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Management of Hyperbilirubinemia in Newborns: Follow-Up Visits

All infants should be examined by a qualified healthcare professional in the first few days after discharge to assess for infant well-being and jaundice. The length of stay in the nursery, risk factors for hyperbilirubinemia and risk of other neonatal problems will help determine the timing of these follow-up visits.

The following recommendations are based on the American Academy of Pediatrics guidelines for the management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. These guidelines emphasize the importance of universal systematic assessment for the risk of severe hyperbilirubinemia, close follow-up and prompt intervention when indicated.

Before discharge, every newborn should be assessed for the risk of developing severe hyperbilirubinemia, especially if the infant is discharged before age 72 hours.

Follow-up office visits rendered by the physician to assess for the development of hyperbilirubinemia in the newborn period when there is no sign of disease should be reported as traditional evaluation and management services. The frequency of the office visit should be based upon clinical assessment and age at discharge.

Infants discharged before age 24 hours should have a follow-up visit by age 72 hours.

Infants discharged between age 24 and 47.9 hours should have a follow-up visit by age 96 hours.

Infants discharged between age 48 and 72 hours should have a follow-up visit by age 120 hours.

Some infants discharged before age 48 hours may require two follow-up visits, the first between 24 and 72 hours and the second between 72 and 120 hours.

Clinical judgment should be used in determining earlier or more frequent follow up visits, especially if there are risk factors for the development of hyperbilirubinemia.

The follow-up assessment should include the infant's weight and change from birth weight, intake and output, and the presence or absence of jaundice.  Clinical judgment should be used to determine the need for a bilirubin measurement.

If there is any question about the degree of jaundice, the bilirubin level should be measured.

These followup visits to assess for the development of hyperbilirubinemia when there is no sign of disease should be reported as traditional evaluation and management services (Current Procedural Terminology [CPT┬«] codes 99201-99215). The level of service would be based on the complexity of the visit. If hyperbilirubinemia or other condition is found, then that may be reported as the diagnosis.

 

Last reviewed: June 3, 2019