cpt code for phototherapy of newborn

During an initial newborn evaluation, watchful waiting conditions are findings that usually resolve without medical intervention in a few weeks to a few years. solute carrier organic anion transporter polypeptide 1B1 (SLCO1B1)] may interact with each other and/or environmental contributors to produce significant hyperbilirubinemia. 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. Pediatrics. Utilization Mangement and Q uality Review Manual Nebraska M edicaid, 2014, Phototherapy equipment (471 N AC 18-004.45A) TcB measurements were inaccurate, regardless of phototherapy technique (Bilibed, conventional phototherapy). Primary outcome was the duration of phototherapy. 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. J Perinatol. 2013;89(5):434-443. Behrman RE, ed. 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. Phototherapy was well-tolerated without evidence of significant photo-damage or photo-carcinogenicity. Aetna considersexchange transfusionmedically necessary forterm andnear-term infantsaccording to guidelines published by the American Academy of Pediatrics (AAP). These researchers examined whether the UGT1A1*28 allele is associated with extreme hyperbilirubinemia. Thirteen infants homozygous for (TA)7 polymorphism associated with GS were in the case group (18.6 %) and 14 in the control group (20.0 %). Canadian Paediatric Society, Fetus and Newborn Committee. Arch Dis Child Fetal Neonatal Ed. Support teaching, research, and patient care. Multiple treatments is coded 6A601ZZ Phototherapy of skin, multiple. cpt code for phototherapy of newborn These are not additional resources. Blood testing done as a diagnostic test, however, meets the requirements for coding the jaundice. Clofibrate in combination with phototherapy for neonatal hyperbilirubinemia is considered experimental and investigational. 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. In a Cochrane review, these investigators examined if administration of prebiotics reduces the incidence of hyperbilirubinemia among term and pre-term infants compared with enteral supplementation of milk with distilled water/placebo or no supplementation. Sometimes, fluid builds up inside the lining, causing a hydrocele. .strikeThrough { However, there was insufficient evidence to recommend their use because of inadequate data on safety and long-term outcomes. 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. Lets review which conditions should be reported and when. 2012;12:CD009017. They stated that TSB assessment remains necessary, if treatment of hyperbilirubinemia is being considered. Waltham, MA: UpToDate;reviewed January 2015; January 2017. Search All ICD-10 Toggle Dropdown. Morris BH, Oh W, Tyson JE, et al; NICHD Neonatal Research Network. When newborns are discharged with the Pavlik harness, code for the placement of an immobilization device, external, limiting the movement of the upper right leg with 2W3NXYZ Immobilization of right upper leg using other device and upper left leg with 2W3PXYZ Immobilization of left upper leg using other device. Long-term follow-up studies reported an increased risk of abnormal neurological examination and cerebral palsy. Available at: http://www.emedicine.com/med/topic1065.htm. Kernicterus in full-term infants--United States, 1994-1998. Discharge normal newborn day 3 _____ 2. 2011;100(2):170-174. No (TA)8 repeat was found in the 2 groups. 'New' bilirubin recommendations questioned. Notes: Prophylactic phototherapy is considered medically necessary for infants showing a rapid rise in bilirubin (greater than 1 mg/dL/hour) and as a temporary measure when one is contemplating exchange transfusion. Wong RJ, Bhutani VK. 1994;94(4 Pt 1):558-565 (reviewed 2000). Exploring the genetic architecture of neonatal hyperbilirubinemia. The Cochrane tool was applied to assessing the risk of bias of the trials. Ambalavanan N, Carlo WA. 2019;32(1):154-163. Cases were identified in the Danish Extreme Hyperbilirubinemia Database that covers the entire population. Practice patterns in neonatal hyperbilirubinemia. The genotype of Gilbert syndrome, the UGT1A1*28 allele, causes markedly reduced activity of this enzyme, but its association with neonatal hyperbilirubinemia is uncertain and its relationship with extreme hyperbilirubinemia has not been studied. 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. The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. The drug was administered into the mouth of the infant by the plastic measure provided with the bottle or with a spoon. These investigatorscalculated the sensitivity and specificity of early TSB, TcB measurements, or risk scores in detecting hyperbilirubinemia. Johnson LH. Cochrane Database Syst Rev. Two reviewers independently assessed studies for inclusion, and discrepancies were resolved with consensus. No statistical difference in the prevalence of UGTA1A1 gene variants was found between cases and controls (p = 1). 2008;358(9):920-928. /* aetna.com standards styles for templates */ Expect to see this monitored; usually there is a consult/referral around six months of age for newborns with undescended testicle(s). 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. Aetna's policy on treatment of hyperbilirubinemia in infants is adapted from guidelines from the American Academy of Pediatrics. Armanian and colleagues (2019) stated that hyperbilirubinemia occurs in approximately 2/3 of all newborns during the first days of life and is frequently treated with phototherapy. [glucose-6-phosphate dehydrogenase (G6PD), uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1), and. list-style-type: lower-roman; Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. UGT1A1 is the rate-limiting enzyme in bilirubin's metabolism. 1993;32:264-267. These investigators searched CENTRAL (The Cochrane Library 2014, Issue 1), MEDLINE (1966 to November 30, 2014), and EMBASE (1990 to November 30, 2014). Only 1 study was able to show reduction in the mean TSB level and requirement of phototherapy with zinc, and the remaining studies did not report any positive effect. In a Cochrane review on early (less than8 days) postnatal corticosteroid treatmentfor preventing chronic lung disease in preterm infants, Halliday et al(2010) concluded that the benefits of early postnatal corticosteroid treatment, especially DXM, may not out-weigh the known or potential adverse effects of this treatment. list-style-type: upper-roman; Clicking hips may develop into dysplasia of the hip. Approximately 2 ml of peripheral venous blood was taken from all subjects. Pediatrics. A total of 15 studies (2 including preterm neonates and 13 including term neonates) were included in this review. The impact of SLCO1B1 genetic polymorphisms on neonatal hyperbilirubinemia: A systematic review with meta-analysis. In most of the trials, Field massage was given; 6 out of 8 trials reported reduction in bilirubin levels in term neonates. Subsequent days of critical care to the critically ill neonate are reported per day with code 99469. www.hayesinc.com. J Adv Nurs. TcB should not be used in patients undergoing phototherapy.". In: BMJ Clinical Evidence. 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. None of the included studies reported any side effects. Percussion should not cause red marks on your child. Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. at the end of this policy for important regulatory and legal information. 99238-99239 _____ 99463 Normal Newborn evaluated & discharged same day 9 Normal Newborn Care 99460 Initial hospital or birthing center care- normal newborn Transcutaneous bilirubinometry in the context of early postnatal discharge. Pediatrics. These researchers systematically evaluated the safety and efficacy of probiotics supplement therapy for pathological neonatal jaundice. 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. 2019;55(9):1077-1083. Oral zinc was administered in a dose of 5 ml twice-daily from day 2 to day 7 post-partum. } Support Lucile Packard Children's Hospital Stanford and child and maternal health, AAP Clinical Practice Guideline -- Full Version, Assessing Risk Based on Bilirubin Level -- "BiliTool", Infants who have not latched-on or nursed effectively for 12 hours, Infants supplemented more than once in 24 hours, Mothers with a history of breastfeeding failure, Antepartum mothers at risk of preterm delivery, AAP Clinical Practice Guideline - Summary. Poland RL. When a baby is born, we all hope he or she can be coded with a 99431 (History and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records). Resources 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. This is caused by a small opening in the abdominal muscles that abdominal contents (e.g., fluid, abdominal lining) spill through. In that case, other conditions can be coded if they were involved in medical decision-making, or otherwise affected the episode of care. Data were statistically extracted and evaluated using RevMan 5.3 software. The total number of neonates enrolled in these different RCT were 749. Per the ICD-10-PCS Official Guidelines for Coding and Reporting, only clinically significant conditions are reported. 2002;3(1). De Luca D, Zecca E, Corsello M, et al. 1986;25(6):291-294. J Pediatr. However, they stated that due to limitations of the trials, current evidence is in sufficient regarding the use of massage therapy for the management of NNH in routine practice. Clin Pediatr (Phila). Attempt to improve transcutaneous bilirubinometry: A double-blind study of Medick BiliMed versus Respironics BiliCheck. 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. 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. Usually, hip clicks involve watchful waiting, with the tendons and muscles continuing to develop until the click is no longer felt. Ch. Correlation between neonatal hyperbilirubinemia and vitamin D levels: A meta-analysis. After the newborn begins to breath on his own, the fetal blood is destroyed and replaced with blood that works with lungs. A systematic evidence review prepared for the Cochrane Collaboration (Suresh et al, 2003) concluded that, based upon limitations of the evidence, "[r]outine treatment of neonatal unconjugated hyperbilirubinemia with a metalloporphyrin cannot be recommended at present.". The presumed mechanism of effect is photo-excitation of bilirubin extravascularly in the skin with the formation of bilirubin isomers which can be e If the lining closes and the fluid has nowhere to go, its a noncommunicating hydrocele. J Matern Fetal Neonatal Med. 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 researchers used the standard methods of the Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. NY State J Med. display: block; As a family physician, you may also address needs of the mother during a newborn's encounter (e.g., lactation problems). Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: US Preventive Services Task Force recommendation statement. Fractured clavicles are usually noted by the pediatrician on the newborn evaluation, but do not meet the definition of clinical significance. This Clinical Policy Bulletin may be updated and therefore is subject to change. Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia: A meta-analysis of randomized controlled studies. 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. Consistent with available guidelines, continued phototherapy is not medically necessary for healthy term infants when the following criteria for discontinuation of phototherapy are met: A delay in discharge from the hospital in order to observe the infant for rebound once the bilirubin has decreased is not considered medically necessary. If your newborn is too warm, remove the curtains or cover from around the light set. Accessed July 16, 2002. It is also important to note that thereare serious health risks associatedwith corticosteroid therapy. Results were summarized as per GRADE guidelines. Stevenson DK, Fanaroff AA, Maisels MJ, et al. For well infants 35 - 37 6/7 wk, can adjust TSB levels for intervention around the medium risk line. In: Nelson Textbook of Pediatrics. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. The pooled estimates of correlation coefficients (r) during phototherapy were: covered sites 0.71 (95 % CI: 0.64 to 0.77, 11 studies), uncovered sites 0.65 (95 % CI: 0.55 to 0.74), 8 studies), forehead 0.70 (95 % CI: 0.64 to 0.75, 12 studies) and sternum 0.64 (95 % CI: 0.43 to 0.77, 5 studies). Initial hospital or birthing center care, per day, for E/M of normal newborn infant, Initial care per day, for E/M of normal newborn infant seen in other than hospital or birthing center, Initial hospital or birthing center care, per day, for E/M of normal newborn infant admitted and discharged on the same date, Circumsion, using clamp or other device with regional dorsal penile or ring block, Circumsion, as above, without dorsal penile or ring block, Circumsion, surgical excision, other than clamp, device, or dorsal slit, neonate (28 days of age or less), Circumsion, surgical excision, other than clamp, device, or dorsal slit, neonate, old then 28 days of age. 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. Chu L, Xue X, Qiao J. Efficacy of intermittent phototherapy versus continuous phototherapy for treatment of neonatal hyperbilirubinaemia: A systematic review and meta-analysis. Toward understanding kernicterus: A challenge to improve the management of jaundiced newborns. Place the thermometer in your newborn's armpit while the phototherapy lights are on. 2006;(4):CD004592. } Prebiotics for the prevention of hyperbilirubinaemia in neonates. @media print { A total of 5 RCTs involving 645 patients were included in the meta-analysis. For most newborns, the transition from fetal to newborn blood simply involves watchful waiting. Hyperbilirubinemia in the term infant: When to worry, when to treat. 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. 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. The ICD-10-PCS code for light treatment of the skin is 6A600ZZ Phototherapy of skin, single for a single treatment. Numerous skin findings may be noted, but are not coded in the inpatient record unless they are clinically significant. A total of 3 small studies evaluating 154 infants were included in this review. }. 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. The authors concluded that current studies are unable to provide reliable evidence regarding the effectiveness of prebiotics on hyperbilirubinemia. Randomized, controlled trial of early intravenous nutrition for prevention of neonatal jaundice in term and near-term neonates. 2021;16(5):e0251584. 6A650ZZ - Phototherapy, Circulatory, Single Version 2023 Billable Code ICD-10-PCS Details 6A650ZZ is a billable procedure code used to specify the performance of phototherapy, circulatory, single. Usually, clicking hips lead to no findings but are noted so other providers know there is not issue. color: blue Clin Pediatr (Phila). Everything I am finding indicates this code is used for dermatological treatment not for jaundice. Most of the included studies only mentioned the use of random allocation, but they did not describe the specific random allocation method. The increased bilirubin from hemolysis often needs phototherapy, exchange transfusion or both after birth. 2005;25(5):325-330. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. Menu penelope loyalty quotes. Lacrimal ducts are the drainage system for fluid that lubricates the eye. Approximately one in 1,000 children have congenital developmental dysplasia of the hip, which is coded Q65.89 Other specified congenital deformities of hip. The receiver operating characteristic analysis (for serum bilirubin levels greater than 205.2 micromol/L or greater than 239.4 micromol/L) showed significantly higher areas under the curve for BiliCheck than those for BiliMed (p < 0.001). 2019;32(10):1575-1585. #closethis { 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis. The authors concluded that effects of screening on the rates of bilirubin encephalopathy are unknown. Elk Grove Village, IL: AAP; 1997. Home phototherapy with the fiberoptic blanket. Suresh GK, Martin CL, Soll RF. Total serum bilirubin concentrations peaked 30 hours earlier in the DXM group (p 0.05). Pediatrics. 1992;89:822-823. Family physicians who perform newborn circumcision should separately report this service. A heterozygous group was also equally distributed between cases (44.3 %) and controls (42.9 %). Normal Newborn visit, day 2 3. } This indicated that cure may have been achieved in a minority of patients. N Engl J Med. 2004;114(1):297-316. } Polymerase chain reaction analysis on blood spot was performed to determine the frequency of UGTA1A1 promoter polymorphisms in cases and controls. Understanding why a pediatrician documents a finding enables you to determine if it should be coded. In a case-control study performed at a single hospital center in Italy, 70 subjects with severe hyperbilirubinemia (defined as bilirubin level greater than or equal to 20 mg/dL or 340 mol/L) and 70 controls (bilirubin level less than 12 mg/dL or 210 mol/L) were enrolled. 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. These investigators included trials where neonates with hyperbilirubinemia received either clofibrate in combination with phototherapy or phototherapy alone or placebo in combination with phototherapy. But unless the breech presentation or other malpresentation caused a significant finding for the newborn, do not code it on the inpatient hospital record. 2012;1:CD007966. Otherwise, at 3 to 4 years of age, the hernia will be surgically repaired. Brown AK, Seidman DS, Stevenson DK. 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. Severe hyperbilirubinemia was used as a surrogate for possible chronic bilirubin encephalopathy (CBE), because no studies directly evaluated the latter as an outcome. No study assessed harms of screening. 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. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. There were no probiotic-related adverse effects. 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. The authors concluded that intermittent phototherapy appeared to be as effective as continuous phototherapy for the treatment of neonatal hyperbilirubinemia and was safer than continuous phototherapy. The fetal blood is designed to attract oxygen from the mothers blood. Inpatient treatment may be medically necessary for pre-term infants who present with a TSB greater than or equal to 18 mg/dL. If the condition involves a diagnostic study, however, it is coded. Paediatrics Child Health. text-decoration: line-through; Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. 4th ed. Eye issues due to immaturity or from the ointment applied to the newborns eyes. Most newborns have ointment administered at birth, or soon after the initial bonding with the mother. 1990;4(6):304-308. FN07-02. 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. Comp arative Effectiveness of Fiberoptic Phototherapy for Hyperbilirubinemia in Term Infants. 2001;21(Suppl 1):S63-S87. 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. 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. Cryptorchidism padding-bottom: 4px; 6. 2011;12:CD007969. RM Kliegman, BF Stanton, JW St. Geme, et al., eds. 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. Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia. 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. Wong RJ, Bhutani VK. The authors concluded that this meta-analysis showed that probiotics supplementation therapy was an effective and safe treatment for pathological neonatal jaundice. 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. 1998;101(6):995-998.