Critical Congenital Heart Disease (CCHD) - Frequently Asked Questions
Do all types of Congenital Heart Disease (CHD) need to be reported to the Texas Department of State Health Services (DSHS)?
No. DSHS requires reporting of confirmed cases of Critical Congenital Heart Disease (CCHD) conditions only.
What is the difference between Congenital Heart Disease (CHD) and Critical Congenital Heart Disease (CCHD)?
Congenital Heart Disease (CHD) involves problems with the heart's structure that are present at birth. There are many types of congenital heart disease that range from simple defects with no symptoms to complex defects.
About 25% of CHDs will be Critical Congenital Heart Disease (CCHD) that causes severe, life-threatening symptoms, and requires medical intervention within the first few hours, days, or months of life.
The seven defects classified as CCHDs are:
- Hypoplastic left heart syndrome
- Pulmonary atresia (with intact septum)
- Tetralogy of Fallot
- Total anomalous pulmonary venous return
- Transposition of the great arteries
- Tricuspid atresia
- Truncus arteriosus.
Confirmed cases of these seven disorders along with the five secondary disorders must be reported to the DSHS. Secondary conditions include:
- Coarctation of the aorta
- Double outlet right ventricle
- Ebstein anomaly
- Interrupted aortic arch
- Single ventricle.
Other CHD’s do not need to be reported to DSHS.
When do I submit a CCHD reporting form?
A CCHD Reporting Form is submitted when a diagnosis of CCHD is confirmed. CCHD conditions are confirmed via diagnostic testing, whether prenatally or postnatally, per Texas Health and Safety Code §33.015. It is not necessary or a requirement to report the results of the CCHD screen.
Is the CCHD reporting form used when the baby is diagnosed with a CCHD condition before birth (prenatally)?
Yes. Once the diagnosis is confirmed, the CCHD reporting form should be completed and submitted to DSHS. On page 2 of the form, there is a “Diagnosis Timeframe” section that will identify when CCHD was diagnosed – prenatal or post-natal.
Is the CCHD reporting form used when the baby is diagnosed prior to performing the screening tool and completion of the CCHD algorithm?
Yes. Anytime a CCHD diagnosis is confirmed, the CCHD reporting form should be completed and faxed to DSHS. If the baby is diagnosed prior to performing pulse oximetry screening, then the pulse oximetry screening algorithm is not required. On page 2 of the form, the “Diagnosis Timeframe” section provides an option for “Post-natal diagnosis prior to pulse oximeter screening.”
Is there a required timeframe for reporting diagnosed cases of CCHD?
DSHS does not have a specific timeframe for reporting confirmed cases of a CCHD condition. Since the care of a baby with low oxygen saturation is immediate and provided at the point of care, DSHS did not identify a time critical reporting requirement. However, the case should be reported as near the time of diagnosis (or birth for those diagnosed prenatally) as reasonably possible. Cases not reported quickly have a greater risk that the reporting will not occur.
How many forms are used to report CCHD to the Newborn Screening Program?
The CCHD reporting form is the only form that should be submitted to the Newborn Screening Program. Law requires reporting of confirmed CCHD cases only.
Is there a specific type of pulse oximeter that must be used to perform the CCHD screening?
Pulse oximeters used to conduct CCHD newborn screening must meet the standards and accuracy as determined by the Food and Drug Administration for hospital use in newborns per §37.78(c).
Is there reimbursement information associated with this screening test for Medicaid, Medicare and third party payers? Is there an associated CPT/HCPCS with this service?
There is no separate reimbursement coding for CCHD screening.
Should the CCHD screen be performed if the newborn is on continuous oxygen or assisted ventilation?
It is recommended that the newborn be screened for CCHD utilizing the pulse oximetry algorithm at 24-48 hours, even if on supplemental oxygen. If the newborn is expected to be on supplemental oxygen for an extended period of time, the CCHD pulse oximetry screen should be repeated when the newborn no longer requires supplemental oxygen or at the time of discharge, regardless of oxygen status.
Who can perform the CCHD Pulse Oximeter screening?
A physician attending a newborn child may delegate the physician's responsibilities related to Newborn Screening to any qualified and properly trained person acting under the physician's supervision [§33.0111(h)].
Who submits the CCHD reporting form for confirmed cases of CCHD?
The provider who confirms the diagnosed CCHD condition is responsible for submitting the CCHD reporting form to DSHS. A physician attending a newborn child may delegate the physician's responsibilities related to Newborn Screening to any qualified and properly trained person acting under the physician's supervision [§33.0111(h)].
Scenario 1 – A baby is born at Provider A, who performs the CCHD pulse oximetry screening. The baby has a positive screen and diagnostic testing is ordered by Provider A. Provider A confirms a CCHD condition based on test results. Provider A completes and submits the CCHD reporting form to DSHS.
Scenario 2 – A baby is born at Provider A, who performs the CCHD pulse oximetry screening. The baby has a positive CCHD screen and the baby is transferred to Provider B for additional diagnostic testing. Provider B confirms a CCHD condition. In this case, Provider B completes and submits the CCHD reporting form to DSHS.
Scenario 3 – A baby is born at Provider A, who performs the CCHD pulse oximetry screening. The baby has a positive CCHD screen and the baby is transferred to Provider B for additional diagnostic testing. Provider B confirms a CCHD condition. Provider B completes and submits the CCHD reporting form to DSHS. The baby is then transferred to Provider C for additional treatment or procedures where it is determined that the baby has a different CCHD condition than was originally diagnosed. Provider C then completes and submits an updated CCHD reporting form to DSHS with the new CCHD condition marking the box “Update to a previously reported case.”
What do I do if a confirmed CCHD condition has been reported and the CCHD diagnosis changes?
If a subsequent test/procedure identifies a different CCHD condition than was originally submitted, a second CCHD reporting form should be submitted with the box checked to indicate that it is an “Update to a previously reported case.”
If a baby is discharged from a birthing center or hospital prior to the recommended time frame to complete the CCHD pulse oximetry screen, when must the screen be completed?
The American Academy of Pediatrics (AAP) policy recommends that screening be done no earlier than 24 hours after birth and prior to discharge from the birth facility. Because of the transition from fetal to neonatal circulation and stabilization of systemic oxygen saturation levels, screening earlier than 24 hours is not as reliable and can produce increased false-positive results (Kemper et al., 2011). If the newborn is to be discharged before 24 hours of age, screening should be done as shortly before discharge as possible.
Babies not screened in the newborn nursery or prior to discharge from a birthing center should be screened as soon as possible, preferably at the first pediatric checkup within a few days of birth. However, CCHD screening does not need to be conducted before discharge or post-discharge if echocardiography has been performed as part of the newborn’s care in the birth facility.
What is required for a CCHD screen?
The test used to for CCHD screening is a pulse oximetry screen using the CCHD Algorithm. If a screen is positive, an echocardiogram can confirm the diagnosis of a CCHD condition.