Icd 10 Cm Code for Hyperbillirubinemia Newborn Baby 4 Days Old
BMC Pediatr. 2019; xix: 53.
Prevalence and burden of illness of treated hemolytic neonatal hyperbilirubinemia in a privately insured population in the U.s.
Tzy-Chyi Yu
1Mallinckrodt Pharmaceuticals, Bedminster, NJ 07921 USA
Chi Nguyen
2HealthCore, Inc., An Independent Subsidiary of Anthem, Inc, Wilmington, DE 19801 United states
Nancy Ruiz
aneMallinckrodt Pharmaceuticals, Bedminster, NJ 07921 USA
Siting Zhou
iiHealthCore, Inc., An Independent Subsidiary of Anthem, Inc, Wilmington, DE 19801 Us
Xian Zhang
iiHealthCore, Inc., An Independent Subsidiary of Anthem, Inc, Wilmington, DE 19801 United states of america
Elaine A. Böing
1Mallinckrodt Pharmaceuticals, Bedminster, NJ 07921 Us
Hiangkiat Tan
2HealthCore, Inc., An Contained Subsidiary of Anthem, Inc, Wilmington, DE 19801 United states
Received 2018 Aug 10; Accepted 2019 January 22.
- Data Availability Statement
-
The corresponding writer has direct access to the dataset used for this study, clarification could be provided upon reasonable asking.
Abstruse
Background
Prevalence of hemolytic neonatal hyperbilirubinemia (NHB) is not well characterized, and economical burden at the population level is poorly understood. This study evaluated the prevalence, clinical characteristics, and economic burden of hemolytic NHB newborns receiving treatment in U.S. real-world settings.
Methods
This accomplice study used authoritative claims from 01/01/2011 to 08/31/2017. The treated cohort had hemolytic NHB diagnosis and received phototherapy, intravenous immunoglobulin, and/or exchange transfusions. They were matched with non-NHB newborns who had neither NHB nor related treatments on the following: delivery hospital/surface area, gender, commitment route, estimated gestational age (GA), health plan eligibility, and closest appointment of nascency within v years. Inferential statistics were reported.
Results
The annual NHB prevalence was 29.6 to 31.7%; hemolytic NHB, 1.8 to 2.4%; treated hemolytic NHB, 0.46 to 0.55%, between 2011 and 2016. The matched analysis included 1373 pairs ≥35 weeks GA. The treated hemolytic NHB cohort had significantly more birth trauma and hemorrhage (four.five% vs. 2.iv%, p = 0.003), vacuum extractor affecting newborn (1.9% vs. 0.8%, p = 0.014), and polycythemia neonatorum (0.8% vs. 0%, p = 0.001) than the matched non-NHB cohort. The treated hemolytic NHB cohort besides had significantly longer mean nascence hospital stays (iv.5 vs. three.0 days, p < 0.001), college level ii–4 neonatal intensive care admissions (15.7% vs. ii.4, fifteen.nine% vs. ii.8 and 10.6% vs. two.5%, respectively, all p < 0.001) and higher thirty-day readmission (8.7% vs. 1.7%, p < 0.001).
One-month and one-year average total costs of care were significantly college for the treated hemolytic NHB cohort vs. the matched non-NHB cohort, $14,405 vs. $5527 (p < 0.001) and $21,556 vs. $12,986 (p < 0.001), respectively. The average costs for xxx-solar day readmission among newborns who readmitted were $13,593 for the treated hemolytic NHB cohort and $3638 for the matched not-NHB cohort, p < 0.001. The authors extrapolated GA-adapted prevalence of treated hemolytic NHB in the U.Southward. newborn population ≥ 35 weeks GA and estimated an incremental healthcare expenditure of $177.0 one thousand thousand during the offset month after birth in 2016.
Conclusions
The prevalence of treated hemolytic NHB was 4.vi–5.5 patients per 1000 newborns. This loftier-adventure hemolytic NHB imposed substantial burdens of healthcare resource utilization and incremental costs on newborns, their caregivers, and the healthcare organisation.
Keywords: Hemolytic neonatal hyperbilirubinemia, Neonatal hyperbilirubinemia, Prevalence, Clinical characteristics, Healthcare resource utilization, Costs, Burden of illness
Background
Neonatal hyperbilirubinemia (NHB), a common status in newborn infants, results from elevated blood bilirubin levels. The excessive bilirubin manifests equally yellowing of the skin and the normally white outer layer of the eyeballs [1–3]. While most cases resolve quickly without intervention, NHB is a common reason for inpatient readmissions, and admission to the neonatal intensive care unit of measurement (NICU) [4, 5]. The prevalence of NHB is not precisely known, notwithstanding, estimates advise that approximately l% total-term and 80% preterm [vi] newborns develop some course of NHB. High-gamble NHB occurs in eight–ix% of neonates during the first week after birth [v, 7].
The origin of NHB may be physiologic or pathologic. Physiologic NHB may exist caused by neonate immaturity and the resulting inability to cope with elevated levels of bilirubin [8]. This beneficial course resolves itself in 2–3 weeks post-obit nascency, and usually without handling [ane, 2]. Pathologic NHB may exist caused past hemolytic disease of the newborn (HDN), cerise blood cell (RBC) enzyme deficiency, or impaired bilirubin excretion [9]. HDN results from incompatibilities between maternal and fetal blood types (Rh, ABO or a minor claret grouping), which may cause ruptures in fetal RBCs and elevated bilirubin levels. Hemolytic NHB usually appears within 24 h later birth [1, 2, 4].
The American University of Pediatrics (AAP) clinical practice guidelines address the assessment, screening, and handling of NHB among infants at ≥35 weeks of gestation [ten]. Risk cess and treatment nomograms based on total serum bilirubin level, postnatal age in hours, and gestational historic period of the newborn with the presence or absence of risk factors are available to guide patient direction [10]. Like guidelines are not available for neonates at less than 35 weeks of gestation because of scant bear witness-based data, differences in clinical manifestations and unclear treatment outcomes [xi].
When treatment is indicated, AAP guidelines recommend phototherapy every bit the initial treatment [6, ten]. In cases where bilirubin levels continue to increment despite phototherapy, the guidelines recommend adding commutation transfusion of whole blood to the treatment regimen, typically in the NICU [2, 10]. For hemolytic cases, AAP guidelines recommend the assistants of intravenous immunoglobulin (IVIg) as adjunctive therapy when bilirubin levels continue to rise despite intensive phototherapy [2, 10]. These challenges in direction of high-risk hyperbilirubinemia substantially increment the urgency for safer and more effective screening and/or treatment options, specially when viewed against the cognition that the permanent sequelae of kernicterus spectrum disorders (KSDs) might exist prevented.
To the best of our knowledge, the prevalence of hemolytic NHB newborns receiving treatment has not been well characterized, and economic burden at the population level is poorly understood. Our study aimed to accost this knowledge gap. We focused on newborns with hemolytic NHB who received handling because the receipt of intervention indicated that those neonates met the AAP guideline for the recommendation of intervention in order to prevent severe NHB and the spectrum of associated complications [10, 12–fourteen].
Methods
Blueprint and data source
This retrospective matched cohort written report used the HealthCore Integrated Research Database (HIRDSM), a geographically dispersed managed-care repository with claims data on more 45 million enrollees residing across all 50 states, to identify infants built-in from 01/01/2011 through 08/31/2017. The HIRD is one of the largest privately insured population databases in the U.S [15]. This observational study was exempt from informed consent stipulations as researchers accessed a express information fix without individual enrollee identifiers and only summary statistics were reported. The study complied with all relevant provisions of the Health Insurance Portability and Accountability Act.
Study population
Newborns were linked to their nativity mothers via shared health plan subscriber identification (ID) numbers. Mothers' delivery dates were verified inside 32 days of newborns' dates of nascency using delivery codes (Appendix: Table seven). Infants with 30-day or longer continuous enrollment after nativity and mothers with at to the lowest degree 12 months of continuous health plan enrollment earlier commitment were included. All newborns, regardless of their estimated gestational age (GA), were included for NHB prevalence estimation. The treated hemolytic NHB and matched not-NHB cohorts were selected among newborns ≥35 weeks GA. Nosotros excluded newborns < 35 weeks GA equally in that location was no clinical practise guidelines available for this group due to lack of evidence-based information, variabilities in clinical manifestations, and uncertainties about treatment benefits [eleven].
NHB population was defined as newborns with ≥1 International Classification of Diseases (ICD)-ix/10-CM diagnostic codes of NHB (ICD-ix-CM = 773.0, 773.one, 773.2, 773.iv, 774.10 and ICD-10-CM = P55.10, P57.x, P58.10, P59.x) during the beginning 30 days after birth. Newborns with ≥i ICD-ix/10-CM diagnosis codes of ICD-9-CM = 773.0, 773.i, 773.two, 773.four, 774.0, 774.1, 774.7 and ICD-x-CM = P55.10, P57.x, P58.0, P58.i, P58.eight, P58.9 were selected for the population of NHB with hemolysis indicators or hemolytic NHB (Appendix: Table 8).
Treated hemolytic NHB cohort
Treated hemolytic NHB cohort were selected from the hemolytic NHB population if they were ≥ 35 weeks GA and received at least one NHB intervention including: phototherapy (Healthcare Mutual Procedure Coding Organisation [HCPCS] = E0202, S9098; ICD-9-CM process = 99.83; ICD-10-PCS = 6A600ZZ, 6A601ZZ), IVIg treatment along with NHB diagnosis lawmaking on the same claim (CPT = 90283, 90284; Generic Production Identifier [GPI] =19100020x; HCPCS = J1459, J1556, J1557, J1559, J1561, J1562, J1566, J1568, J1569, J1572, J1599), or exchange transfusions (CPT = 36450, 36456; ICD-ix-CM process = 99.01; ICD-10-PCS = 30233H1, 30243H1).
Non-NHB cohort
A non-NHB cohort was established using 1:ane matching with newborns in the treated hemolytic NHB cohort ≥35 weeks GA. Inclusion in the non-NHB accomplice required the absence of NHB diagnostic codes, no NHB treatment and a minimum of thirty-mean solar day health plan enrollment after nativity. Exact matching was performed based on delivery hospital/provider, gender, delivery route (C-department or vaginal), estimated GA, and post-alphabetize wellness plan continuous enrollment. When the matching of delivery infirmary/provider was non possible, residence naught lawmaking (5-digit) was used instead. Afterward all factors of interest were matched, newborns with the closest date of nativity inside 5 years were selected.
Gestational age
Nosotros calculated the GA of a newborn from prenatal procedure testing dates, from a range of common prenatal tests in the mother's medical claims, using the weighted procedure appointment-based average methodology, equally described by Wallace et al. [16]. This method demonstrated that 67% of all deliveries and 60% of preterm deliveries had estimated GA staying within 1 week of the actual GA [16].
Outcomes
Prevalence of NHB
The annual prevalence of NHB, hemolytic NHB and treated hemolytic NHB were estimated for 2011 through 2016 as the number of newborns diagnosed with a disease divided past the total number of newborns afterward female parent-baby linkage and health program eligibility requirement during a item calendar year.
Hospitalization and healthcare resources utilization
All-cause infirmary measures included birth hospitalization, length of stay, NICU admissions, receipt of NHB treatments, and readmissions. The employ of emergency section (ED) visits, physician office visits, other outpatient visits, and prescription fills were also presented. All healthcare resource utilization during the first 30 days and get-go year after birth were summarized.
Clinical characteristics and outcomes
The effects of hyperbilirubinemia on the brain and neurodevelopmental status were examined by evaluating occurrences of kernicterus, cerebral palsy, encephalopathy, hearing and vision loss, motor dysfunction, and neurodevelopmental delay during the offset year later nativity. These clinical outcomes were identified using ICD-9/ten-CM diagnosis codes, requiring ≥ane diagnosis for inpatient/ED settings or ≥ two diagnoses on distinct dates for physician office settings (Appendix: Table 9).
Costs of care
Total all-crusade costs during the showtime 30 days and first year after nascency were reported. Since newborn intendance during birth hospitalization could be billed under their mothers' plan ID, mothers' delivery hospitalization costs were included to avoid any potential unequal underestimation betwixt the newborn cohorts. These costs were the sum of the total paid amount past wellness plans, members' out-of-pocket costs, and coordination of benefits. Total costs consisted of expenses incurred in inpatient, ED, function visits, other outpatient settings and pharmacy costs. Costs were adjusted for inflation using the Medical Care Consumer Price Index, and calculated in terms of 2017 U.Due south. dollars [17].
Extrapolation to the U.South. newborn population
Using U.S. Centers for Disease Control and Prevention (CDC) 2016 nascency data by gestational age [xviii] and the estimated prevalence from our written report, nosotros applied a directly standardization method to extrapolate the 2016 U.S. GA-adjusted treated hemolytic NHB prevalence [19]. Nosotros then calculated population-level full healthcare expenditure based on our extrapolated prevalence and costs estimates.
Statistical analysis
All event measures were compared between the treated hemolytic NHB and matched non-NHB cohorts. Statistical differences between groups were assessed using McNemar or McNemar-Bowker tests for categorical variables and paired t-tests or Wilcoxon signed-rank tests for continuous variables, respectively. A conventional alpha of 0.05 with two-tailed level of significance was used to translate statistical significance. Statistical analyses were performed with SAS EG vii.1 (SAS Institute, Cary, NC).
Results
Study population
Of the 1.4 meg identified newborns, 365,937 were successfully linked to their nascence mothers (Fig.i). A total of 1673 newborns with hemolytic NHB received treatment and were of ≥35 weeks GA. Among those, 1373 treated hemolytic NHB newborns were matched with not-NHB newborns; the matching rate was 82.1%.
Menses nautical chart of the written report population. Treated hemolytic NHB newborns were exactly matched to not-NHB newborns on commitment hospital/provider, gender, delivery route (Csection or vaginal), estimated GA, and post-alphabetize wellness program continuous enrollment. When the matching of commitment hospital/provider was not possible, residence zip lawmaking (five-digit) was used instead. Later on all of the above factors were matched, newborn with the closest DOB within five years was selected. DOB: date of nascency; GA: gestational historic period; NHB: neonatal hyperbilirubinemia
Prevalence of NHB
The annual prevalence of NHB ranged from 29.half dozen to 31.7% during 2011 to 2016. The prevalence of hemolytic NHB during that period ranged from i.8 to two.four%, while the range for treated hemolytic NHB was 0.46 to 0.55% (Fig.ii). Upon stratification by estimated GA, the prevalence (95% Confidence Interval (CI)) of NHB among newborns < 35 weeks GA was 49.4% (95% CI: 48.6–l.one%), 38.4% (95% CI: 37.9–38.8%) of those 35–37 weeks GA, and 27.9% (95% CI: 27.7–28.ane%) of those > 37 weeks GA during 2011 to 2016. Hemolytic NHB was reported in 2.eight% (95% CI: 2.five–3.0%) of newborns < 35 weeks GA, 2.3% (95% CI: 2.one–2.four%) of those 35–37 weeks GA, and 2.0% (95% CI: 1.9–2.0%) of those > 37 weeks GA. The prevalence of treated hemolytic NHB among newborns < 35 weeks GA was 1.09% (95% CI: 0.93–1.25%), 0.70% (95% CI: 0.62–0.77%) of those 35–37 weeks GA, and 0.44% (95% CI: 0.41–0.46%) of those > 37 weeks GA (Table 1).
Prevalence of NHB, hemolytic NHB and treated hemolytic NHB stratified past GA from 2011 to 2016
Table ane
Prevalence of NHB, hemolytic NHB and treated hemolytic NHB stratified past gestational age (GA) from 2011 to 2016
| Estimated GA | Prevalence (95% Conviction Interval) | ||
|---|---|---|---|
| NHB | Hemolytic NHB | Treated hemolytic NHB | |
| > 37 weeks GA | 27.9% (27.7–28.i%) | ii.0% (ane.9–two.0%) | 0.44% (0.41–0.46%) |
| 35–37 weeks GA | 38.4% (37.9–38.8%) | two.three% (2.i–two.four%) | 0.lxx% (0.62–0.77%) |
| < 35 weeks GA | 49.4% (48.6–l.one%) | 2.viii% (2.five–3.0%) | 1.09% (0.93–ane.25%) |
| All newborns | thirty.six% (30.five–xxx.8%) | ii.0% (2.0–2.1%) | 0.51% (0.49–0.54%) |
NHB neonatal hyperbilirubinemia
Female parent and newborn demographic and clinical characteristics
The mean historic period of mothers of treated hemolytic NHB and matched non-NHB (32.2 vs. 32.i years, p = 0.forty), region of residence, blazon of health plan, comorbidity and gestational diabetes were similar at time of delivery. Slightly less than one-third (29.1%) of births was delivered by C-section, and 18.2% of newborns were of 35–37 weeks GA in each cohort (Table two).
Table 2
Mother and newborn demographic and clinical characteristics
| Treated hemolytic NHB accomplice (N = ane,373) | Matched non-NHB cohort (North = 1,373) | p-value3 | |
|---|---|---|---|
| Mothers | |||
| Age on delivery (year), mean (SD) | 32.ii (iv.63) | 32.i (iv.43) | 0.401 |
| Geographic region, n (%) | 0.394 | ||
| Northeast | 289 (21.0) | 285 (xx.8) | |
| Midwest | 503 (36.half-dozen) | 494 (36.0) | |
| South | 363 (26.four) | 368 (26.8) | |
| West | 212 (15.4) | 218 (15.nine) | |
| Other/Unknown1 | 6 (0.iv) | 8 (0.6) | |
| Health Program type, north (%) | 0.928 | ||
| HMO | 270 (nineteen.7) | 262 (19.i) | |
| PPO | 831 (sixty.5) | 845 (61.5) | |
| CDHP | 272 (xix.8) | 266 (xix.4) | |
| Modified Deyo-Charlson Comorbidity Alphabetize2, mean (SD) | 0.1 (0.47) | 0.1 (0.40) | 0.274 |
| Gestational diabetes, north (%) | 239 (17.4) | 222 (16.ii) | 0.367 |
| C-section, n (%) | 399 (29.i) | 399 (29.1) | _ |
| Newborns | |||
| Gender, northward (%) | _ | ||
| Male | 667 (48.half-dozen) | 667 (48.6) | |
| Female | 706 (51.four) | 706 (51.iv) | |
| Estimated gestational historic period, n (%) | _ | ||
| 35–37 weeks | 250 (xviii.ii) | 250 (18.2) | |
| > 37 weeks | 1,123 (81.eight) | 1,123 (81.8) | |
| Year of nascency, due north (%) | < 0.001 | ||
| 2011 | 217 (xv.eight) | 217 (15.8) | |
| 2012 | 211 (xv.four) | 195 (14.2) | |
| 2013 | 187 (13.half dozen) | 206 (15.0) | |
| 2014 | 197 (fourteen.3) | 239 (17.4) | |
| 2015 | 228 (sixteen.6) | 239 (17.4) | |
| 2016 | 208 (15.one) | 188 (thirteen.vii) | |
| 2017 | 125 (9.1) | 89 (vi.5) | |
NHB treatment
During birth hospitalizations, 69.one% of the treated hemolytic NHB cohort received treatment. During the first thirty days subsequently birth, 98.9% received phototherapy simply, 0.3% received exchange transfusion only, 0.1% received phototherapy plus IVIg, and 0.seven% received phototherapy plus substitution transfusion (Table three).
Table 3
NHB treatment design during 30 days afterward birth
| Treatment design | Treated hemolytic NHB cohort (Northward = 1373) |
|---|---|
| During nativity hospitalization (mutually sectional) | |
| Whatsoever NHB treatment during birth hospitalization, n% | 949 (69.i) |
| Phototherapy but, n% | 937 (68.ii) |
| IVIg simply, n% | 0 (0) |
| Commutation transfusion only, n% | iv (0.iii) |
| Phototherapy + IVIg, n% | ii (0.one) |
| Phototherapy + Exchange transfusion, n% | 6 (0.4) |
| IVIg + Exchange transfusion, n% | 0 (0) |
| Phototherapy + IVIg + Exchange transfusion, n% | 0 (0) |
| During xxx days later birth (mutually exclusive) | |
| Phototherapy but, n% | 1358 (98.9) |
| IVIg only, northward% | 0 (0) |
| Exchange transfusion only, n% | four (0.3) |
| Phototherapy + IVIg, due north% | 2 (0.1) |
| Phototherapy + Exchange transfusion, northward% | 9 (0.7) |
| IVIg + Exchange transfusion, n% | 0 (0) |
| Phototherapy + IVIg + Commutation transfusion, due north% | 0 (0) |
NHB neonatal hyperbilirubinemia, IVIg intravenous immunoglobulin
Newborn clinical conditions and neurodevelopmental disorders
Newborns in the treated hemolytic NHB accomplice had significantly higher proportions of birth trauma and hemorrhage (4.five% vs. 2.4%, p = 0.003), commitment past vacuum extractor affecting newborn (i.9% vs. 0.viii%, p = 0.014), and polycythemia neonatorum (0.viii% vs. 0.0%, p = 0.001) compared to the matched non-NHB accomplice (Tabular arrayiv). No difference was observed in neurodevelopmental disorders during the showtime year after birth betwixt cohorts. Ix (1.2%) of the treated hemolytic NHB newborns had kernicterus.
Tabular array 4
Newborn clinical conditions and neurodevelopmental disorders
| Treated hemolytic NHB cohort | Matched non-NHB cohort | p-value1 | |
|---|---|---|---|
| Clinical conditions during 30 days after nascence, total due north | i,373 | 1,373 | |
| Breech delivery and extraction affecting fetus or newborn, northward (%) | 114 (eight.three) | 107 (7.8) | 0.579 |
| Birth trauma and hemorrhage, northward (%) | 62 (4.5) | 33 (2.four) | 0.003 |
| Commitment by vacuum extractor affecting fetus or newborn, northward (%) | 26 (1.9) | xi (0.8) | 0.014 |
| Polycythemia neonatorum, due north (%) | 11 (0.viii) | 0 (0) | 0.001 |
| Other malpresentation, malposition, and disproportion during labor and delivery affecting fetus or newborn, n (%) | nine (0.7) | ix (0.7) | 1.000 |
| Forceps delivery affecting fetus or newborn, northward (%) | 5 (0.iv) | 7 (0.five) | 0.564 |
| Neonatal hematemesis and melena due to swallowed maternal blood, n (%) | 0 (0) | 0 (0) | _ |
| Neurodevelopmental disorders during one yr after birth, full n | 765 | 765 | |
| Kernicterus, northward (%) | 9 (i.two) | 0 (0) | 0.004 |
| Motor dysfunction, n (%) | 4 (0.v) | two (0.3) | 0.687 |
| Hearing loss, north (%) | 3 (0.4) | two (0.iii) | 1.000 |
| Encephalopathy, due north (%) | two (0.3) | 2 (0.three) | 1.000 |
| Aberrant behavior, n (%) | 1 (0.1) | 3 (0.4) | 0.625 |
| Cerebral palsy, due north (%) | 1 (0.1) | 0 (0) | one.000 |
| Vision loss, northward (%) | 0 (0) | 2 (0.3) | 0.500 |
| Neurodevelopmental delay, northward (%) | 0 (0) | ane (0.1) | i.000 |
| Cognitive disorders, due north (%) | 0 (0) | 0 (0) | _ |
| Linguistic communication disorders, n (%) | 0 (0) | 0 (0) | _ |
Healthcare resource utilization and costs during xxx days afterward birth
Treated hemolytic NHB newborns had longer average length of stay during birth hospitalization (four.5 days vs. 3.0 days; p < 0.001), and a greater proportion were admitted to NICU (82.6% vs. 70.0%; p < 0.001) compared to matched non-NHB newborns (Table5). Significantly higher proportions of treated hemolytic NHB newborns were admitted to NICU levels 2–4 (15.vii% vs. 2.four%; xv.ix% vs. 2.8%; and 10.6% vs. 2.5%, respectively; all p < 0.001). Infirmary readmissions and doctor part visits were significantly higher for treated hemolytic NHB newborns than the matched not-NHB cohort, 8.7% vs. 1.7% (p < 0.001) and xc.8% vs. 82.6% (p < 0.001), respectively. No difference was reported for ED visits (ane.7% vs. 1.iv%, p = 0.54) and prescription fills (half-dozen.three% vs. 6.0%, p = 0.81) between the groups.
Table 5
Healthcare resource utilization and costs during xxx days later nativity
| Treated hemolytic NHB cohort (N = 1373) | Matched non-NHB cohort (N = 1373) | p-valuei | |
|---|---|---|---|
| All-cause healthcare resource apply | |||
| Inpatient | |||
| Birth hospitalization LOS, mean (SD) | 4.v (6.06) | 3.0 (5.74) | < 0.001 |
| NICU admission during nascence hospitalization, n (%) | 1,134 (82.6) | 961 (70.0) | < 0.001 |
| NICU Level 1 | 903 (65.8) | 910 (66.3) | 0.713 |
| NICU Level ii | 215 (xv.seven) | 33 (2.4) | < 0.001 |
| NICU Level three | 218 (fifteen.ix) | 38 (ii.8) | < 0.001 |
| NICU Level 4 | 146 (ten.6) | 35 (2.v) | < 0.001 |
| Readmission within xxx-days after nascence, n (%) | 119 (8.7) | 23 (i.7) | < 0.001 |
| LOS, mean (SD) | 2.4 (2.62) | 1.7 (1.34) | 0.033 |
| Emergency room visits, northward (%) | 23 (ane.7) | 19 (1.iv) | 0.537 |
| Number of visits, mean (SD) | 1.0 (0.21) | ane.i (0.23) | 0.919 |
| Physician office visits, due north (%) | 1,247 (xc.eight) | ane,134 (82.half-dozen) | < 0.001 |
| Number of visits, mean (SD) | 2.eight (i.49) | ii.2 (1.15) | < 0.001 |
| Other outpatient visits2, n (%) | one,001 (72.9) | 427 (31.one) | < 0.001 |
| Number of visits, mean (SD) | three.viii (3.29) | one.v (1.26) | < 0.001 |
| Prescription fills, n (%) | 86 (vi.three) | 83 (6.0) | 0.811 |
| Number of fills, mean (SD) | ane.two (0.43) | 1.1 (0.36) | 0.533 |
| All-cause healthcare costs, mean (SD), 2017 USD | |||
| Medical costs | $14,403 ($43,918) | $5,524 ($l,078) | < 0.001 |
| Inpatient (including birth hospitalization) | $13,794 ($43,949) | $5,216 ($l,083) | < 0.001 |
| Nascency hospitalization | $12,616 ($42,475) | $5,155 ($fifty,080) | < 0.001 |
| Readmission during 30 days after birthiii | $13,593 ($34,524) | $3,638 ($5685) | < 0.001 |
| Emergency department | $xx ($187) | $17 ($169) | 0.636 |
| Md office visit | $313 ($258) | $224 ($203) | < 0.001 |
| Other outpatient visits | $276 ($651) | $67 ($289) | < 0.001 |
| Pharmacy costs | $2 ($12) | $2 ($28) | 0.923 |
| Total medical and pharmacy costs | $xiv,405 ($43,918) | $v,527 ($50,079) | < 0.001 |
| Incremental all-crusade healthcare costs | |||
| Treated hemolytic NHB newborn incremental costs | $8,878 ($59,943) | ||
| Female parent'due south delivery incremental costs4 | $503 ($19,969) | ||
| Total incremental costs | $9,381 ($63,558) | ||
Mean (SD) total 30-24-hour interval all-crusade costs for the newborns were $14,405 ($43,918) for the treated hemolytic NHB group and $5,527 ($l,079) for the matched non-NHB cohort (p < 0.001). The treated hemolytic NHB group incurred hateful (SD) total inpatient hospitalization costs of $13,794 ($43,949) compared to $5,216 ($50,083) in the matched non-NHB group, p < 0.001. The average costs of readmissions among those readmitted to the hospitals were $thirteen,593 ($34,524) and $3,638 ($five,685) for the treated hemolytic NHB and non-NHB groups, respectively. The mean (SD) 30-24-hour interval incremental full all-cause costs associated with treated hemolytic NHB newborns was $9,381 ($63,558) composed of $8,878 ($59,943) from newborns plus $503 ($19,969) from mothers' delivery hospitalization.
Healthcare resource utilization and costs during one year after birth
Of ane,373 pairs, 765 (55.7%) matched pairs with one-year follow-up were included in the analysis. There was no statistically pregnant difference between the two cohorts in inpatient admissions and ED visits during the period from 31 days to 1 year after birth. Physician part visits and prescription fills were slightly higher in the treated hemolytic NHB group compared to the matched not-NHB group (99.7% vs. 97.4%, p < 0.001 and 69.seven% vs. 63.five%, p = 0.009, respectively). The mean (SD) full one-year all-cause costs incurred by the treated hemolytic NHB cohort were $21,556 ($60,823) compared to $12,986 ($72,164) in the matched non-NHB cohort, p < 0.001. The average (SD) one-year incremental full all-crusade costs associated with treated hemolytic NHB was $9,383 ($84,478), consisting of $813 ($12,922) from mother's delivery hospitalization and $eight,570 ($82,379) from newborns (Table6).
Table 6
Healthcare resource utilization and costs during ane year after birth
| Treated hemolytic NHB cohort (N = 765) | Matched not-NHB cohort (N = 765) | p-value1 | |
|---|---|---|---|
| All-cause healthcare resources use | |||
| Inpatient | |||
| Readmission within 30-days after birth, n (%) | 60 (7.8) | fourteen (1.eight) | < 0.001 |
| Inpatient access from 31 days to one year later nativity | 36 (4.7) | 24 (3.1) | 0.109 |
| Emergency room visits, n (%) | 138 (xviii.0) | 125 (sixteen.3) | 0.378 |
| Number of visits, mean (SD) | 1.three (0.72) | 1.2 (0.fifty) | 0.690 |
| Md part visits, northward (%) | 763 (99.vii) | 745 (97.4) | < 0.001 |
| Number of visits, mean (SD) | 12.ii (5.44) | 10.7 (4.92) | < 0.001 |
| Other outpatient visits2, n (%) | 763 (99.vii) | 736 (96.ii) | < 0.001 |
| Number of visits, mean (SD) | 11.three (7.25) | 8.three (vii.28) | < 0.001 |
| Prescription fills, due north (%) | 533 (69.7) | 486 (63.5) | 0.009 |
| Number of fills, mean (SD) | 4.three (4.36) | 3.nine (3.94) | 0.140 |
| All-cause healthcare costs, hateful (SD), 2017 USD | |||
| Newborns | |||
| Medical costs | $21,407 ($60,808) | $12,784 ($71,669) | < 0.001 |
| Inpatient (including nascency hospitalization) | $16,679 ($58,723) | $8865 ($seventy,060) | < 0.001 |
| Emergency department | $279 ($850) | $235 ($749) | 0.199 |
| Physician office visits | $ane,443 ($847) | $1,248 ($864) | < 0.001 |
| Other outpatient visits | $3,006 ($four,096) | $2,436 ($3,712) | < 0.001 |
| Pharmacy costs | $149 ($359) | $202 ($1494) | 0.038 |
| Total newborn medical and pharmacy costs | $21,556 ($sixty,823) | $12,986 ($72,164) | < 0.001 |
| Incremental all-cause healthcare costs | |||
| Treated hemolytic NHB newborn incremental costs | $8,570 ($82,379) | ||
| Female parent's delivery incremental costs3 | $813 ($12,922) | ||
| Total incremental costs | $9,383 ($84,478) | ||
Extrapolation to the U.Due south. population
The extrapolation of 2016 U.S. GA-adjusted treated hemolytic NHB prevalence was 0.53%, 20,854 newborns (95% CI, 18,398-23,311) amidst 3.nine one thousand thousand newborns in the U.S. in 2016. Among newborns ≥35 weeks GA, the GA-adapted prevalence of treated hemolytic NHB was 0.fifty% resulting in 18,872 newborns (95% CI, 16,523 - 21,221). The xviii,872 treated hemolytic NHB newborns represent an estimated total healthcare expenditure of $271.9 million and incremental costs of $177.0 million compared with their counterparts without NHB during the first month after birth in the U.S. in 2016.
Discussion
To the all-time of our cognition, this is the first study to estimate the prevalence of high-risk hemolytic NHB newborns receiving intervention, and to quantify the burden of hemolytic NHB in the U.s.a.. The proportions of newborns with hemolytic NHB who received treatment were 0.46 to 0.55% in a privately insured population in the U.s.. Although not prevalent, those loftier-risk hemolytic NHB neonates who received treatment were associated with substantial healthcare resource utilization and incremental economical brunt.
NHB inquiry in the U.S. has been express, and prevalence estimates vary markedly in the scattering of studies in the literature. In a systematic review that included xiv studies to examine the effects and outcomes of phototherapy, Woodgate and Jardine noted that about 50% of full-term and 80% preterm newborns developed jaundice [6]. In a survey at medical centers that practiced universal pre-discharge total serum bilirubin (TSB) screening, Bhutani et al. reported jaundice in 84% of good for you newborns ≥35 weeks GA [20]. Another study, which used inpatient data from the Healthcare Costs and Utilization Projection (HCUP), reported 15.6% of newborns had jaundice [21]. These variations could, in part, exist due to differences in the written report population, example definitions (eastward.g., TSB level vs. visible jaundice), data sources, and underdiagnosis or underreporting of balmy cases. Mild NHB typically resolves without intervention, and may not be fully captured in administrative claims (used in our report) and hospital discharge data (HCUP). Such cases may not exist reflected in reimbursements because of bundled payments, which could result in an underestimation of general NHB prevalence.
Our report focused on NHB specifically with etiology of hemolytic diseases, and nosotros found that approximately vii% of the NHB cases were hemolytic NHB. Our estimated prevalence of treated hemolytic NHB (ranging from 0.46–0.55%) was comparable to < ane% of significant hemolysis reported by Wagle and Deshpande [22]. Chang et al. estimated that about six% of newborns ≥35 weeks GA received phototherapy at Kaiser Permanente hospitals [23]. Using our approximate that 7% of the NHB newborns in this written report had hemolytic NHB forth with the supposition that all the newborns in the Chang et al. study had NHB, we inferred that approximately 0.42% of newborns in Chang et al. were phototherapy-treated hemolytic NHB — which is close to our approximate. Handling rates could vary remarkably as treatment practice across hospitals/institutions differ in how cases are identified and when treatment should be initiated [24, 25]. Additionally, prior literature suggested that NHB patients could exist under-treated. One U.Southward. report showed that only approximately half (54%) of good for you term newborns for whom AAP clinical practice guidelines recommended phototherapy received treatment [26].
We institute that treated hemolytic NHB newborns had significantly longer length of stay during their birth hospitalization, higher 30-twenty-four hours readmission rates, higher NICU use and slightly higher rates of doctor office visits, compared to their matched counterparts. Length of stay of mothers' delivery hospitalizations were as well slightly longer in the treated hemolytic NHB cohort (2.9 days vs two.five days, data not shown). These findings suggest meaning burden to patients, their caregivers, and the healthcare system. Prior studies have shown that NHB was equally major crusade of readmission. Approximately half (51%) of all readmissions occurring ii weeks later on birth were attributable to NHB [27]. The increase in md office visits we reported was besides consistent with bachelor literature, which institute that NHB was associated with increased parental awareness, and newborns receiving phototherapy had higher rates of outpatient visits [28].
Nosotros also establish that hemolytic NHB newborns who received treatment incurred 2.vi times the average costs of their matched non-NHB counterparts during the first thirty days subsequently nativity. The majority of the incremental cost was derived from nascence hospitalizations. Indirect costs associated with patients' and caregivers' quality of life as well equally caregivers' loss of productivity could non be evaluated using claims data. Equally of now, no prior study has examined the economic burden of hemolytic NHB. One before written report estimated the average cost of childbirth via vaginal or caesarian at $eighteen,329 or $27,866, respectively, in a private health program [29]. Those estimates were close to the boilerplate costs, $twenty,568, of the sum of maternal delivery (mean (SD) = $15,413 ($20,010), data non shown) and newborn nascence hospitalization ($5,155 ($fifty,080), Table 5) in the not-NHB cohort in our written report. Such comparability might warrant the representativeness and generalizability of our study results to other privately insured populations. In this study, we found that the majority of treated hemolytic NHB newborns received phototherapy. A total of 15 (one%) newborns received IVIg or ET, which are recommended by AAP when bilirubin levels go along to rise despite intensive phototherapy. This group imposed fifty-fifty greater economic burden with average (SD) full one-month all-crusade costs of $81,065 ($133,767) (data not shown).
We extrapolated our findings to the entire U.S. newborn population in 2016. The extrapolation estimated full healthcare expenditure of $271.ix million and incremental costs of $177.0 one thousand thousand among xviii,872 treated hemolytic NHB newborns as compared with their counterparts without NHB during the get-go calendar month afterward nascence. Our extrapolation causeless our estimates were applicable to the U.S. newborn population mainly insured by private insurance plans or Medicaid. This projection should be interpreted with circumspection equally privately insured populations tend to have college socioeconomic status and healthcare expenditures than the Medicaid population [thirty]. Further research in the Medicaid newborn population is warranted to examine our assumptions and estimates.
We did not detect significant difference in neurodevelopment delay, language disorders, motor dysfunction, cerebral palsy, aberrant behavior, encephalopathy, hearing and vision loss betwixt treated hemolytic NHB newborns and the matched non-NHB cohort during the start year of nascency. Withal, the observation catamenia was probable too brusque as many of these conditions might not be identifiable nor noticeable in the offset yr of life. Kernicterus, a brain injury resulting from severe NHB, was found in nine newborns, approximately 1.2% of all treated hemolytic NHB newborns during the one-year follow up. Kernicterus has been reported from 1.0 to iii.7 cases per 100,000 live nativity in the literature [31, 32], merely these incidence rates were estimated for the general population in contrast to the loftier-take chances hemolytic NHB population (treated) in this written report. As hemolytic NHB was strongly correlated with higher incidences of birth trauma, polycythemia, and other subsequent morbidities which could as well cause neurodevelopment disorders, neurodevelopment disorders in this population could exist due to a combination of hemolytic NHB and other morbidities, rather than hemolytic NHB lone.
Effective direction of high-risk hemolytic NHB is critical to reduce the impact of illness burden on patients, their caregivers, and the healthcare system. Several studies have investigated comprehensive approaches, such as pre-discharge bilirubin screening for all newborns [25], or the implementation of a standard pathway including handling algorithms (due east.one thousand., requiring irradiance compliance to ensure consequent delivery of constructive phototherapy) and education to increment awareness among clinicians [33]. These comprehensive approaches accept demonstrated success in reducing costs, length of stay [33] and hospital readmission rates [25]. In addition, new treatment options are needed. For example, an investigational treatment – stannsoporfin (SnMP, a heme oxygenase inhibitor) with or without phototherapy was studied for use in the management of NHB or hemolytic NHB [34, 35].
Limitations
Our results should exist interpreted in light of certain limitations. Known adventure factors such as family history, race and ethnicity, and breastfeeding status are not available in administrative claims data. Cases of mild NHB exercise not unremarkably require intervention, and tin can be underdiagnosed and/or under-coded in administrative data leading to underestimation of NHB and hemolytic NHB. The use of phototherapy during hospitalization might not take been observed due to bundled payments and/or under-coding. Duration on phototherapy was also not captured. This written report population was from a U.S. privately insured population, which may limit the generalizability of these results to other population segments, such as Medicaid.
Conclusions
This is likely the kickoff study estimating the prevalence of newborns with hemolytic NHB who received intervention in the U.S. This loftier-risk population imposes a substantial brunt of healthcare resource utilization and incremental costs on newborns, their caregivers, and the healthcare system. Constructive management protocols and emerging new treatments may assistance to mitigate the overall brunt of hemolytic NHB.
Acknowledgements
The authors thank B. Bernard Tulsi for writing and editorial back up and Nianya Liu for data programming and querying. We also would like to thank Dr. Joseph Singer, Master Medical Officeholder, for providing clinical input and perspectives to the written report. Thanks to Dr. Holly Romero, Andrew Rava, Ruixin Tan, and all reviewers of the protocol or manuscript for their helpful feedback. All errors or omissions remain the responsibility of the authors.
Funding
The study was funded past Mallinckrodt Pharmaceuticals. Authors T-CY, NR, and EAB, employees of Mallinckrodt at the time of the study, participated in study blueprint, data interpretation, and revising dissimilar versions of this commodity, and canonical information technology for submission.
Availability of information and materials
The corresponding author has straight access to the dataset used for this report, clarification could be provided upon reasonable request.
Abbreviations
| AAP | American Academy of Pediatrics |
| CI | Confidence Interval |
| GA | Gestational historic period |
| HCRU | Healthcare resource utilization |
| HDN | Hemolytic disease of the newborn |
| ICD-9/x-CM | The international classification of diseases, 9/10th Revision, clinical modification |
| ICD-9-CM/10-PCS | The international classification of diseases, ix/10th Revision, procedure coding organization |
| IVIg | Intravenous immunoglobulin |
| KSDs | Kernicterus spectrum disorders |
| NHB | Neonatal hyperbilirubinemia |
| NICU | Neonatal intensive intendance unit of measurement |
| RBC | Blood-red blood cell |
| SD | Standard deviation |
| TSB | Full serum bilirubin |
Appendix
Table vii
Codes to identify delivery
| one. Codes to identify all deliveries | |
| CPT codes | |
| Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care | 59400 |
| Vaginal commitment merely (with or without episiotomy and/or forceps) | 59409 |
| Vaginal commitment merely (with or without episiotomy and/or forceps), including postpartum care | 54910 |
| External cephalic version, with or without tocolysis | 59412 |
| Delivery of placenta (divide procedure) | 59414 |
| Antepartum care only; four–vi visits | 59425 |
| Antepartum care only; 7+ visits | 59,426 |
| Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum intendance, after previous cesarean commitment | 59610 |
| Vaginal delivery but, later previous cesarean delivery (with or without episiotomy and/or forceps); | 59612 |
| Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care | 59614 |
| Routine obstetric care including antepartum intendance, cesarean delivery, and postpartum care | 59510 |
| Cesarean delivery just | 59514 |
| Cesarean delivery only; including postpartum intendance | 59515 |
| Routine obstetric intendance including antepartum care, cesarean commitment, and postpartum care, following attempted vaginal commitment later previous cesarean delivery | 59618 |
| Cesarean delivery only, post-obit attempted vaginal commitment subsequently previous cesarean delivery; | 59620 |
| Cesarean commitment only, following attempted vaginal commitment after previous cesarean delivery; including postpartum care | 59622 |
| Acquirement Codes | |
| Labor Room/Commitment | 72.10 |
| ICD-nine-CM diagnosis | |
| Outcome of delivery | |
| Single liveborn | V27.0x |
| Twins, both liveborn | V27.2x |
| Twins, one liveborn one stillborn | V27.3x |
| Other multiple, all liveborn | V27.5x |
| Other multiple, some liveborn | V27.6x |
| Unspecified | V27.9x |
| Liveborn infants consuming healthcare | |
| Single liveborn | V30.xx |
| Twin, mate liveborn | V31.xx |
| Twin, mate stillborn | V32.xx |
| Twin, unspecified | V33.xx |
| Other multiple, mates all liveborn | V34.20 |
| Other multiple, mates all stillborn | V36.xx |
| Other multiple, unspecified | V37.xx |
| Unspecified | V39.xx |
| Normal delivery | 650.twenty |
| Forceps or vacuum extractor delivery without mention of indication | 669.5x |
| Breech extraction, without mention of indication | 669.6x |
| Cesarean delivery, without mention of indication | 669.7x |
| ICD-nine-CM procedure | |
| Forceps, vacuum, and breech commitment | 72.xx |
| Other procedures inducing or profitable commitment | 73.20 |
| Cesarean section and removal of fetus | 74.xx |
| ICD-10-CM diagnosis | |
| Outcome of commitment | |
| Unmarried liveborn | Z37.0x |
| Twins, both liveborn | Z37.2x |
| Twins, one liveborn i stillborn | Z37.3x |
| Other multiple, all liveborn | Z37.5x |
| Other multiple, some liveborn | Z37.6x |
| Unspecified | Z37.9x |
| Liveborn infants consuming healthcare | |
| Unmarried liveborn | Z38.0x-Z38.2x |
| Twin liveborn | Z38.3x-Z38.5x |
| Other multiple liveborn | Z38.6x-Z38.8x |
| Encounter for full-term unproblematic delivery | O80x |
| See for cesarean delivery without indication | O82x |
| ICD-10-PCS procedure | |
| Extraction of POC, Classical, Open up Approach | 10D00Z0 |
| Extraction of POC, Depression Cervical, Open Approach | 10D00Z1 |
| Extraction of POC, Extraperitoneal, Open Approach | 10D00Z2 |
| Extraction of POC, Depression Forceps, Via Opening | 10D07Z3 |
| Extraction of POC, Mid Forceps, Via Opening | 10D07Z4 |
| Extraction of POC, High Forceps, Via Opening | 10D07Z5 |
| Extraction of Products of Conception, Vacuum, Via Opening | 10D07Z6 |
| Extraction of POC, Int Version, Via Opening | 10D07Z7 |
| Extraction of Products of Formulation, Other, Via Opening | 10D07Z8 |
| Delivery of Products of Formulation, External Approach | 10E0XZZ |
| two. Codes to identify cesarean delivery | |
| CPT codes | |
| Routine obstetric care including antepartum care, cesarean delivery, and postpartum intendance | 59510 |
| Cesarean delivery only | 59514 |
| Cesarean delivery but; including postpartum care | 59515 |
| Routine obstetric care including antepartum intendance, cesarean delivery, and postpartum care, post-obit attempted vaginal commitment after previous cesarean delivery | 59618 |
| Cesarean delivery merely, post-obit attempted vaginal delivery afterwards previous cesarean delivery; | 59620 |
| Cesarean commitment simply, following attempted vaginal delivery later on previous cesarean delivery; including postpartum care | 59622 |
| ICD-9-CM diagnosis | |
| Single liveborn, born in hospital, delivered by cesarean delivery | V30.01 |
| Twin, mate liveborn, built-in in hospital, delivered by cesarean delivery | V31.01 |
| Twin, mate stillborn, born in hospital, delivered by cesarean delivery | V32.01 |
| Twin, unspecified whether mate stillborn or liveborn, built-in in hospital, delivered by cesarean delivery | V33.01 |
| Other multiple, mates all liveborn, born in hospital, delivered by cesarean delivery | V34.01 |
| Other multiple, mates all stillborn, born in infirmary, delivered by cesarean commitment | V35.01 |
| Other multiple, mates liveborn and stillborn, built-in in hospital, delivered by cesarean commitment | V36.01 |
| Other multiple, unspecified whether mates stillborn or liveborn, built-in in infirmary, delivered by cesarean delivery | V37.01 |
| Liveborn babe, unspecified whether single, twin, or multiple, born in hospital, delivered past cesarean | V39.01 |
| Cesarean delivery, without mention of indication | 669.7x |
| ICD-9-CM procedure | |
| Cesarean section and removal of fetus | 74.twenty |
| ICD-10-CM diagnosis | |
| Single liveborn babe, delivered past cesarean | Z38.01 |
| Twin liveborn infant, delivered by cesarean | Z38.31 |
| Triplet liveborn infant, delivered by cesarean | Z38.62 |
| Quadruplet liveborn infant, delivered by cesarean | Z38.64 |
| Quintuplet liveborn infant, delivered by cesarean | Z38.66 |
| Other multiple liveborn infant, delivered by cesarean | Z38.69 |
| Encounter for cesarean commitment without indication | O82x |
| ICD-x-PCS procedure | |
| Extraction of POC, Classical, Open up Approach | 10D00Z0 |
| Extraction of POC, Low Cervical, Open Arroyo | 10D00Z1 |
| Extraction of POC, Extraperitoneal, Open Approach | 10D00Z2 |
Tabular array viii
Codes to identify neonatal hyperbilirubinemia
| Description | ICD-9-CM | ICD-10-CM |
|---|---|---|
| Hemolytic illness of fetus or newborn due to Rh isoimmunization | 773.0 | P55.0 |
| Hemolytic disease of fetus or newborn due to ABO isoimmunization | 773.1 | P55.1 |
| Hemolytic illness of fetus or newborn due to other and unspecified isoimmunization | 773.2 | P55.8, P55.9 |
| Kernicterus of fetus or newborn due to isoimmunization | 773.4 | P57.0 |
| Perinatal jaundice from hereditary hemolytic anemias | 774.0 | P58.8 |
| Perinatal jaundice from other excessive hemolysis | 774.one | P58.0, P58.2, P58.3, P58.41, P58.v, P58.8 |
| Kernicterus of fetus or newborn non due to isoimmunization | 774.7 | P57.8 |
| Rh isoimmunization of newborn | 794 | P55.0 |
| ABO isoimmunization of newborn | 794 | P55.1 |
| Other hemolytic diseases of newborn | 793 | P55.8 |
| Hemolytic illness of newborn, unspecified | 793 | P55.9 |
| Kernicterus due to isoimmunization | 793 | P57.0 |
| Other specified kernicterus | 793 | P57.8 |
| Kernicterus, unspecified | 793 | P57.9 |
| Neonatal jaundice due to bruising | 794 | P58.0 |
| Neonatal jaundice due to bleeding | 794 | P58.one |
| Neonatal jaundice due to other specified excessive hemolysis | 794 | P58.viii |
| Neonatal jaundice due to excessive hemolysis, unspecified | 794 | P58.nine |
Table 9
Codes to identify NICU admission, gestational historic period estimation and newborn clinical conditions
| Descriptions | ICD-9-CM | ICD-10-CM | CPT/ Revenue codes |
|---|---|---|---|
| Neonatal Intensive Care Unit (NICU) | |||
| Level 1 | Revenue: 171 | ||
| Level 2 | Revenue: 172 | ||
| Level three | Revenue: 173 | ||
| Level 4 | Revenue: 174 | ||
| Prenatal tests and preterm codes for gestational age interpretation | |||
| Oral glucose tolerance test (OGTT) | 82950, 82951, 82952 | ||
| Blastoff-fetoprotein (AFP) | 82105 | ||
| Inhibin-A (IHA) | 86336 | ||
| Ultrasound, meaning uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic test | 76801,76802,76805,76810, 76811,76812,76813,76814, 76815,76816,76817,76818, 76819,76820 | ||
| Pregnancy-associated protein plasma-A (PAPP-A) | 84163 | ||
| Chorionic villus sampling | 59015 | ||
| Preterm 35–37 weeks | 765.28 | P07.38, P07.39 | |
| Preterm < 35 weeks | 765.21, 765.22, 765.23, 765.24, 765.25,765.26, 765.27 | P07.21, P07.22, P07.23, P07.24, P07.25, P07.26, P07.31, P07.32, P07.33, P07.34, P07.35, P07.36, P07.37 | |
| Preterm unspecified | 765.twenty, | P07.xx, P07.30, | |
| P07.0x, P07.1x, | |||
| 644.2x | O60.1x | ||
| Newborn clinical weather condition | |||
| Birth trauma and/or hemorrhage (associated with the development of potential jaundice from bleeding) | 864.00–864.05,864.09, 865.00–865.04,865.09, 767.0,767.11,770.three, 772.10–772.14, 772.two–772.9 | P10x,P12.0x,P12.1x, P12.3x,P15.0x, P15.1x,P26x, P52x, P53x, P54x | |
| Polycythemia neonatorum | 776.4 | P61.1x | |
| Neonatal hematemesis and melena due to swallowed maternal blood | 777.3 | P78.2x | |
| Breech delivery and extraction affecting fetus or newborn | 763.0 | P03.0x | |
| Forceps commitment affecting fetus or newborn | 763.two | P03.2x | |
| Delivery by vacuum extractor affecting fetus or newborn | 763.3 | P03.3x | |
| Other malpresentation, malposition, and asymmetry during labor and delivery affecting fetus or newborn | 763.1 | P03.1x | |
| Newborn neurodevelopmental disorders | |||
| Developmental delay | 299.xx, 315.8, 315.nine, 330.eight | F84x, F88x, F89x | |
| Cerebral disorders (nonspecific) | 310.9x | F09x | |
| Language disorder (or speed disorder, dysarthria) | 315.3x | F80x | |
| Motion dysfunction | 315.4x, 781.two, 719.7, 781.3, | F82x, R26x, R27x | |
| Cerebral palsy | 343.10, 333.71, | G80x | |
| Abnormal behavior | 314.x, 312.x, 309.21, 313.x, 307.x, | F90x-F98x | |
| Bilirubin encephalopathy (kernicterus spectrum disorder) | 773.4, 774.7 | P57x | |
| Encephalopathy | 348.3x | G93.4x | |
| Hearing loss | 389.xx, 388.01, 388.2388.eleven | H90x, H91x | |
| Vision loss | 368.xx | H53x | |
Authors' contributions
All the authors contributed substantially to the conceptualization and pattern of this written report. Authors CN, SZ, XZ and HT, employees of HealthCore, engaged in data conquering and analysis. Authors T-CY, NR, and EAB, were/are employees of Mallinckrodt Pharmaceuticals, forth with all the other authors CN, NR, SZ, XZ, and HT were involved in study design, data estimation and participated in drafting and revising the different versions of this article. The final version of the article was approved by all authors.
Notes
Ethics approval and consent to participate
This non-experimental observational study was exempt from Institutional Review Board (IRB) informed consent stipulations. The researchers accessed a limited dataset without individual enrollee identifiers, and only summary statistics were reported. This work complied with all relevant provisions of the Us federal Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Consent for publication
Not applicable. The study does not contain information from any individual person.
Competing interests
The authors declare the following: T-CY is an employee and a stockholder of Mallinckrodt Pharmaceuticals, Bedminster, New Bailiwick of jersey 07921, USA. NR was an employee and is a stockholder of Mallinckrodt Pharmaceuticals, Bedminster, New Jersey 07921, Us. EAB is an employee of Mallinckrodt Pharmaceuticals, Bedminster, New Bailiwick of jersey 07921, United states of america. CN, SZ, XZ, HT are employees of HealthCore, Inc Wilmington, Delaware 19,801, U.s. whose activities on research projects are funded by diverse pharmaceutical/biotech/medical device companies.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369553/
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