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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. Coding Guidelines 18, 19 The third trimester is the time of rapid weight gain, development of muscle mass and fat stores for the newborn. London, UK: BMJ Publishing Group;November 2006. Travan et al (2014) examined if UGT1A1 promoter polymorphisms associated with Gilbert Syndrome (GS) occur with a greater frequency in neonates with severe hyperbilirubinemia. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. The authors concluded that genetic variants of bilirubin metabolism genes, including G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512, were associated with the risk of neonatal hyperbilirubinemia, and are potential markers for predicting the disorder. There is no CPT code because these hospital screenings are usually done by hospital staff who are trained by an audiologist. If the lining still has an opening into the abdomen, the fluid can move in and out of the lining surrounding the testicle. However, the results remain controversial. 16th ed. Pediatrics. Hayes Directory. list-style-type: lower-roman; TcB should not be used in patients undergoing phototherapy.". TcB consistently under-estimated TSB levels significantly. 66940 Removal of lens material; extracapsular (other than 66840, 66850, 66852) Learn more about pediatric cataract billing in Ophthalmic Coding: Learn to Code . 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. Pediatrics. Montreal, QC: CETS; October 2000. Grabert BE, Wardwell C, Harburg SK. 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. 1992;89:822-823. TcB measurements obtained on the forehead, sternum, abdomen and covered lower abdomen were statistically compared with the corresponding TSB. For the same reason, subcutaneous vaccine administration (3E0134Z Introduction of serum, toxoid and vaccine into subcutaneous tissue, percutaneous approach) usually is not coded. at the end of this policy for important regulatory and legal information. 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. .newText { 1990;4(6):304-308. 1992;89:827-828. The following are general age-in-hours specificTSBthreshold values forexchange transfusionbased 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 ofless 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. 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. E0202 is the HCPC for phototherapy that would normally be billed by the hospital/dme provider. 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. Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. Yang and colleagues (2018) noted that zinc sulfate may be a promising approach to treat neonatal jaundice. Lazar L, Litwin A, Nerlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. Aetna considers transcutaneous bilirubin devices for evaluating hyperbilirubinemia in term and near-term infants while undergoing phototherapy experimental and investigational becasue this approach is not reliable in infantsin this setting. 2013;89(5):434-443. Use a cupped hand or percussor cup. The correlation between TSB and TcB was found to be moderately close (r = 0.4 to 0.5). This reduction may be offset by an increase in mortality among infants weighing 501 to 750 g at birth. Am Fam Physician. Suresh GK, Martin CL, Soll RF. 2012;1:CD007966. Most newborns have ointment administered at birth, or soon after the initial bonding with the mother. Meta-analysis (random-effects model) showed probiotic supplementation reduced duration of phototherapy [n=415, MD: -11.80 (-17.47 to -6.13); p<0.0001; level of evidence (LOE): low]; TSB was significantly reduced at 96hours [MD: -1.74 (-2.92 to -0.57); p=0.004] and 7 days [MD: -1.71 (-2.25 to -1.17); p<0.00001; LOE: low] after probiotic treatment. This risk increased significantly in the CC genotype carriers at the rs4149056 locus of the SLCO1B1 gene (OR=2.17, 95 % CI: 1.87 to 2.33), whereas it decreased significantly in individuals carrying the G-allele at the rs699512 locus of the BLVRA gene (adjusted OR=0.84, p= 0.01, 95 % CI: 0.75 to 0.95). In pre-planned subgroup analyses, the rates of death were 13 % with aggressive phototherapy and 14 % with conservative phototherapy for infants with a birth weight of 751 to 1,000 g and 39 % and 34 %, respectively (relative risk, 1.13; 95 % CI: 0.96 to 1.34), for infants with a birth weight of 501 to 750 g. The authors concluded that aggressive phototherapy did not significantly reduce the rate of death or neurodevelopmental impairment. Only 1 study met the criteria of inclusion in the review. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. The authors concluded that limited low-quality evidence indicated that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. 202;11(1):e040182. 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. Care of newborns who are not normal but do not require intensive services may be reported with codes for initial hospital care (99221-99223). Probiotics supplementation treatment showed efficacy [RR: 1.19, 95 % CI: 1.12 to 1.26), p < 0.00001] in neonatal jaundice. The authors found a moderate correlation between TcB and TSB during phototherapy with a marginal improvement in the post-phototherapy phase. phototherapy in the home, applied by a . 2. 1994;94(4 Pt 1):558-565 (reviewed 2000). Ludwig MA. 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. Associations between G6PD, OATP1B1 and BLVRA variants and susceptibility to neonatal hyperbilirubinaemia in a Chinese Han population. Numerous skin findings may be noted, but are not coded in the inpatient record unless they are clinically significant. This is not a reportable inpatient condition. So why would you not use one of the codes from 99221-99223 for the first day? list-style-type: upper-alpha; CETS 99-6 RE. 3. Most of the included studies only mentioned the use of random allocation, but they did not describe the specific random allocation method. 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. Use total bilirubin. There were no significant differences in SLCO1B1 463 C>A between the hyperbilirubinemia and the control group. Acta Paediatr. Cochrane Database Syst Rev. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. J Perinatol. Typically, no extra resources are required during the newborn hospitalization, so do not code the condition. There is no CPT code because these hospital screenings are usually done by hospital staff who are trained by an audiologist. Wong RJ, Bhutani VK. Johnson LH. 2017:1-9. Inpatient coders do not code immature lacrimal ducts because the condition does not use additional resources. Randomized, controlled trial of early intravenous nutrition for prevention of neonatal jaundice in term and near-term neonates. Do not subtract direct (conjugated) bilirubin. color: red 4. 1986;25(6):291-294. .strikeThrough { Clin Pediatr (Phila). 2019;68(1):E4-E11. These are not additional resources. Blood testing done as a diagnostic test, however, meets the requirements for coding the jaundice. padding: 10px; Pediatrics. If time is not significant, and it does not impact medical decision-making, it does not meet the definition of an additional professional encounter diagnosis. Search All ICD-10 Toggle Dropdown. Approximately 2 ml of peripheral venous blood was taken from all subjects. 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. 2008;359(18):1885-1896. The literature search was done for various RCTs by searching the Cochrane Library, PubMed, and Embase. Hulzebos CV, Bos AF, Anttila E, et al. Bhutani VK, Stark AR, Lazzeroni LC, et al; Initial Clinical Testing Evaluation and Risk Assessment for Universal Screening for Hyperbilirubinemia Study Group. Everything I am finding indicates this code is used for dermatological treatment not for jaundice. Makay B, Duman N, Ozer E, et al. During an initial newborn evaluation, watchful waiting conditions are findings that usually resolve without medical intervention in a few weeks to a few years. Pediatrics. 2002;65(4):599-606. 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. Bilirubin recommendations present problems: New guidelines simplistic and untested. Analysis of rebound and indications for discontinuing phototherapy. list-style-type: upper-roman; 2008;358(9):920-928. Menu penelope loyalty quotes. This is caused by a small opening in the abdominal muscles that abdominal contents (e.g., fluid, abdominal lining) spill through. A total of 10 articles were included in the study. Guidelines from the American Academy of Pediatrics (AAP, 2004)on management of hyperbilirubinemia in thenewborn infantstate that "Measurement of the glucose-6-phosphate dehydrogenase (G6PD) level is recommended for a jaundiced infant who is receiving phototherapy and whose family history or ethnic or geographic origin suggest the likelihood of G6PD deficiency or for an infant in whom the response to phototherapy is poor(evidence quality C: benefits exceed harms)". Cases were identified in the Danish Extreme Hyperbilirubinemia Database that covers the entire population. A heterozygous group was also equally distributed between cases (44.3 %) and controls (42.9 %). For more information about blocked lacrimal ducts, visit: aao.org/eye-health/diseases/treatment-blocked-tear-duct. 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. Mt Sinai J Med. Both trials in preterm neonates and most of the trials in term neonates (5 trials) reported increased stool frequencies. 1992;89:823-824. These investigators included trials where neonates with hyperbilirubinemia received either clofibrate in combination with phototherapy or phototherapy alone or placebo in combination with phototherapy. 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. This review included 6 RCTs that fulfilled inclusion criteria. Report code 99466 for 30-74 minutes of hands-on care and code 99467 for each additional 30 minutes of hands-on care. 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. J Perinatol. Per the ICD-10-PCS Official Guidelines for Coding and Reporting, only clinically significant conditions are reported. Data were statistically extracted and evaluated by RevMan 5.3 software. On the pediatricians encounter, code P13.4 Fracture of clavicle due to birth injury because it involved medical decision-making. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. 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. Available at: http://www.natus.com/information/breath_analysis/. Although screening can predict hyperbilirubinemia, there is no robust evidence to suggest that screening is associated with favorable clinical outcomes. The authors concluded that the role of zinc in the prevention of neonatal hyperbilirubinemia is not supported by the current evidence. A total of 3 small studies evaluating 154 infants were included in this review. The beroptic system consists of a pad of 1992;31(6):345-352. eMedicine J. French S. Phototherapy in the home for jaundiced neonates. These investigators conducted a systematic review and meta-analysis to examine the safety and efficacy of zinc sulfate on hyperbilirubinemia among neonates. This Clinical Policy Bulletin may be updated and therefore is subject to change. In that case, other conditions can be coded if they were involved in medical decision-making, or otherwise affected the episode of care. 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. 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. Studies were analyzed for methodological quality in a "Risk of bias" table. Testicles develop in the abdomen. display: block; For well infants 35 - 37 6/7 wk, can adjust TSB levels for intervention around the medium risk line. tradicne jedla na vychodnom slovensku . Several risk factors for hyperbilirubinemia are known, but in a large number of patients, a causal factor is never established. Do I Use 25 or 59 for Same-day Assessment and E/M? The dose of zinc varied from 5 to 20mg/day and duration from 5 to 7 days. Clin Pediatr. Evidence Report/Technology Assessment No. 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). .strikeThrough { 2018;31(10):1311-1317. If the newborn jaundice is excessive, hospitals use bili lights. The order of use of the instruments was randomized. Sacral dimples without diagnostic services, such as diagnostic imaging, are not coded on inpatient records. cpt code for phototherapy of newbornhippo attacks human video. 2021;34(21):3580-3585. } 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. 2019;55(9):1077-1083. The authors concluded that early DXM treatment does not affect the severity of neonatal hyperbilirubinemia in ELBW preterm infants. Although inflammation occurs less frequently now than in the past because the medication used has changed, it may occur. There was no evidence of a significant difference in duration of phototherapy between the prebiotic and control groups, which was only reported by 1 study (MD 0.10 days, 95 % CI: -2.00 to 2.20; 1 study, 50 infants; low-quality evidence). If this is your first visit, be sure to check out the. For more information about cryptorchidism, visit: ncbi.nlm.nih.gov/pubmed/10932966. 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. Codes for circumcision procedures include: When providing E/M services to other than normal newborns, choose the level of care based on the intensity of the service and status of the newborn. 2006;117(2):474-485. In: Nelson Textbook of Pediatrics. 66850 Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration. 2010;(1):CD001146. 2001;21(Suppl 1):S63-S87. Maisels MJ, McDonagh AF. Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants. Pediatrics. Incidence is as high as 30 percent in premature male neonates. In those (uncommon) circumstances, report P83.5 Congenital hydrocele. Infants had been treated with DXM (0.25 mg/kg twice-daily at postnatal day 1 and 2) or with placebo (normal saline). We are looking for thought leaders to contribute content to AAPCs Knowledge Center. Hamelin K, Seshia M. Home phototherapy for uncomplicated neonatal jaundice. Although the duration of phototherapy in the zinc group was significantly shorter compared to the placebo group (n = 286; MD -12.80, 95 % CI: -16.93 to -8.67), the incidence of need for phototherapy was comparable across both the groups (n = 286; RR 1.20; 95 % CI: 0.66 to 2.18). Pediatrics. Brown AK, Seidman DS, Stevenson DK. www.hayesinc.com. They considered all RCTs that studied neonates comparing enteral feeding supplementation with prebiotics versus distilled water/placebo or no supplementation. This service includes time spent addressing routine feeding issues. All the studies used zinc sulfate, only 1 study used zinc gluconate. Clayton,VIC: Centre for Clinical Effectiveness (CCE); 2003. Pediatrics. Clofibrate in combination with phototherapy for neonatal hyperbilirubinemia is considered experimental and investigational. 2017:1-10. Treatment of jaundice in low birthweight infants. Stevenson DK, Fanaroff AA, Maisels MJ, et al. Third, since RCTs of included studies centered in a short observation period and did not follow-up the patients in long-term, the methodological quality of clinical trials with probiotics supplementation therapy for neonatal jaundice needed further improvement. 2014;134(3):510-515. It suggested that these researchers should use the same guideline to detect the time of jaundice fading in future study. 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). The fetal blood is designed to attract oxygen from the mothers blood. This document addresses the use of home phototherapy and the devices used for the treatment of neonatal jaundice that is physiologic (that is, non-pathologic) in nature. Approximately one in 1,000 children have congenital developmental dysplasia of the hip, which is coded Q65.89 Other specified congenital deformities of hip. 2003;(1):CD004207. 2011;100(2):170-174. 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. Management of neonatal hyperbilirubinemia. Data were statistically extracted and evaluated using RevMan 5.3 software. For harms associated with phototherapy, case reports or case series were also included. Gholitabar M, McGuire H, Rennie J, et al. These researchers conducted a systematic review of studies comparing TcB devices with TSB in infants receiving phototherapy or in the post-phototherapy phase. Mishra S, Cheema A, Agarwal R, et al. Stigma (plural stigmata) is a finding that may indicate an abnormal condition, such as a sacral dimple without a visible floor being stigma for occult spina bifida. Newborn jaundice happens when the newborns liver and sunshine on the newborns skin dont remove the fetal blood components in an efficient manner. J Perinatol. Some studies showed that unclear random allocation and allocation plan might exaggerate the hidden effect of up to 30 to 41 %. 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. 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. The increased bilirubin from hemolysis often needs phototherapy, exchange transfusion or both after birth. Do not code this condition for the newborn inpatient encounter, unless additional resources are 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. These researchers evaluated the role of massage therapy for reduction of NNH in both term and preterm neonates. Phototherapy for neonatal jaundice. Prebiotics for the prevention of hyperbilirubinaemia in neonates. It is also important to note that thereare serious health risks associatedwith corticosteroid therapy. Torres-Torres M, Tayaba R, Weintraub A, et al. Total serum bilirubin concentrations peaked 30 hours earlier in the DXM group (p 0.05). The authors concluded that phototherapy significantly interfered with the accuracy of transcutaneous bilirubinometry; TcB measurements performed 2 hours after stopping phototherapy were not reliable, even if they were performed on the unexposed body area. 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. Chawla D, Parmar V. Phenobarbitone for prevention and treatment of unconjugated hyperbilirubinemia in preterm neonates: A systematic review and meta-analysis. Severe hyperbilirubinemia was used as a surrogate for possible chronic bilirubin encephalopathy (CBE), because no studies directly evaluated the latter as an outcome. 6. The authors concluded that there is a compelling need for the long-term follow-up and reporting of late outcomes, especially neurological and developmental outcomes, among surviving infants who participated in all randomized trials of early postnatal corticosteroid treatment. Waltham, MA: UpToDate;reviewed January 2015; January 2017. The RR or MD with a 95 % CI was used to measure the effect. 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). Sometimes, a parent declines prophylactic services such as the eye ointment and vaccinations. Chen Z, Zhang L, Zeng L, et al. Wennberg RP, Ahlfors CE, Bhutani VK, et al. Percussion should not cause red marks on your child. 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. 2010;15(3):164-168. 2014;165(1):42-45. Oral zinc was administered in a dose of 5 ml twice-daily from day 2 to day 7 post-partum. Travan L, Lega S, Crovella S, et al. After maintenance phototherapy was discontinued, 7 patients (23% ) had a sustained disease-free interval lasting more than 58 months (median of greater than 90 months). Incidence of hyperbilirubinaemia, defined as serum total bilirubin (STB) greater than or equal to 15 mg/dL, was similar between groups (n = 286; risk ratio (RR) 0.94, 95 % CI: 0.58 to 1.52). Do not percuss over the backbone, breastbone, or lower two ribs. If the lining closes and the fluid has nowhere to go, its a noncommunicating hydrocele. Privacy Policy | Terms & Conditions | Contact Us. 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. 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. 1992;89:821-822. Links to various non-Aetna sites are provided for your convenience only. Nelson Textbook of Pediatrics. The ICD-10-PCS code for light treatment of the skin is 6A600ZZ Phototherapy of skin, single for a single treatment. 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. Malpresentations are almost always noted on the inpatient record. None of the studies reported on bilirubin encephalopathy rates, neonatal mortality rates, or the levels of parental or staff satisfactions with the interventions. Two studies also provided results as Bland-Altman difference plots (mean TcB-TSB differences -29.2 and 30 mol/L, respectively). Aetna considers measurement of glucose-6-phosphate dehydrogenase (G6PD) levelsmedically necessary for jaundiced infants who are receiving phototherapy, where response to phototherapy is poor, or where the infant is at an increased risk of G6PD deficiency due to family history, ethnic or geographic origin. } When no additional resources are used, this is not coded on the inpatient record, and is part of the pediatricians well-baby check. Morris and colleagues (2008) compared aggressive versus conservative phototherapy for infants with extremely low birth weight. A total of 259 neonates were included in the meta-analysis. 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. Saunders Co.; 2000:513-519. 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. All studies were found to be of low-risk based on Cochrane Collaborative Risk of Bias Tool. Otherwise, at 3 to 4 years of age, the hernia will be surgically repaired.