2002;3(1). Cases were identified in the Danish Extreme Hyperbilirubinemia Database that covers the entire population. Do not confuse light treatment with ultraviolet light therapy, which is usually used for skin conditions such as psoriasis. Support teaching, research, and patient care. 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 Copyright 2023 American Academy of Family Physicians. 2001;21(Suppl 1):S63-S87. 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. Hayes Directory. Aggressive phototherapy did reduce rates of neurodevelopmental impairment (26 %, versus 30 %for conservative phototherapy; relative risk, 0.86; 95 % CI: 0.74 to 0.99). 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 Effects of Gly71Arg mutation in UGT1A1 gene on neonatal hyperbilirubinemia: A systematic review and meta-analysis. In search of a 'gold standard' for bilirubin toxicity. 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. Last Review You are using an out of date browser. None of the included studies reported any side effects. A total of 5 RCTs involving 645 patients were included in the meta-analysis. Chawla D, Parmar V. Phenobarbitone for prevention and treatment of unconjugated hyperbilirubinemia in preterm neonates: A systematic review and meta-analysis. Gholitabar M, McGuire H, Rennie J, et al. } 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. Toggle navigation. PDF Clinical Policy: Phototherapy for Neonatal Hyperbilirubinemia Stevenson DK, Fanaroff AA, Maisels MJ, et al. J Pediatr. Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. 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. Accessed July 16, 2002. The condition affects 3 percent of term male infants, and 1 percent of male infants at one year. The authors concluded that zinc sulfate could not reduce the TSB on 3 days and 7 days, the incidence of hyperbilirubinemia and phototherapy requirement, but resulted in significantly decreased duration of phototherapy. 1986;25(6):291-294. Watchko JF, Lin Z. Behrman RE, ed. Management of neonatal hyperbilirubinemia. The authors concluded that limited low-quality evidence indicated that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. J Paediatr Child Health. Neonatal hyperbilirubinemia: An evidence-based approach. 202;11(1):e040182. 1991;91:483-489. Hamelin K, Seshia M. Home phototherapy for uncomplicated neonatal jaundice. 2019;8:CD012731. 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. Pediatrics. Description This policy details medical necessity criteria for home phototherapy for the treatment of neonatal . 1992;89:822-823. phototherapy | Medical Billing and Coding Forum - AAPC J Matern Fetal Neonatal Med. The longer the newborn has before an auditory function screening, the greater the chance of a successful screening. There is no CPT code because these hospital screenings are usually done by hospital staff who are trained by an audiologist. I have a provider that ordered phototherapy for a newborn in the hospital with jaundice and he is wanting to bill 96900. Results were summarized as per GRADE guidelines. 7. 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. Coding for Newborn Care Services (99460, 99461, & 99463) | AAFP cpt code for phototherapy of newborn Newborn Care 1. US Preventive Services Task Force; Agency for Healthcare Research and Quality. 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 literature search was done for various RCTs by searching the Cochrane Library, PubMed, and Embase. 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. Yang and colleagues (2018) noted that zinc sulfate may be a promising approach to treat neonatal jaundice. Aetna considers massage therapy experimental and investigational for the treatment ofneonatal hyperbilirubinemia because its effectiveness has not been established. Clicking hips may develop into dysplasia of the hip. Natus Medical Inc. ETCOc - An indicator of elevated hemolysis in neonatal hyperbilirubinemia. Description Medline, Embase, Cochrane Library, CINAHL and Scopus databases (from inception to May 8, 2014) were searched. 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. In those (uncommon) circumstances, report P83.5 Congenital hydrocele. CG-DME-12 Home Phototherapy Devices for Neonatal Hyperbilirubinemia Discharge normal newborn day 3 _____ 2. For these hydroceles, the swelling will become greater and decrease. 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. Mt Sinai J Med. Pediatrics. 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). Liu J, Long J, Zhang S, et al. If the newborn jaundice is excessive, hospitals use bili lights. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. Cochrane Database Syst Rev. The China National Knowledge Infrastructure and MEDLINE databases were searched. Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. New perspectives on neonatal hyperbilirubinemia. 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. It has been debated if there is an upper limit on the efficiency of phototherapy. When the visit is in follow-up to an identified problem such as jaundice, infrequent stools, or infrequent feedings, and the physician, nurse practitioner, or physician assistant provides the service, an office visit (e.g., 99212-99215) and problem specific diagnosis codes should be reported. 99238-99239 _____ 99463 Normal Newborn evaluated & discharged same day 9 Normal Newborn Care 99460 Initial hospital or birthing center care- normal newborn In: BMJ Clinical Evidence. Treating providers are solely responsible for medical advice and treatment of members. } Meta-analysis was performed using random- or fixed-effect models. The USPSTF concluded that the evidence is insufficient to assess the balance of benefits and harms of screening for hyperbilirubinemia to prevent CBE. The nurses role in caring for newborns and their caregivers. Pediatrics. The drug was administered into the mouth of the infant by the plastic measure provided with the bottle or with a spoon. 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. } JavaScript is disabled. The need for PT as well as the duration of PT were similar in both groups. The authors concluded that this meta-analysis showed that probiotics supplementation therapy was an effective and safe treatment for pathological neonatal jaundice. Phototherapy Coding and Documentation in the Time of Biologics .fixedHeaderWrap { If the lining closes and the fluid has nowhere to go, its a noncommunicating hydrocele. 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). These are not additional resources. Blood testing done as a diagnostic test, however, meets the requirements for coding the jaundice. OL LI { Now, newborns are checked with a transcutaneous bilirubinometer, and the pediatrician reviews standard laboratory blood screenings. Travan L, Lega S, Crovella S, et al. If your newborn is too warm, remove the curtains or cover from around the light set. A total of 3 small studies evaluating 154 infants were included in this review. San Carlos, CA: Natus Medical Inc.; 2002. Sometimes issues heal without interventions, such as minor hematomas from the birth process and laceration from the fetal monitoring electrode. N Engl J Med. foam closure strips for metal roofing | keokuk, iowa arrests newington high school football coach 0 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. None of the studies reported on bilirubin encephalopathy rates, neonatal mortality rates, or the levels of parental or staff satisfactions with the interventions. Thomas JT, Muller P, Wilkinson C. Antenatal phenobarbital for reducing neonatal jaundice after red cell isoimmunization. [Phototherapy of newborn infants] The effect of light treatment on neonates with jaundice was discovered in 1958. Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 . Only one physician may report this code. Cochrane Database Syst Rev. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. Policy Home phototherapy is considered reasonable and necessary for a full-term J Matern Fetal Neonatal Med. 2021;34(21):3580-3585. A condition does not need to be coded on the inpatient hospital encounter to be coded on the pediatricians hospital encounter. Home Birth Coding Examples | Kaiser Permanente Washington BiliCheck variability (+/- 2 SD of the mean bias from serum bilirubin) was within -87.2 to 63.3 micromol/L, while BiliMed variability was within -97.5 to 121.4 micromol/L. But unless the breech presentation or other malpresentation caused a significant finding for the newborn, do not code it on the inpatient hospital record. 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. Probiotics supplementation therapy for pathological neonatal jaundice: A systematic review and meta-analysis. 2021;77(1):12-22. 2002;65(4):599-606. Ch. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. 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. NY State J Med. Accessed January 30, 2019 . Can Nurse. Search All ICD-10 Toggle Dropdown. 2011;128(4):e1046-e1052. list-style-type: upper-roman; Oral zinc for the prevention of hyperbilirubinaemia in neonates. There were no probiotic-related adverse effects. J Perinatol. His or her temperature should be between 97F and 100F (36.1C and 37.8C). Read more Therefore, its functional efficiency is important for your market reputation. Subgroup analysis was done for AB0 incompatible cases. The authors concluded that the role of zinc in the prevention of neonatal hyperbilirubinemia is not supported by the current evidence. Everything I am finding indicates this code is used for dermatological treatment not for jaundice. These investigators also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for RCTs and quasi-randomized trials. Inpatient treatment may be medically necessary for pre-term infants who present with a TSB greater than or equal to 18 mg/dL. 2017;8:432. Utilization Mangement and Q uality Review Manual Nebraska M edicaid, 2014, Phototherapy equipment (471 N AC 18-004.45A) 2010;(1):CD001146. 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. Phototherapy in the home setting. All the studies used zinc sulfate, only 1 study used zinc gluconate. 2006;117(2):474-485. Montreal, QC: CETS; October 2000. When to use normal care, sick care codes for newborns in hospital 2006;(4):CD004592. If the nurse visit results in a visit with the physician, only the physician services would be reported. Moreover, individuals carrying the A-allele of G6PD 1388 G>A and BLVRA rs699512 had a significantly increased risk of developing neonatal hyperbilirubinemia (OR=5.01, p< 0.001, 95 % CI: 3.42 to 7.85). 16th ed. Mehrad-Majd H, Haerian MS, Akhtari J, et al. For most newborns, hematomas from the birth process resolve spontaneously.