TMPPM 2010 > Children's Services Handbook > THSteps Medical > Services/Benefits, Limitations, and Prior Authorization > Screening Components With Additional Requirements > Laboratory Procedures

6.3.2.6.6 Required Laboratory Tests Related to Medical Checkups

The following laboratory screening procedures are required components of the THSteps medical checkup and are to be performed in accordance with the age and frequency specified on the THSteps medical checkup periodicity schedule. Due to changes in specimen collection, handling, and submission criteria, providers should contact the DSHS Laboratory for the most current specimen requirements by calling 1-888-963-7111, Ext. 7430 or visiting the DSHS website at www.dshs.state.tx.us/lab/MRS_labtests_toc.shtm.

Hemoglobin or Hematocrit

Hemoglobin or hematocrit levels are required. These tests may be completed in a provider's office if there is an urgent need for test results and test results must be documented in the client's medical record.

Lead Screening and Testing

In accordance with current federal regulations, THSteps requires that clients be screened for lead poisoning through either blood tests and/or parent questionnaires at 6, 9, 12, 15, 18, 24, and 30 months of age and annually until 6 years of age.

Lead poison screening is required from 6 months through 6 years of age. A blood lead level is mandatory at 12 and 24 months of age or any first checkup after 12 or 24 months of age, if there is no documented blood lead level results available. The results of the questions contained in the Lead Exposure Questionnaire, if documented in the client's record, is acceptable at other visits.

Providers may download the Pb-110: Risk Assessment for Lead Exposure Questionnaire, which is provided in both English and Spanish at www.dshs.state.tx.us/lead.

Providers may obtain more information about the medical and environmental management of lead poisoned children from the DSHS Childhood Lead Poisoning Prevention Program by calling 1-800-588-1248 or visit the web page at www.dshs.state.tx.us/lead

Refer to: Appendix C: Lead Screening in this handbook for more information on lead screening procedures and follow-up

Hemoglobin Type/Hemoglobin Electrophoresis

If the hemoglobin type has been done as a part of newborn screening and results are documented on the chart, the test does not need to be repeated. Results from dates of service on or after July 12, 2002, are available from the DSHS Laboratory. The test also may be performed at the provider's discretion, as appropriate for age and population groups.

Hyperlipidemia

Screening for hyperlipidemia is based on risk assessment. THSteps does not provide a formal risk assessment tool. Providers may refer to the AAP policy statement on cholesterol screening for more information. Specimens may be sent to the laboratory of the provider's choice, including the DSHS Laboratory.

Diabetes

Screening for risk of Type 2 diabetes is based on risk assessment. THSteps does not provide a formal risk assessment tool. Specimens may be sent to the laboratory of the provider's choice, including the DSHS Laboratory.

Newborn Screening

The mandated newborn screen at 1 to 2 weeks of age is a required component of the THSteps medical checkup. Clients should not be referred to the local health department or other providers for this service.

Health and Safety Code, Chapter 33, Vernon's Texas Codes Annotated, requires testing for the disorders recommended by the American College of Medical Genetics (ACMG) on all newborns. This testing is the responsibility of any provider attending the newborn. All newborns must be tested at 24-48 hours of age and a second time at 1 to 2 weeks of age. If there is any doubt that a client younger than 12 months of age was properly tested, the provider should submit the blood sample on the appropriate DSHS Form NBS 3 to the DSHS Newborn Screening Laboratory.

Note: The results are mailed to the address that the provider indicated on Form NBS 3. Recommendations for necessary follow-up procedures are included with the report. The DSHS NBS Case Management staff will contact providers when there are significant abnormalities.

The newborn screening should only be obtained prior to 1 week of age if a first newborn screen was not obtained before discharge from the hospital. The second newborn screening should be completed at the 1- or 2-week visit. If a potential or confirmed medical problem related to the newborn screen results requires monitoring, it is recommended that the infant be seen in a clinic or medical provider's office, and Texas Medicaid should be billed using codes for an acute care visit.