cpt code for phototherapy of newborn

(For the definition of critically ill or injured see the Critical Care Services subsection of CPT before codes 99291-99292.) The pediatrician notes the abnormal results have implications for future healthcare. Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia. The authors concluded that this meta-analysis showed that probiotics supplementation therapy was an effective and safe treatment for pathological neonatal jaundice. 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. 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. Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. 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. map of m6 motorway junctions. Seidman DS, Stevenson DK, Ergaz Z, et al. 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. The ball at the proximal end of the femur is supposed to fit snuggly into the acetabulum (the cup-shaped depression in the pelvis). Brown AK, Seidman DS, Stevenson DK. Nelson Textbook of Pediatrics. In a systematic review and meta-analysis, Chu and colleagues (2021) examined if intermittent phototherapy is more effective than continuous phototherapy in the treatment of neonatal hyperbilirubinemia. Most of the included studies only mentioned the use of random allocation, but they did not describe the specific random allocation method. J Pediatr (Rio J). Pediatrics. www.hayesinc.com. 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. color: blue!important; 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. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. However, there was insufficient evidence to recommend their use because of inadequate data on safety and long-term outcomes. The increased bilirubin from hemolysis often needs phototherapy, exchange transfusion or both after birth. Approximately 10 to 20 percent of newborns have an umbilical hernia. ICD-10 Restricts Same-day Sick and Well Visits. Pediatrics. } J Pediatr. The correlation between TSB and TcB was found to be moderately close (r = 0.4 to 0.5). 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. 202;11(1):e040182. It affects approximately 2.4 to 15 % of neonates during the first 2 weeks of life. Thomas JT, Muller P, Wilkinson C. Antenatal phenobarbital for reducing neonatal jaundice after red cell isoimmunization. @media print { Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: US Preventive Services Task Force recommendation statement. 2011;128(4):e1046-e1052. display: block; So why would you not use one of the codes from 99221-99223 for the first day? 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. 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. Home phototherapy. Prebiotics for the prevention of hyperbilirubinaemia in neonates. Various trials in pregnant women who were not isoimmunized but had other risk factors for neonatal jaundice have shown a reduction in need for phototherapy and exchange transfusion by the use of antenatal phenobarbital. Waltham, MA: UpToDate;reviewed January 2015; January 2017. 2003;88(6):F459-F463. 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). Last Review A recent retrospective case-controlled study showed reduction in the need for exchange transfusion for the neonates from isoimmunized pregnancies. 2021;34(21):3580-3585. Neonatology. The order of use of the instruments was randomized. 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. In a Cochrane review, Thomas et al (2007) stated that neonates from isoimmunized pregnancies have increased morbidity from neonatal jaundice. J Perinatol. The impact of SLCO1B1 genetic polymorphisms on neonatal hyperbilirubinemia: A systematic review with meta-analysis. 1995;96(4 Pt 1):727-729. Murki S, Dutta S, Narang A, et al. 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. 99462 3. I have a provider that ordered phototherapy for a newborn in the hospital with jaundice and he is wanting to bill 96900. .strikeThrough { A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. 1992;31(6):345-352. Do not percuss over the backbone, breastbone, or lower two ribs. Do not confuse light treatment with ultraviolet light therapy, which is usually used for skin conditions such as psoriasis. 2011;12:CD007969. Both case and control subjects were full term newborns. 1998;94(1):39-40. 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. Additionally, no serious adverse reaction was reported. Clinical evaluation (e.g., specialty consult during the hospitalization); Therapeutic treatment (e.g., bili lights for clinically significant neonatal jaundice); Diagnostic procedures (e.g., ultrasound due to sacral dimple); Extended length of hospital stay (e.g., beyond the average for the MS-DRG); Increased nursing care and/or monitoring (e.g., neonatal intensive care unit); or. The drug was administered into the mouth of the infant by the plastic measure provided with the bottle or with a spoon. Am Fam Physician. Home-based phototherapy versus hospital-based phototherapy for treatment of neonatal hyperbilirubinemia: A systematic review and meta-analysis. Associations between G6PD, OATP1B1 and BLVRA variants and susceptibility to neonatal hyperbilirubinaemia in a Chinese Han population. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for reporting methods and results of synthesis with meta-analysis. Assign codes for conditions that have been specified by the provider as having implications for future healthcare needs. www.stanfordchildrens.org/en/topic/default?id=developmental-dysplasia-of-the-hip-ddh-90-P02755 hip dysplasia Other methods, such as enteral feeding supplementation with prebiotics, may have an effective use in the management of hyperbilirubinemia in neonates. 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. Aetna considers genotyping of BLVRA, SLCO1B1 and UGT1A1 experimental and investigational for assessing risk of neonatal hyperbilirubinemia because the clinical value of this approach has not been established. The presumed mechanism of effect is photo-excitation of bilirubin extravascularly in the skin with the formation of bilirubin isomers which can be e Multiple treatments is coded 6A601ZZ Phototherapy of skin, multiple. This is not the same as for professional services coding, where the first-listed diagnosis is the reason for the encounter. The authors concluded that zinc sulfate could not reduce the TSB on 3 days and 7 days, the incidence of hyperbilirubinemia and phototherapy requirement, but resulted in significantly decreased duration of phototherapy. 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. Wong RJ, Bhutani VK. Cochrane Database Syst Rev. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. 2010;15(3):169-175. 2019;68(1):E4-E11. J Pediatr. These investigators assessed the safety and efficacy of probiotics in reducing the need for phototherapy and its duration in NNH. Two studies also provided results as Bland-Altman difference plots (mean TcB-TSB differences -29.2 and 30 mol/L, respectively). None of the included studies reported any side effects. Everything I am finding indicates this code is used for dermatological treatment not for jaundice. NY State J Med. A total of 3 small studies evaluating 154 infants were included in this review. J Perinatol. 2018;31(10):1311-1317. 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. on Watchful Waiting:Collecting Newborn Information, Watchful Waiting:Collecting Newborn Information, Tech & Innovation in Healthcare eNewsletter, Capture Active Duty Diagnoses with DoD Unique Codes, Finally Tobacco Use That Isn't a Mental Health Issue, Know Your Payer to Make the Most of Modifier 24, Modifier 25 for E/M on the Day of an Injection Procedure. Some watchful waiting issues require continued outpatient evaluation until resolution. J Matern Fetal Neonatal Med. Ludwig MA. 1994;61(5):424-428. OL OL OL LI { The authors concluded that intermittent phototherapy appeared to be as effective as continuous phototherapy for the treatment of neonatal hyperbilirubinemia and was safer than continuous phototherapy. They performed a systematic review of RCTs of probiotic supplementation for prevention or treatment of jaundice in neonates (any gestation or weight) using the Cochrane methodology. Cochrane Database Syst Rev. All searches were re-run on April 2, 2012. Cochrane Database Syst Rev. Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. 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. In: BMJ Clinical Evidence. Aetna considers the use of metalloporphyrins (e.g., stannsoporfin (tin mesoporphyrin), Stanate, WellSpring Pharmaceutical Corporation, Neptune, NJ) for the treatment of neonatal jaundice experimental and investigational because their safety and effectiveness for this indication has not been established. 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. If the nurse visit results in a visit with the physician, only the physician services would be reported. These investigators conducted a systematic review and meta-analysis to examine the safety and efficacy of zinc sulfate on hyperbilirubinemia among neonates. .newText { Pediatrics. Pediatrics. 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. Accessed January 30, 2019 . J Perinatol. 2021;16(5):e0251584. 1992;89:823-824. list-style-type: upper-alpha; Report an inclusive screening finding (R94.120 Abnormal auditory function study) in the professional record so the newborn can be retested at the well-baby checks. E0202 is the HCPC for phototherapy that would normally be billed by the hospital/dme provider. Evaluation and treatment of jaundice in the term infant: A kinder, gentler approach. Waltham, MA: UpToDate;reviewed January 2016. Chawla D, Parmar V. Phenobarbitone for prevention and treatment of unconjugated hyperbilirubinemia in preterm neonates: A systematic review and meta-analysis. I have a provider that ordered phototherapy for a newborn in the hospital with jaundice and he is wanting to bill 96900. Newman TB, Maisels MJ. Cryptorchidism Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. Armanian AM, Jahanfar S, Feizi A, et al. All 3 review authors independently assessed study eligibility and quality. Mean STB levels, mg/dL, at 72 12 hours were comparable in both the groups (n = 286; mean difference (MD) -0.20; 95 % CI: -1.03 to 0.63). There were no significant differences in SLCO1B1 463 C>A between the hyperbilirubinemia and the control group. In a case-control study performed at a single hospital center in Italy, 70 subjects with severe hyperbilirubinemia (defined as bilirubin level greater than or equal to 20 mg/dL or 340 mol/L) and 70 controls (bilirubin level less than 12 mg/dL or 210 mol/L) were enrolled. 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. 2006;(4):CD004592. These usually heal and resolve on their own. Genotypes were obtained through the Danish Neonatal Screening Biobank. Inpatient coders do not code immature lacrimal ducts because the condition does not use additional resources. Pediatrics. All Rights Reserved. Pediatrics. Less than 30 minutes of hands-on care during transport would not be separately reported. Sometimes issues heal without interventions, such as minor hematomas from the birth process and laceration from the fetal monitoring electrode. These researchers conducted a systematic review of studies comparing TcB devices with TSB in infants receiving phototherapy or in the post-phototherapy phase. 2008;93(2):F135-F139. Gu J, Zhu Y, Zhao J. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. } cpt code for phototherapy of newbornhippo attacks human video. Fractured clavicles are usually noted by the pediatrician on the newborn evaluation, but do not meet the definition of clinical significance. The nurses role in caring for newborns and their caregivers. Watchko JF, Lin Z. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. 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). 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. 4th ed. Pediatrics. Phototherapy was started at an average of 7 h of age, and the first IVIG dose was administered at an average of 13 h of life; nearly 25% received a second IVIG dose. Spontaneous descent after one year is uncommon. Pediatrics. J Matern Fetal Neonatal Med. Early corticosteroid treatment does not affect severity of unconjugated hyperbilirubinemia in extreme low birth weight preterm infants. 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). Screening is usually done as close as possible to inpatient discharge for this reason. cursor: pointer; Aetna considersphototherapy medically necessary forterm andnear-term infantsaccording to guidelines published by the American Academy of Pediatrics (AAP). 1993;32:264-267. For preterm neonates, there was a significantly lower bilirubin level in the 100 mg/kg clofibrate group compared to the control group with a mean difference of -1.37 mg/dL (95 % CI: -2.19 mg/dL to -0.55 mg/dL) (-23 mol/L; 95 % CI: -36 mol/L to -9 mol/L) after 48 hours. Data selection and extraction were performed independently by 2 reviewers. There is no CPT code because these hospital screenings are usually done by hospital staff who are trained by an audiologist. The authors concluded that current studies are unable to provide reliable evidence regarding the effectiveness of prebiotics on hyperbilirubinemia. Some infants may require intensive care services but do not meet the CPT definition of critically ill or injured required for reporting of critical care services. Numerous skin findings may be noted, but are not coded in the inpatient record unless they are clinically significant. Starting Feb. 1, 2022, five new CPT codes will require preauthorization. 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 10 publications (11 studies) were eligible. 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. Read more Therefore, its functional efficiency is important for your market reputation. 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.". 2012;1:CD007966. Kernicterus. } The smallest but significant difference between TSB and TcB was found on the lower abdomen. Usually, procedures coded: Low-cost, low-risk screening and prevention procedures usually are not coded. Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants. In those (uncommon) circumstances, report P83.5 Congenital hydrocele. Do not code this condition for the newborn inpatient encounter, unless additional resources are used. Understanding why a pediatrician documents a finding enables you to determine if it should be coded. text-decoration: line-through; JavaScript is disabled. New perspectives on neonatal hyperbilirubinemia. Place the thermometer in your newborn's armpit while the phototherapy lights are on. Also, no association was found for AB0 incompatible cases. Expect to see this monitored; usually there is a consult/referral around six months of age for newborns with undescended testicle(s). J Adv Nurs. On the pediatricians encounter, code P13.4 Fracture of clavicle due to birth injury because it involved medical decision-making. Links to various non-Aetna sites are provided for your convenience only. Stevenson DK, Fanaroff AA, Maisels MJ, et al. Reporting of codes for the services requires careful attention to CPT instructions and when more than one physician is caring for the infant, attention to which physician reports which codes. Although generally seen as safe, there is rising concern regarding phototherapy and its potentially damaging effects on DNA and increased side effects particularly for pre-term infants. 2009;124(4):1162-1171. The G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512 SNPs had a significant impact on STB levels. Analysis was performed on an intention-to-treat basis. 1991;91:483-489. Two hundred years ago, newborns would have been placed on blankets in the sun for newborn jaundice. 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. Pediatrics. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. 3. The RR or MD with a 95 % CI was used to measure the effect. The condition affects 3 percent of term male infants, and 1 percent of male infants at one year. Kernicterus in full-term infants--United States, 1994-1998. 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. 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. Approximately 2 ml of peripheral venous blood was taken from all subjects. The ICD-10-PCS code for light treatment of the skin is 6A600ZZ Phototherapy of skin, single for a single treatment. Chu L, Qiao J, Xu C, et al. Resources Watchko and Lin (2010) noted that the potential for genetic variation to modulate neonatal hyperbilirubinemia risk is increasingly being recognized. .strikeThrough { Pediatrics. Both trials in preterm neonates and most of the trials in term neonates (5 trials) reported increased stool frequencies. 1992;89:822-823. Now, newborns are checked with a transcutaneous bilirubinometer, and the pediatrician reviews standard laboratory blood screenings. Home Phototherapy Okwundu CI, Okoromah CA, Shah PS. Pediatrics. Suresh GK, Martin CL, Soll RF. Neonatal hyperbilirubinemia: An evidence-based approach. However, the results remain controversial. Thayyil S, Milligan DW. Normal Newborn visit, initial service 1. 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. In some cases, phototherapy will only be needed for 24 hours or less, in some cases, it may be required for 5 to 7 days. Cochrane Database Syst Rev. Phototherapy was well-tolerated without evidence of significant photo-damage or photo-carcinogenicity. Poland RL. For these hydroceles, the swelling will become greater and decrease. If separately documented in the mother's chart, you may report these services in addition to the services provided to the infant. Medline, Embase, Cochrane Library, CINAHL and Scopus databases (from inception to May 8, 2014) were searched. Chu and colleagues (2020) stated that phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. Ip S, Glicken S, Kulig J, et al. At the well-baby check, report K42.9 Umbilical hernia without obstruction or gangrene if the condition is addressed (not merely noted in the documentation). 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. Arch Dis Child Fetal Neonatal Ed. Atotal of 686 healthy newborns needing measurement of their bilirubin were enrolled over a 4-month period. It involves the exposure of the newborn to an ultraviolet light source (bili-light) in the home for a prescribed period of time. Each payer can develop its own diagnosis-related group. 2007;(2):CD005541. French S. Phototherapy in the home for jaundiced neonates. 2014;165(1):42-45. /*margin-bottom: 43px;*/ 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. 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). None of the studies showed any effect on the duration of phototherapy, incidence of phototherapy, age of starting of phototherapy and any serious adverse effect. }. You must log in or register to reply here. It suggested that these researchers should use the same guideline to detect the time of jaundice fading in future study. color: red PubMed, Embase, Web of science, EBSCO, Cochrane library databases, Ovid, BMJ database, and CINAHL were systematically searched; RCTs evaluating the effect of zinc sulfate versus placebo on the prevention of jaundice in neonates were included. Weisiger RA. list-style-type: decimal; An UpToDate review on "Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants" (Wong and Bhutani, 2015) does not mention genotyping of SLCO1B1 and UGT1A1 as management tools. 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. Travan et al (2014) examined if UGT1A1 promoter polymorphisms associated with Gilbert Syndrome (GS) occur with a greater frequency in neonates with severe hyperbilirubinemia. Support teaching, research, and patient care. Data were statistically extracted and evaluated by RevMan 5.3 software. If the screening must be done during the well-baby check, possible CPT codes to collect the screening are: The total number of neonates enrolled in these different RCT were 749. J Pediatr Gastroenterol Nutr. US Preventive Services Task Force; Agency for Healthcare Research and Quality. This indicated that cure may have been achieved in a minority of patients. The China National Knowledge Infrastructure and MEDLINE databases were searched. 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). 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.