Description:
Transfusion therapy for fetal and neonatal diseases can involve either a simple transfusion or an exchange transfusion. In neonates, an exchange transfusion is the method used, while in fetuses, the various intrauterine transfusion therapies may use either a simple transfusion or an exchange transfusion.

In fetuses, one of three types of intrauterine transfusion techniques may be used:

1. Intraperitoneal intrauterine fetal transfusion
2. Direct intrauterine transfusion (via umbilical artery/vein) without exchange of donor blood for fetal blood
3. Intrauterine exchange transfusion (via umbilical artery/vein)

Policy:
Transfusion therapy is considered MEDICALLY NECESSARY in the treatment of the following diseases of the fetus and the newborn:

• Erythroblastosis fetalis
• Hydrops fetalis
• ABO incompatibility
• Rh incompatibility
• Hemolytic anemia
• Hyperbilirubinemia

Coding Section

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross Blue Shield Association technology assessment program (TEC) and other nonaffiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology © American Medical Association. All Rights Reserved" 

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