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. 66920 Removal of lens material; intracapsular. These researchers systematically evaluated the safety and efficacy of probiotics supplement therapy for pathological neonatal jaundice. The smallest but significant difference between TSB and TcB was found on the lower abdomen. Lacrimal ducts are the drainage system for fluid that lubricates the eye. 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. Li and colleagues (2019) examined the associations between G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512 variants and the risk of neonatal hyperbilirubinemia in a Chinese neonate population. J Paediatr Child Health. 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. }. Halliday HL, Ehrenkranz RA, Doyle LW. Testicles develop in the abdomen. 2001;108(1):175-177. Chu L, Xue X, Qiao J. Efficacy of intermittent phototherapy versus continuous phototherapy for treatment of neonatal hyperbilirubinaemia: A systematic review and meta-analysis. Usually, procedures coded: Low-cost, low-risk screening and prevention procedures usually are not coded. Put a thin layer of clothing, such a T- shirt, on your child's chest. Phototherapy to prevent severe neonatal hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. 19th ed. 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. Policy Home phototherapy is considered reasonable and necessary for a full-term In that case, other conditions can be coded if they were involved in medical decision-making, or otherwise affected the episode of care. However, the accuracy of TcB devices in infants exposed to phototherapy is unclear. 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. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. It has been debated if there is an upper limit on the efficiency of phototherapy. 1990;4(6):304-308. 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. 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. Hyperbilirubinemia in the term infant: When to worry, when to treat. Hospital readmission due to neonatal hyperbilirubinemia. Data were statistically extracted and evaluated using RevMan 5.3 software. 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. Makay B, Duman N, Ozer E, et al. Probiotics supplementation therapy for pathological neonatal jaundice: A systematic review and meta-analysis. 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. Cochrane Database Syst Rev. 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. Pediatrics. Other methods, such as enteral feeding supplementation with prebiotics, may have an effective use in the management of hyperbilirubinemia in neonates. 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). Analysis of rebound and indications for discontinuing phototherapy. Arch Dis Child Fetal Neonatal Ed. You must log in or register to reply here. Mean TSB (120 +/-19 mol/L versus 123 +/- 28 mol/L, DXM versus placebo, respectively) and maximum TSB (178 +/- 23 mol/L versus 176 +/- 48, DXM versus placebo, respectively) concentrations were similar. The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. 2016;36(10):858-861. 1992;89:821-822. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. 1994;61(5):424-428. 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. For most newborns, hematomas from the birth process resolve spontaneously. The studies were included if they compared TcB results with TSB in term and near-term infants during phototherapy or after discontinuation of phototherapy. Even if it meets the technical meaning of conjunctivitis (inflammation of the conjunctiva), it isnt contagious; its self-limiting and does not affect medical decision-making, so it cannot be coded on the pediatricians encounter. No (TA)8 repeat was found in the 2 groups. Ip S, Glicken S, Kulig J, et al. 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. 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). Ambalavanan N, Carlo WA. } The increased bilirubin from hemolysis often needs phototherapy, exchange transfusion or both after birth. For harms associated with phototherapy, case reports or case series were also included. 1992;89:827-828. } Clinical Information. 1995;96(4 Pt 1):727-729. 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. J Adv Nurs. Pediatrics. Front Pharmacol. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. If your newborn is too warm, remove the curtains or cover from around the light set. Two reviewers independently assessed studies for inclusion, and discrepancies were resolved with consensus. 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. eMedicine J. Johnson LH. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for reporting methods and results of synthesis with meta-analysis. J Matern Fetal Neonatal Med. No statistical difference in the prevalence of UGTA1A1 gene variants was found between cases and controls (p = 1). 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). The correlation between TSB and TcB was found to be moderately close (r = 0.4 to 0.5). Inpatient coders dont collect watchful waiting conditions. Stevenson DK, Fanaroff AA, Maisels MJ, et al. 2008;93(2):F135-F139. list-style-type: lower-alpha; J Perinatol. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. Approximately 10 to 20 percent of newborns have an umbilical hernia. It affects approximately 2.4 to 15 % of neonates during the first 2 weeks of life. J Matern Fetal Neonatal Med. The authors concluded that current studies are unable to provide reliable evidence regarding the effectiveness of prebiotics on hyperbilirubinemia. 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. The therapy may be in the form of a lamp, light panel, or special light blanket. Starting Feb. 1, 2022, five new CPT codes will require preauthorization. } PLoS One. Cochrane Database Syst Rev. Nagar G, Vandermeer B, Campbell S, Kumar M. Effect of phototherapy on the reliability of transcutaneous bilirubin devices in term and near-term infants: A systematic review and meta-analysis. Murki S, Dutta S, Narang A, et al. Clin Pediatr (Phila). Swelling in such a hydrocele is uniform, over time, until the fluid is absorbed by the body. For the G6PD 1388 G>A SNP, individuals carrying the A-allele were associated with a significantly increased risk of neonatal hyperbilirubinemia (adjusted OR=1.49, p< 0.001, 95 % CI: 1.31 to 1.67). Data selection and extraction were performed independently by 2 reviewers. Severe neonatal hyperbilirubinemia and UGT1A1 promoter polymorphism. Toggle navigation. However, the results remain controversial. The pediatrician will spend time evaluating the condition, and at some point, a code in the Q53 Undescended and ectopic testicle range will be used. 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. color: #FFF; 16th ed. Although an undescended testicle usually is described as palpable or impalpable, also get the location, if you can. list-style-type: lower-roman; 2007;12(5):1B-12B. There is no CPT code because these hospital screenings are usually done by hospital staff who are trained by an audiologist. 1986;25(6):291-294. 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. Reference Number: CP.MP.150 Coding Implications Date of Last Revision: 10/22 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Approximately 2 ml of peripheral venous blood was taken from all subjects. Expect to see this monitored; usually there is a consult/referral around six months of age for newborns with undescended testicle(s). J Perinatol. Diagnosis code Z00.121 (encounter for routine child health examination with abnormal findings) and the appropriate problem diagnosis would be used. 2004;114(1):297-316. Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia. The correlation coefficient improved marginally in the post-phototherapy phase (r = 0.72, 95 % CI: 0.64 to 0.78, 4 studies). In particular, polymorphisms across 3 genes involved in bilirubin production and metabolism: Variant gene co-expression including compound and synergistic heterozygosity enhances hyperbilirubinemia risk, contributing to the etiologic heterogeneity and complex nature of neonatal jaundice. Data were statistically extracted and evaluated by RevMan 5.3 software. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. Indian Pediatr. Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. N Engl J Med. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2002. Some watchful waiting issues require continued outpatient evaluation until resolution. map of m6 motorway junctions. Waltham, MA: UpToDate;reviewed January 2015; January 2017. 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. Our providers amend their office note to indicate the patient was admitted due to results then charge an Initial Outpatient Care code (99218-99220) for the day of admission and then 99217 for discharge. Home Phototherapy color: blue On the pediatricians encounter, code P13.4 Fracture of clavicle due to birth injury because it involved medical decision-making. Stevenson DK, Fanaroff AA, Maisels MJ, et al. Lets review which conditions should be reported and when. } A total of 14 studies were identified. For instance, abnormal findings on screenings for example, newborn hearing screening or lab screenings are not coded in the inpatient record, unless: Here are several watchful waiting findings to consider. Sharma and colleagues (2017) examined the role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia in term and preterm infants. Valaes T. Problems with prediction of neonatal hyperbilirubinemia. Probiotics supplementation treatment showed efficacy [RR: 1.19, 95 % CI: 1.12 to 1.26), p < 0.00001] in neonatal jaundice. Aetna considers management of physiologic hyperbilirubinemia medically necessary in preterm infants (defined as an infant born prior to 37 weeks gestation) according to guidelines published by the AAP. Both trials in preterm neonates and most of the trials in term neonates (5 trials) reported increased stool frequencies. Liu J, Long J, Zhang S, et al. Percussion should not cause red marks on your child. Usually prior to birth, the testicles descend into the scrotum. Pediatrics. UGT1A1 is the rate-limiting enzyme in bilirubin's metabolism. If approved, tin-mesoporphyrin could find immediate application in preventing the need for exchange transfusion in infants who are not responding to phototherapy." A total of 416 records were identified through database searching; 4 studies (3 randomized studies and 1 retrospective study) meet the final inclusion criteria. 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.