So why would you not use one of the codes from 99221-99223 for the first day? The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. J Paediatr Child Health. Exchange transfusion involves taking small aliquots of blood from the infant and replacing them with donor red cells until the infants blood volume has been replaced twice to remove bilirubin and antibodies that may be causing hemolysis. Most of the included studies only mentioned the use of random allocation, but they did not describe the specific random allocation method. Jaundice, Coombs, and Phototherapy AAP Clinical Practice Guideline - Summary Bhutani Nomogram Guidelines for Phototherapy FAQs About Phototherapy When the depression is too shallow, the femoral head may move around in the depression and sometimes move out of the acetabulum. 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. The increased bilirubin from hemolysis often needs phototherapy, exchange transfusion or both after birth. Clayton,VIC: Centre for Clinical Effectiveness (CCE); 2003. Data were statistically extracted and evaluated by RevMan 5.3 software. J Perinatol. There was diagnostic testing or a specialty inpatient consult; or. Phototherapy for neonatal jaundice. Thayyil S, Milligan DW. Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants. list-style-type: upper-roman; These researchers performed a systematic review with meta-analysis including genetic studies, which assessed the association between neonatal hyperbilirubinemia and 388 G>A, 521 T>C, and 463 C>A variants of SLCO1B1 between January of 1980 and December of 2012. 2016;36(10):858-861. It is an option to provide conventional phototherapy in hospital or at home at TSB levels 2 - 3 mg/dL below those shown, but home phototherapy should not be used in any infant with risk factors. The therapy may be in the form of a lamp, light panel, or special light blanket. None of the included studies reported any side effects. 2010;(1):CD001146. 2018;31(10):1311-1317. If no feeding or other health problem has been previously noted, this visit may be the first well-child visit when provided by a physician, nurse practitioner, or physician assistant. If the lining still has an opening into the abdomen, the fluid can move in and out of the lining surrounding the testicle. Philadelphia, PA: W.B. 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. 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. 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). Coding for this service depends on the provider of the service and whether the visit is in follow-up to an already identified problem or screening for problems. US Preventive Services Task Force; Agency for Healthcare Research and Quality. } 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. PICOS eligibility criteria were used to select original studies published from 1984 through 2019. This is not a reportable inpatient condition. 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. Several risk factors for hyperbilirubinemia are known, but in a large number of patients, a causal factor is never established. The results revealed that SLCO1B1 388 G>A is associated with an increased risk of neonatal hyperbilirubinemia (odds ratio [OR], 1.39; 95 % CI: 1.07 to 1.82) in Chinese neonates, but not in white, Thai, Latin American, or Malaysian neonates. 16th ed. --> Support teaching, research, and patient care. This review included 6 RCTs that fulfilled inclusion criteria. Chu and colleagues (2020) stated that phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. } J Pediatr. Infants had been treated with DXM (0.25 mg/kg twice-daily at postnatal day 1 and 2) or with placebo (normal saline). The G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512 SNPs had a significant impact on STB levels. Toggle navigation. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. Arch Dis Child Fetal Neonatal Ed. The code is valid for the year 2023 for the submission of HIPAA-covered transactions. Prediction of hyperbilirubinemia in near-term and term infants. Poland RL. 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. There were no probiotic-related adverse effects. 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). Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. Huang J, Zhao Q, Li J, et al. 99460-99461 initial service 2. Screening is usually done as close as possible to inpatient discharge for this reason. Do not confuse light treatment with ultraviolet light therapy, which is usually used for skin conditions such as psoriasis. 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. Aggressive vs. conservative phototherapy for infants with extremely low birth weight. Murki S, Dutta S, Narang A, et al. 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. Watchko and Lin (2010) noted that the potential for genetic variation to modulate neonatal hyperbilirubinemia risk is increasingly being recognized. Waltham, MA: UpToDate;reviewed January 2015; January 2017. Normal Newborn visit, initial service 1. Treatment of unconjugated hyperbilirubinemia in term and late preterm infants. Involve significant costs (e.g., use of the operating room, more expensive diagnostic imaging types, such as computed tomography and magnetic resonance imaging); Are risky (e.g., bedside spinal taps, epidural/regional/general anesthesia); Milia (including Bohn nodules on the gum and Epstein pearls on the palate). Randomized, controlled trial of early intravenous nutrition for prevention of neonatal jaundice in term and near-term neonates. Language services can be provided by calling the number on your member ID card. Some watchful waiting conditions include: Some conditions happen more frequently in premature newborns such as cryptorchidism and umbilical hernias. They stated that a Cochrane review of clofibrate (2012) and metalloporphyrins (2003) found that when added to phototherapy, these medications significantly decreased serum bilirubin levels and duration of phototherapy. In: BMJ Clinical Evidence. 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. RM Kliegman, BF Stanton, JW St. Geme, et al., eds. Care of newborns who are not normal but do not require intensive services may be reported with codes for initial hospital care (99221-99223). 2006;117(2):474-485. 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. Immaturity is not congenital absence, agenesis, stenosis, stricture, or malformation. Schuman AJ, Karush G. Fiberoptic vs conventional home phototherapy for neonatal hyperbilirubinemia. 2019;32(10):1575-1585. 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. padding: 10px; Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. 2019;55(9):1077-1083. No studies met the inclusion criteria for this review. 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. 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. No (TA)8 repeat was found in the 2 groups. Single versus double volume exchange transfusion in jaundiced newborn infants. New perspectives on neonatal hyperbilirubinemia. } Clofibrate in combination with phototherapy for unconjugated neonatal hyperbilirubinaemia. 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. Accessed July 16, 2002. Ch. Now, newborns are checked with a transcutaneous bilirubinometer, and the pediatrician reviews standard laboratory blood screenings. Bilirubin recommendations present problems: New guidelines simplistic and untested. Although an undescended testicle usually is described as palpable or impalpable, also get the location, if you can. Lets review which conditions should be reported and when. Early corticosteroid treatment does not affect severity of unconjugated hyperbilirubinemia in extreme low birth weight preterm infants. 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. The literature search was done for various randomized control trial (RCT) by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, Scopus, Index Copernicus, African Index Medicus (AIM), Thomson Reuters (ESCI), Chemical Abstracts Service (CAS) and other data base. The authors concluded that limited low-quality evidence indicated that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. One infant (1.6%) met all three AAP guideline criteria of being DAT-positive, bilirubin within 3 of exchange level, and rising bilirubin despite intensive phototherapy. 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. Total serum bilirubin concentrations peaked 30 hours earlier in the DXM group (p 0.05). These investigators assessed the safety and efficacy of probiotics in reducing the need for phototherapy and its duration in NNH. Pediatrics. color: blue Front Pharmacol. 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 %). They included English-language publications evaluating the effects of screening for bilirubin encephalopathy using early TSB, TcB measurements, or risk scores. 2007;(2):CD005541. An alternative to prolonged hospitalization of the full-term, well newborn. Evans D. Neonatal jaundice. Wong RJ, Bhutani VK. Usually prior to birth, the testicles descend into the scrotum. 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. According to available guidelines, no further measurement of bilirubin is necessary in most cases. Risk of bias was assessed using the QUADAS-2 tool. Subsequent hospital care of infants who are not critically ill or injured as defined in CPT but who had a very low birth weight and continue to require intensive care services as described for code 99477 above may be reported with codes 99478-99480. 2003;88(6):F459-F463. In that case, other conditions can be coded if they were involved in medical decision-making, or otherwise affected the episode of care. Stevenson DK, Fanaroff AA, Maisels MJ, et al. Centers for Disease Control and Prevention (CDC). The authors concluded that the UGT1A1*28 allele was not associated with risk for extreme hyperbilirubinemia in this study. Pediatrics. Comp arative Effectiveness of Fiberoptic Phototherapy for Hyperbilirubinemia in Term Infants. Genotypes were obtained through the Danish Neonatal Screening Biobank. Expect to see this monitored; usually there is a consult/referral around six months of age for newborns with undescended testicle(s). Gholitabar M, McGuire H, Rennie J, et al. Data were statistically extracted and evaluated using RevMan 5.3 software. When there is a diagnostic study, such as an ultrasound with no diagnosis, the justification for the diagnostic study is coded with R29.4 Clicking hip. Last Review04/29/2022. However, the accuracy of TcB devices in infants exposed to phototherapy is unclear. As a family physician, you may also address needs of the mother during a newborn's encounter (e.g., lactation problems). li.bullet { Merenstein GB. 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). 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. 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. 2021;16(5):e0251584. Although inflammation occurs less frequently now than in the past because the medication used has changed, it may occur. According to available guidelines, inpatient treatment may be considered medically necessary for healthy full-term infants who present with aTSB greater than or equal to 20 mg/dL in the first post-natal week. All of the outcome measures should be monitored by a standardized effective report system in clinical trials and rare serious adverse reaction could be observed through epidemiological studies. 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. A total of 716 neonates were included in the meta-analysis. Medline, Embase, Cochrane Library, CINAHL and Scopus databases (from inception to May 8, 2014) were searched. It is an option to provide conventional phototherapy in hospital or at home at TSB levels 2 - 3 mg/dL below those shown, but home phototherapy should not be used in any infant with risk factors. These researchers stated that healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinemia. Pediatrics. 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. These researchers used the standard methods of the Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. Code History 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-PCS) 2017 (effective 10/1/2016): No change All 3 review authors independently assessed study eligibility and quality. color: #FFF; 2014;134(3):510-515. In those (uncommon) circumstances, report P83.5 Congenital hydrocele. Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. 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. Seidman DS, Stevenson DK, Ergaz Z, et al. 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. Transcutaneous bilirubinometry in the context of early postnatal discharge. Policy Home phototherapy is considered reasonable and necessary for a full-term N Engl J Med. 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. There is no CPT code because these hospital screenings are usually done by hospital staff who are trained by an audiologist. 1992;89:822-823. 1986;25(6):291-294. Family physicians who perform newborn circumcision should separately report this service. Watchko JF, Lin Z. .newText { When the hematoma is extensive or combined with other issues that cause excessive hemolysis, involving additional resources, look to P58 Neonatal jaundice due to other excessive hemolysis. TcB consistently under-estimated TSB levels significantly. If the newborn jaundice is excessive, hospitals use bili lights. The authors concluded that this meta-analysis showed that probiotics supplementation therapy was an effective and safe treatment for pathological neonatal jaundice. There is insufficient evidence to support the use of metalloporphyrins (e.g., stannsoporfin (tin mesoporphyrin), Stanate, WellSpring Pharmaceutical Corporation, Neptune, NJ) for the treatment of neonatal jaundice. Exploring the genetic architecture of neonatal hyperbilirubinemia. This review included total of 10 RCTs (2 in preterm neonates and 8in term neonates) that fulfilled inclusion criteria. A total of 416 records were identified through database searching; 4 studies (3 randomized studies and 1 retrospective study) meet the final inclusion criteria. 1992;89:827-828. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. For more information about cryptorchidism, visit: ncbi.nlm.nih.gov/pubmed/10932966. 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). tradicne jedla na vychodnom slovensku . For the same reason, subcutaneous vaccine administration (3E0134Z Introduction of serum, toxoid and vaccine into subcutaneous tissue, percutaneous approach) usually is not coded. Saunders Co.; 2000:513-519. Home-based phototherapy versus hospital-based phototherapy for treatment of neonatal hyperbilirubinemia: A systematic review and meta-analysis. The authors concluded that the limited evidence available has not shown that oral zinc supplementation given to infants up to 1 week old reduces the incidence of hyperbilirubinaemia or need for phototherapy. 2007;44(3):354-358. Oral zinc for the prevention of hyperbilirubinaemia in neonates. The USPSTF reviewed experimental and observational studies that included comparison groups. 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. The authors concluded that home-based phototherapy was more effective than hospital-based phototherapy in treatment for neonatal hyperbilirubinemia; home-based phototherapy was an effective, feasible, safe, and alternative to hospital-based phototherapy 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). Additional citations were identified from the bibliography of selected articles and from the abstracts of conference proceedings. Hamelin K, Seshia M. Home phototherapy for uncomplicated neonatal jaundice. Approximately 60% of term babies and 85% preterm babies will develop clinically apparent jaundice, which classically becomes visible on day 3, peaks days 5-7 and resolves by 14 days of age in a term infant and by 21 days in the preterm infant. However, that is not always the case. Wennberg RP. The studies were included if they compared TcB results with TSB in term and near-term infants during phototherapy or after discontinuation of phototherapy. The authors concluded that the role of massage therapy in the management of NNH was supported by the current evidence. Utilization Mangement and Q uality Review Manual Nebraska M edicaid, 2014, Phototherapy equipment (471 N AC 18-004.45A) De Luca D, Zecca E, Corsello M, et al. Eye issues due to immaturity or from the ointment applied to the newborns eyes. background: #5e9732; [glucose-6-phosphate dehydrogenase (G6PD), uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1), and. A randomized, triple-blind, placebo-controlled trial of prophylactic oral phenobarbital to reduce the need for phototherapy in G6PD-deficient neonates. Evidence Centre Evidence Report. Valaes T. Problems with prediction of neonatal hyperbilirubinemia. 2001;108:31-39. 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. 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. Do not subtract direct (conjugated) bilirubin. Ludwig MA. Cochrane Database Syst Rev. This reduction may be offset by an increase in mortality among infants weighing 501 to 750 g at birth. Prebiotics for the prevention of hyperbilirubinaemia in neonates. The USPSTF concluded that the evidence is insufficient to assess the balance of benefits and harms of screening for hyperbilirubinemia to prevent CBE. 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). Coding Guidelines 18, 19 The third trimester is the time of rapid weight gain, development of muscle mass and fat stores for the newborn. The authors found a moderate correlation between TcB and TSB during phototherapy with a marginal improvement in the post-phototherapy phase. In most of the trials, Field massage was given; 6 out of 8 trials reported reduction in bilirubin levels in term neonates. Can Nurse. For well infants 35 - 37 6/7 wk, can adjust TSB levels for intervention around the medium risk line. Starting Feb. 1, 2022, five new CPT codes will require preauthorization. Percussion should not cause red marks on your child. The AAP Guidelines suggest that an infant readmitted for hyperbilirubinemia, with a level of 18 mg/dL or more, should have a level of 13 - 14 mg/dL in order to discontinue phototherapy. NY State J Med. Hospitals typically decide the data provided by 3E0CX2 is not coded because it takes time to collect, clutters the rest of the data, and does not provide information to improve patient care or efficiency. MMWR Morb Mortal Wkly Rep. 2001;50(23):491-494. Search All ICD-10; ICD-10-CM Diagnosis Codes; ICD-10-PCS Procedure Codes 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. 2010;15(3):169-175. The primary outcome was a composite of death or neurodevelopmental impairment determined for 91 % of the infants by investigators who were unaware of the treatment assignments. Learn how we are healing patients through science & compassion, Stanford team stimulates neurons to induce particular perceptions in mice's minds, Students from far and near begin medical studies at Stanford. Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants. However, there is limited evidence regarding the effect of probiotics on bilirubin level in neonates. Everything I am finding indicates this code is used for dermatological treatment not for jaundice. 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. Aetna considers the use of antenatal phenobarbital to reduce neonatal jaundice in red cell isoimmunized pregnant women experimental and investigational because its effectiveness has not been established. A total of 3 small studies evaluating 154 infants were included in this review. These investigators also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for RCTs and quasi-randomized trials. 99462 3. Discharge normal newborn day 3 _____ 2. 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). The authors concluded that early DXM treatment does not affect the severity of neonatal hyperbilirubinemia in ELBW preterm infants. 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.". 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 A total of 259 neonates were included in the meta-analysis. Guidelines for Perinatal Care. 3. 65. Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: US Preventive Services Task Force recommendation statement. TcB measurements obtained on the forehead, sternum, abdomen and covered lower abdomen were statistically compared with the corresponding TSB. Treatment of jaundice in low birthweight infants. Description This policy details medical necessity criteria for home phototherapy for the treatment of neonatal . Aetna considersphototherapy medically necessary forterm andnear-term infantsaccording to guidelines published by the American Academy of Pediatrics (AAP). Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. 6. It has been debated if there is an upper limit on the efficiency of phototherapy. Digestive System Disorders. If the nurse visit results in a visit with the physician, only the physician services would be reported. If the abnormal results lead to diagnostic testing, they should be coded on an inpatient record.