were performed independently by 2 reviewers. But unless the breech presentation or other malpresentation caused a significant finding for the newborn, do not code it on the inpatient hospital record. 2011;12:CD007969. } Santa Barbara, CA: Elsevier Saunders; 2011. color: blue!important; UGT1A1 is the rate-limiting enzyme in bilirubin's metabolism. 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. A heterozygous group was also equally distributed between cases (44.3 %) and controls (42.9 %). There was a significantly lower duration of phototherapy in the clofibrate group compared to the control group for both preterm and term neonates with a weighted mean difference of -23.82 hours (95 % CI: -30.46 hours to -17.18 hours) and -25.40 hours (95 % CI: -28.94 hours to -21.86 hours), respectively. The authors concluded that the UGT1A1*28 allele was not associated with risk for extreme hyperbilirubinemia in this study. Centers for Disease Control and Prevention (CDC). Guidelines from the Canadian Paediatric Society (2007) found that phenobarbitol, studied as a means of preventing severe hyperbilirubinemia in infants with G6PD deficiency, did not improve clinically important outcomes in a randomized controlled clinical study (Murki et al, 2005). /* aetna.com standards styles for templates */ This service includes time spent addressing routine feeding issues. They stated that TSB assessment remains necessary, if treatment of hyperbilirubinemia is being considered. Last Review .strikeThrough { There are implications for future healthcare needs (e.g., having a specialty consult ordered prior to discharge). 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. Normal Newborn visit, day 2 3. Chu and colleagues (2020) stated that phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. 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). CPT CODE 96910, 96912, 96920 CPT/HCPCS Codes: 96910 Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B . Yang L, Wu, Wang B, et al. J Matern Fetal Neonatal Med. This review included 6 RCTs that fulfilled inclusion criteria. 2002;3(1). The authors concluded that early DXM treatment does not affect the severity of neonatal hyperbilirubinemia in ELBW preterm infants. In a Cochrane review, Thomas et al (2007) stated that neonates from isoimmunized pregnancies have increased morbidity from neonatal jaundice. Although early corticosteroid treatment facilitates extubation and reduces the risk of chronic lung disease and patent ductus arteriosus, it causes short-term adverse effects including gastro-intestinal bleeding, intestinal perforation, hyperglycaemia, hypertension, hypertrophic cardiomyopathy and growth failure. Usually, the time spent teaching parents how to care for the newborns eyes until the lacrimal ducts mature is not significant. 4th ed. 2007;(2):CD005541. The pediatrician notes the abnormal results have implications for future healthcare. 1994;61(5):424-428. For these hydroceles, the swelling will become greater and decrease. Testicles develop in the abdomen. Also, no association was found for AB0 incompatible cases. Travan et al (2014) examined if UGT1A1 promoter polymorphisms associated with Gilbert Syndrome (GS) occur with a greater frequency in neonates with severe hyperbilirubinemia. For more information about blocked lacrimal ducts, visit: aao.org/eye-health/diseases/treatment-blocked-tear-duct. 2010;(1):CD001146. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. However, the accuracy of TcB devices in infants exposed to phototherapy is unclear. Spontaneous descent after one year is uncommon. 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. Inpatient treatment may be medically necessary for pre-term infants who present with a TSB greater than or equal to 18 mg/dL. Typically, no extra resources are required during the newborn hospitalization, so do not code the condition. newborn, known as hyperbilirubenemia. Screening had good ability to detect hyperbilirubinemia: reported area-under-the-curve values ranged between 0.69 and 0.84, and reported sensitivities and specificities suggested similar diagnostic ability. However, the results remain controversial. Suresh GK, Martin CL, Soll RF. 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. 2007;44(3):354-358. These researchers systematically evaluated the safety and efficacy of probiotics supplement therapy for pathological neonatal jaundice. Diagnosis code Z00.121 (encounter for routine child health examination with abnormal findings) and the appropriate problem diagnosis would be used. } The Cochrane tool was applied to assessing the risk of bias of the trials. Once the skin is clear or alm Guidelines for Perinatal Care. Clinical Information. Usually prior to birth, the testicles descend into the scrotum. Otherwise, at 3 to 4 years of age, the hernia will be surgically repaired. One study reported a significant reduction in the risk of hyperbilirubinemia and rate of treatment with phototherapy associated with enteral supplementation with prebiotics (RR 0.75, 95 % CI: 0.58 to 0.97; 1 study, 50 infants; low-quality evidence). Exchange transfusion should be performed in a neonatal intensive care unit (NICU) due to significant risks. J Perinatol. 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. Depending on the study, 2 to 10 percent of newborns have inconclusive results at discharge (e.g., there may be fluid in the middle ear; the newborn may be fussy; one ear might pass, but the other does not). 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. FN07-02. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. Procedures included in the services represented by code 99477 include those listed for the Critical Care Services subsection of CPT (codes 99291 and 99292), as well as additional procedures listed in the Inpatient Neonatal and Pediatric Critical Care subsection (codes 99468-99476, 99466-99467). Although declining the inpatient prophylactic services is not reportable by inpatient hospital coders (because it does not affect the hospitalization), outpatient physician office coders can and should use Z28 Immunization not carried out and under immunization status codes when provider-recommended immunizations are not administered. Waltham, MA: UpToDate;reviewed January 2015; January 2017. 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. Savinetti-Rose B, Kempfer-Kline RE, Mabry CM. There were no reports of the need for exchange transfusion and incidence of acute bilirubin encephalopathy, chronic bilirubin encephalopathy, and major neurodevelopmental disability in the included studies. 66850 Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration. }. Numerous skin findings may be noted, but are not coded in the inpatient record unless they are clinically significant. Data were statistically extracted and evaluated using RevMan 5.3 software. Aetna considers genotyping of BLVRA, SLCO1B1 and UGT1A1 experimental and investigational for assessing risk of neonatal hyperbilirubinemia because the clinical value of this approach has not been established. In preterm infants, phototherapy should be initiated at 50 to 70 % of the maximum indirect levels below: * Complications include but are not limited to prenatal asphyxia, acidosis, hypoxia, hypoalbuminemia, meningitis, intraventricular hemorrhage, hemolysis, hypoglycemia, or signs of kernicterus. Randomized and quasi-randomized controlled trials of pregnant women established to have red cell isoimmunization in the current pregnancy during their antenatal testing and given phenobarbital alone or in combination with other drugs before birth were selected for review. Wong RJ, Bhutani VK. Accessed January 30, 2019 . Expect to see this monitored; usually there is a consult/referral around six months of age for newborns with undescended testicle(s). 96.4. Pediatrics. Am Fam Physician. UpToDate [online serial]. 1990;10(4):435-438. Accessed July 16, 2002. 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. In most of the trials, Field massage was given; 6 out of 8 trials reported reduction in bilirubin levels in term neonates. The beroptic system consists of a pad of No studies met the inclusion criteria for this review. Mehrad-Majd H, Haerian MS, Akhtari J, et al. 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. Meta-analysis was performed using random- or fixed-effect models. Hulzebos CV, Bos AF, Anttila E, et al. Nagar and associates (2016) noted that TcB devices are commonly used for screening of hyperbilirubinemia in term and near-term infants not exposed to phototherapy. Hyperbilirubinemia in the term newborn. Aetna considers zinc supplementation for the prevention of hyperbilirubinaemia experimental and investigational because its effectiveness has not been established. 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. This is not a reportable inpatient condition. Pediatrics. [glucose-6-phosphate dehydrogenase (G6PD), uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1), and. Mt Sinai J Med. 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. The RR or MD with a 95 % CI was used to measure the effect. Study authors were contacted for additional information. 2019;55(9):1077-1083. In a Cochrane review, Mishra and colleagues (2015) examined the effect of oral zinc supplementation compared to placebo or no treatment on the incidence of hyperbilirubinaemia in neonates during the first week of life and to evaluate the safety of oral zinc in enrolled neonates. Mishra S, Cheema A, Agarwal R, et al. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. 1992;89:827-828. The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia: A meta-analysis of randomized controlled studies. The initial day of critical care for the evaluation and management of a critically ill neonate, 28-days of age or less, is reported with code 99468. display: block; The China National Knowledge Infrastructure and MEDLINE databases were searched. Dennery PA. Metalloporphyrins for the treatment of neonatal jaundice. Resources (Codes may be selected based on time spent in counseling and coordination of care when documentation indicates more than 50% of face-to-face time was spent in these activities.) 1992;89:823-824. Each payer can develop its own diagnosis-related group. Hyperbilirubinemia, conjugated. 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 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). First, because the value of jaundice fading in each guideline was different, the heterogeneity was high in time of jaundice fading. 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. Normal newborn care services are reported with these codes: 99460 Initial hospital or birthing center care, per day, for E/M of normal newborn infant 99462 Subsequent hospital care, per day, for E/M of normal newborn The Coding for Pediatrics manual defines a normal newborn as the following: Transitions to life in the usual manner. 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. Severe neonatal hyperbilirubinemia and UGT1A1 promoter polymorphism. Sometimes, a parent declines prophylactic services such as the eye ointment and vaccinations. TcB should not be used in patients undergoing phototherapy.". When the depression is too shallow, the femoral head may move around in the depression and sometimes move out of the acetabulum. 2008;359(18):1885-1896. Pediatrics. For the same reason, subcutaneous vaccine administration (3E0134Z Introduction of serum, toxoid and vaccine into subcutaneous tissue, percutaneous approach) usually is not coded. Report code 99466 for 30-74 minutes of hands-on care and code 99467 for each additional 30 minutes of hands-on care. Usually, clicking hips lead to no findings but are noted so other providers know there is not issue. 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. The authors concluded that the role of massage therapy in the management of NNH was supported by the current evidence. Treatment of jaundice in low birthweight infants. J Fam Pract. There is a new code for sacral dimples, Q82.6 Congenital sacral dimple, which can be coded in the professional encounter if they affect care, such as when an ultrasound is ordered and there is no finding of occult spina bifida. The authors concluded that limited low-quality evidence indicated that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. Lacrimal ducts are the drainage system for fluid that lubricates the eye. 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. A recent retrospective case-controlled study showed reduction in the need for exchange transfusion for the neonates from isoimmunized pregnancies. 2008;358(9):920-928. Additionally, no serious adverse reaction was reported. Brown AK, Seidman DS, Stevenson DK. 2011;128(4):e1046-e1052. OL OL LI { Published March 24, 2016 (updated June 1 2, 2018). Serum and transcutaneous bilirubin (TcB) measurements were taken with both devices within 15 mins. Cases were identified in the Danish Extreme Hyperbilirubinemia Database that covers the entire population. Correlation between neonatal hyperbilirubinemia and vitamin D levels: A meta-analysis. Pediatrics. Although screening can predict hyperbilirubinemia, there is no robust evidence to suggest that screening is associated with favorable clinical outcomes. 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. list-style-type : square !important; A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. 2010;15(3):169-175. .headerBar { J Matern Fetal Neonatal Med. If done right, you will hear a popping sound. Thayyil S, Milligan DW. For harms associated with phototherapy, case reports or case series were also included. 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. padding-bottom: 4px; Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. Natus Medical Inc. ETCOc - An indicator of elevated hemolysis in neonatal hyperbilirubinemia. Aetna's policy on treatment of hyperbilirubinemia in infants is adapted from guidelines from the American Academy of Pediatrics. Makay B, Duman N, Ozer E, et al. Pediatrics. For more information about congenital hydrocele, visit: www.webmd.com/parenting/baby/tc/congenital-hydrocele-topic-overview#1.