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If another physician provides critical care services to the neonate on the same date, that physician must report the services with critical care service codes 99291-99292. Home phototherapy. Other methods, such as enteral feeding supplementation with prebiotics, may have an effective use in the management of hyperbilirubinemia in neonates. } Mishra S, Cheema A, Agarwal R, et al. An alternative to prolonged hospitalization of the full-term, well newborn. text-decoration: line-through; These researchers evaluated the role of massage therapy for reduction of NNH in both term and preterm neonates. Approximately 2 ml of peripheral venous blood was taken from all subjects. Description Testicles develop in the abdomen. 1992;89:821-822. .newText { First, because the value of jaundice fading in each guideline was different, the heterogeneity was high in time of jaundice fading. registered for member area and forum access. Percussion should not cause red marks on your child. In a Cochrane review, Thomas et al (2007) stated that neonates from isoimmunized pregnancies have increased morbidity from neonatal jaundice. Cochrane Database Syst Rev. Study authors were contacted for additional information. The linear regression analysis showed a better correlation between BiliCheck and serum bilirubin (r = 0.75) than between BiliMed and serum bilirubin (r = 0.45). Immaturity is not congenital absence, agenesis, stenosis, stricture, or malformation. Typically, no extra resources are required during the newborn hospitalization, so do not code the condition. It may not display this or other websites correctly. 65. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. The extracted information of RCTs should include efficacy rate, serum total bilirubin level, time of jaundice fading, duration of phototherapy, duration of hospitalization, adverse reactions. Although declining the inpatient prophylactic services is not reportable by inpatient hospital coders (because it does not affect the hospitalization), outpatient physician office coders can and should use Z28 Immunization not carried out and under immunization status codes when provider-recommended immunizations are not administered. The impact of SLCO1B1 genetic polymorphisms on neonatal hyperbilirubinemia: A systematic review with meta-analysis. Exchange transfusion should be performed in a neonatal intensive care unit (NICU) due to significant risks. li.bullet { Garg BD, Kabra NS, Balasubramanian H. Role of massage therapy on reduction of neonatal hyperbilirubinemia in term and preterm neonates: A review of clinical trials. 7. } Inpatient treatment is generally not medically necessary for healthy full-term infants with aTSB less than 20 mg/dL, as these infants can usually be treated with expectant observation or home phototherapy. foam closure strips for metal roofing | keokuk, iowa arrests newington high school football coach 0 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. Language services can be provided by calling the number on your member ID card. In general, serum bilirubin levels . The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for reporting methods and results of synthesis with meta-analysis. NY State J Med. Randomized and quasi-randomized controlled trials of pregnant women established to have red cell isoimmunization in the current pregnancy during their antenatal testing and given phenobarbital alone or in combination with other drugs before birth were selected for review. Now, newborns are checked with a transcutaneous bilirubinometer, and the pediatrician reviews standard laboratory blood screenings. All searches were re-run on April 2, 2012. 2008;359(18):1885-1896. 99462 3. 2016;109(3):203-212. newborn, known as hyperbilirubenemia. 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. 2005;25(5):325-330. If approved, tin-mesoporphyrin could find immediate application in preventing the need for exchange transfusion in infants who are not responding to phototherapy." Pediatrics. Arch Dis Child Fetal Neonatal Ed. 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. If the nurse visit results in a visit with the physician, only the physician services would be reported. UpToDate[online serial]. OL OL OL OL LI { Yang and colleagues (2018) noted that zinc sulfate may be a promising approach to treat neonatal jaundice. 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. 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. Front Pharmacol. background: #5e9732; Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. J Pediatr. 2007;(2):CD005541. 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. 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. Hayes Directory. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Chu and colleagues (2020) stated that phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. }. Schuman AJ, Karush G. Fiberoptic vs conventional home phototherapy for neonatal hyperbilirubinemia. His or her temperature should be between 97F and 100F (36.1C and 37.8C). Treatment of unconjugated hyperbilirubinemia in term and late preterm infants. ICD-10 Restricts Same-day Sick and Well Visits. An example is hemangiomas (e.g., strawberry hemangiomas), which do not impinge on vital structures and are not located in the periorbital area, lip, neck, or sacral region. 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. So, it was hard for these investigators to determine whether the allocation scheme was appropriate and whether blinding of participants and personnel was implemented. Expect to see this monitored; usually there is a consult/referral around six months of age for newborns with undescended testicle(s). Randomized controlled trials were identified by searching MEDLINE (1950 to April 2012) before being translated for use in The Cochrane Library, EMBASE 1980 to April 2012 and CINAHL databases. 2017:1-9. So why would you not use one of the codes from 99221-99223 for the first day? map of m6 motorway junctions. J Paediatr Child Health. Curr Opin Pediatr. Most newborns have ointment administered at birth, or soon after the initial bonding with the mother. Eye issues due to immaturity or from the ointment applied to the newborns eyes. Newborn jaundice happens when the newborns liver and sunshine on the newborns skin dont remove the fetal blood components in an efficient manner. 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 investigators evaluated the effects of antenatal phenobarbital in red cell isoimmunized pregnancies in reducing the incidence of phototherapy and exchange transfusion for the neonate. Evaluation and management (E/M) services provided to normal newborns in the first days of life prior to hospital discharge are reported with Newborn Care Services codes. Normal Newborn visit, day 2 3. After the newborn begins to breath on his own, the fetal blood is destroyed and replaced with blood that works with lungs. 2007;12(5):1B-12B. Everything I am finding indicates this code is used for dermatological treatment not for jaundice. 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. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. A total of 9 RCTs (prophylactic: 6 trials, n=1,761; therapeutic: 3 trials, n=279) with low- to high-risk of bias were included. American Academy of Pediatrics and American College of Obstetricians and Gynecologist. Multiple treatments is coded 6A601ZZ Phototherapy of skin, multiple. Accessed January 30, 2019 . Risk of bias was assessed using the QUADAS-2 tool. Prediction of hyperbilirubinemia in near-term and term infants. Search All ICD-10; ICD-10-CM Diagnosis Codes; ICD-10-PCS Procedure Codes 1986;25(6):291-294. Fractured clavicles are usually noted by the pediatrician on the newborn evaluation, but do not meet the definition of clinical significance. Medline, Embase, Cochrane Library, CINAHL and Scopus databases (from inception to May 8, 2014) were searched. Petersen JP, Henriksen TB, Hollegaard MV, et al. 1991;91:483-489. 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. Pediatrics. A total of 10 articles were included in the study. Hamelin K, Seshia M. Home phototherapy for uncomplicated neonatal jaundice. Stevenson DK, Fanaroff AA, Maisels MJ, 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. All Rights Reserved. #closethis { With time, the lacrimal ducts mature and the membrane covering the nasolacrimal ducts open. Codes for initial care of the normal newborn include: After the newborn has been discharged to home, it is common practice to see the infant to assess for jaundice or any feeding problems. J Perinatol. Semin Fetal Neonatal Med. 1992;89:809-818. Hyperbilirubinemia in the term newborn. Attempt to improve transcutaneous bilirubinometry: A double-blind study of Medick BiliMed versus Respironics BiliCheck. .strikeThrough { A fetus blood is different than an adults. Phototherapy was well-tolerated without evidence of significant photo-damage or photo-carcinogenicity. 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. Okwundu CI, Okoromah CA, Shah PS. 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. Kernicterus in full-term infants--United States, 1994-1998. In a Cochrane review, Mishra and colleagues (2015) examined the effect of oral zinc supplementation compared to placebo or no treatment on the incidence of hyperbilirubinaemia in neonates during the first week of life and to evaluate the safety of oral zinc in enrolled neonates. 1998;101(1 Pt 1):25-31. This indicated that cure may have been achieved in a minority of patients. The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. Clin Pediatr (Phila). Brown AK, Seidman DS, Stevenson DK. Care of newborns who are not normal but do not require intensive services may be reported with codes for initial hospital care (99221-99223). Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. color: blue Travan L, Lega S, Crovella S, et al. Treatment of jaundice in low birthweight infants. Phototherapy for neonatal jaundice. Clofibrate in combination with phototherapy for neonatal hyperbilirubinemia is considered experimental and investigational. Some studies showed that unclear random allocation and allocation plan might exaggerate the hidden effect of up to 30 to 41 %. Johnson LH. Torres-Torres M, Tayaba R, Weintraub A, et al. The drug was administered into the mouth of the infant by the plastic measure provided with the bottle or with a spoon. J Perinatol. No (TA)8 repeat was found in the 2 groups. Screening is usually done as close as possible to inpatient discharge for this reason. The need for PT as well as the duration of PT were similar in both groups. These ELBW infants had participated in a randomized controlled trial of early DXM therapy thataimed toevaluate effects on chronic lung disease. Intensive phototherapy in form of double light is used worldwide in the treatment of severe neonatal hyperbilirubinemia. 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis. Zhang M , Tang J, He Y, et al. 2006;117(2):474-485. Although an undescended testicle usually is described as palpable or impalpable, also get the location, if you can. If done right, you will hear a popping sound. Second, according to Cochrane risk of bias estimation, randomized allocation of participants was mentioned in 9 trials. They stated that further research is needed before the use of TcB devices can be recommended for these settings. Toggle navigation. J Adv Nurs. Newborn Care 1. The provider should document whether the testis is ectopic (e.g., in the superficial inguinal pouch) or abdominal. These researchers identified studies through Medline searches, perusing reference lists and by consulting with United States Preventive Services Task Force(USPSTF) lead experts. Utilization Mangement and Q uality Review Manual Nebraska M edicaid, 2014, Phototherapy equipment (471 N AC 18-004.45A) FN07-02. Conseil de valuation des Technologies de la Sant du Qubec (CETS). Swelling in such a hydrocele is uniform, over time, until the fluid is absorbed by the body. It affects approximately 2.4 to 15 % of neonates during the first 2 weeks of life. None of the studies reported on bilirubin encephalopathy rates, neonatal mortality rates, or the levels of parental or staff satisfactions with the interventions. Dennery PA. Metalloporphyrins for the treatment of neonatal jaundice. Atotal of 686 healthy newborns needing measurement of their bilirubin were enrolled over a 4-month period. They considered all RCTs that studied neonates comparing enteral feeding supplementation with prebiotics versus distilled water/placebo or no supplementation. Inpatient coders dont collect watchful waiting conditions. 96.4. Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: US Preventive Services Task Force recommendation statement. 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). Genotypes were obtained through the Danish Neonatal Screening Biobank. 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). American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Chu L, Qiao J, Xu C, et al. 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. 2003;(1):CD004207. 2008;93(2):F135-F139. The authors concluded that the use of antenatal phenobarbital to reduce neonatal jaundice in red cell isoimmunized pregnant women has not been evaluated in randomized controlled trials. They used a fixed-effect method in combining the effects of studies that were sufficiently similar; and then used the GRADE approach to assess the quality of the evidence. Wennberg RP. As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. 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. Although inflammation occurs less frequently now than in the past because the medication used has changed, it may occur. Hospital readmission due to neonatal hyperbilirubinemia. Exploring the genetic architecture of neonatal hyperbilirubinemia. The longer the newborn has before an auditory function screening, the greater the chance of a successful screening. 2021;16(5):e0251584. In those (uncommon) circumstances, report P83.5 Congenital hydrocele. The increased bilirubin from hemolysis often needs phototherapy, exchange transfusion or both after birth. Incidence is as high as 30 percent in premature male neonates. Evidence Centre Evidence Report. This service includes time spent addressing routine feeding issues. 99460-99461 initial service 2. } Maisels MJ, Watchko JF. J Pediatr Gastroenterol Nutr. Use a cupped hand or percussor cup. TcB measurements were inaccurate, regardless of phototherapy technique (Bilibed, conventional phototherapy). Because this is a normal condition, there is no code for it. In 54 ELBW preterm infants, TSB and phototherapy (PT) data during the first 10 days were evaluated retrospectively. Unless there are issues, congenital hydroceles also are not coded on the well-baby checks. Usually, the time spent teaching parents how to care for the newborns eyes until the lacrimal ducts mature is not significant. Jaundice, Coombs, and Phototherapy AAP Clinical Practice Guideline - Summary Bhutani Nomogram Guidelines for Phototherapy FAQs About Phototherapy In preterm infants, phototherapy should be initiated at 50 to 70 % of the maximum indirect levels below: Footnotes* Complications include but are not limited to prenatal asphyxia, acidosis, hypoxia, hypoalbuminemia, meningitis, intraventricular hemorrhage, hemolysis, hypoglycemia, or signs of kernicterus. Chen Z, Zhang L, Zeng L, et al. In a prospective study, Casnocha and colleagues (2016) tested the accuracy of TcB measure in newborns undergoing phototherapy. 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). J Matern Fetal Neonatal Med. . Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants. Deshmukh and associates (2017) noted that neonatal jaundice requiring phototherapy is associated with significant socioeconomic burden including hospital re-admission, prolonged hospital stay, and separation of the baby from mother. 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. In most of the trials, Field massage was given; 6 out of 8 trials reported reduction in bilirubin levels in term neonates. Casnocha Lucanova L, Matasova K, Zibolen M, Krcho P. Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy. Pediatrics. You must log in or register to reply here. 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. Toward understanding kernicterus: A challenge to improve the management of jaundiced newborns. The USPSTF concluded that the evidence is insufficient to assess the balance of benefits and harms of screening for hyperbilirubinemia to prevent CBE. The literature search was done for various RCTs by searching the Cochrane Library, PubMed, and Embase. Serum and transcutaneous bilirubin (TcB) measurements were taken with both devices within 15 mins. herman's coleslaw recipe. As with the initial critical care, only one physician may report code 99469 on a given date. This Clinical Policy Bulletin may be updated and therefore is subject to change. These usually heal and resolve on their own. 1992;31(6):345-352. 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. Two hundred years ago, newborns would have been placed on blankets in the sun for newborn jaundice. One study reported a significant reduction in the risk of hyperbilirubinemia and rate of treatment with phototherapy associated with enteral supplementation with prebiotics (RR 0.75, 95 % CI: 0.58 to 0.97; 1 study, 50 infants; low-quality evidence). Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. 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. .strikeThrough { The SLCO1B1 521 T>C mutation showed a low risk of neonatal hyperbilirubinemia in Chinese neonates, while no significant associations were found in Brazilian, white, Asian, Thai, and Malaysian neonates. J Pediatr Health Care. For well infants 35 - 37 6/7 wk, can adjust TSB levels for intervention around the medium risk line. 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). Overall, compared with placebo, zinc sulfate supplementation failed to significantly reduce TSB on 3 days (MD=0.09mg/dL; 95 % CI:-0.49 to 0.67; p=0.77), TSB on 7 days (MD=-0.37mg/dL; 95 % CI:-98 to 0.25; p=0.25) as well as the incidence of hyperbilirubinemia (OR=1.14; 95 % CI:0.74 to 1.76; p=0.56). 2004;114(1):297-316. The influence of zinc sulfate on neonatal jaundice: A systematic review and meta-analysis. 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. 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. Sacral dimples without diagnostic services, such as diagnostic imaging, are not coded on inpatient records. Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. padding-bottom: 4px; The dose of zinc varied from 5 to 20mg/day and duration from 5 to 7 days. Probiotics supplementation therapy for pathological neonatal jaundice: A systematic review and meta-analysis. It has been debated if there is an upper limit on the efficiency of phototherapy. This is not a reportable inpatient condition. 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. Morris BH, Oh W, Tyson JE, et al; NICHD Neonatal Research Network. 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. } When the newborn is critically ill or injured, codes exist for reporting of services provided during interfacility transport, initial critical care, and subsequent critical services. Cases were identified in the Danish Extreme Hyperbilirubinemia Database that covers the entire population. Merenstein GB. color: red The pediatrician will wait watchfully and check the clavicle until its healed. 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. 2017;30(16):1953-1962. 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. The fetal blood is designed to attract oxygen from the mothers blood. Newborn/neonate - Age ranges from birth to 28 days Anomaly - Developmental deformity Congenital - Condition present at birth, however, may not manifest until later in life 5 Neonatal Coding Guidelines Newborn/perinatal conditions are never reported on the mother's record, and likewise, pregnancy Several risk factors for hyperbilirubinemia are known, but in a large number of patients, a causal factor is never established. No study assessed harms of screening. Guidelines for Perinatal Care. CPT CODE 96910, 96912, 96920 CPT/HCPCS Codes: 96910 Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B . The smallest but significant difference between TSB and TcB was found on the lower abdomen. J Matern Fetal Neonatal Med. Only 1 study met the criteria of inclusion in the review. 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. A total of 259 neonates were included in the meta-analysis. Comp arative Effectiveness of Fiberoptic Phototherapy for Hyperbilirubinemia in Term Infants. 2012;12:CD009017. Less than 30 minutes of hands-on care during transport would not be separately reported. Elk Grove Village, IL: AAP; 1997. Data were statistically extracted and evaluated using RevMan 5.3 software. 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.

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