Medical Review - Articles by Medical Review Staff

November 12, 2004

Screening Lipid Testing

Prepared October 14, 2004

By Howell Johnson, M.D., Associate Medical Director

Standard guidelines for coronary artery disease risk assessment in adults include a routine fasting lipid profile. This profile includes measurements of total cholesterol, LDL and HDL cholesterol, and triglyceride levels.

Lipid subfractions, such as lipoprotein(a) and low-density lipoprotein particle size are being studied. Although routine assessment for primary prevention is not yet recommended, measurement of lipoprotein(a) may be warranted in patients with premature vascular disease or a strong family history.

The value of determining LDL particle size is controversial. Specific therapy to alter the size distribution of LDL particles is not available. Therefore, the goal should be to decrease LDL cholesterol concentration to as low a level as possible.

Postprandial measurements of triglycerides, intermediate-density lipoprotein, and very-low density lipoprotein cannot be recommended in routine clinical practice.

Appropriate lipid testing include:

Lipid panel	80061
Cholesterol	82465
HDL	83718
TG	84478

Other lipid test (listed below) will be evaluated for medical necessity by report. For payment, submit the claim with records for medical necessity determination.

IDL	0026T
Lipoprotein Quantitation	83715
Lipoprotein Subclasses	83716
Direct VLDL	83719
Direct LDL	83721

References:

1 . Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA.2001;285:2486-97. PMID: 113368702

2. Sniderman AD, Furberg CD, Keech A, Roeters van Lennep JE, Frohlich J, Jungener I, Walldius G. Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatment. Lancet. 2003;361:777-80. PMID: 12620753

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