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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : Appendix C. Lead Screening : C.3 Measuring Blood Lead Levels

C.3
A blood lead test is the only definitive method to detect exposure. BLLs are measured as micrograms of lead per deciliter of whole blood (µg/dL). In Texas, a BLL requires medical case management and follow-up testing if the level is greater than or equal to 5 µg/dL.
Blood lead tests, in order of occurrence:
Screening test—A blood lead test that indicates whether a client may have an EBLL. This test must be sent to the DSHS lab, or may be done using point-of-care technology in the provider’s office.
Diagnostic test—A venous blood lead test that is performed within recommended guidelines to determine the status of a client who has previously had an EBLL on a screening test (See subsection C.5, “Lead Poisoning Prevention Educational Materials and Forms” in this appendix for a link to form Pb-109 and recommended guidelines).
Note:
A follow-up test is not related to the THSteps follow-up visit. A visit to monitor a child with EBLL would be submitted as an acute care evaluation and management (E/M) visit.
Providers are responsible for conducting a diagnostic test when a screening test finds a lead level of 5 µg/dL or greater. Blood for a screening test may be drawn from a venous or capillary site. A venous blood draw is strongly recommended and preferred. To order venous sample supplies from the DSHS Laboratory, call 1-888-963-7111, Ext. 7661.
Note:
The capillary lead screen analysis is subject to a false positive result from skin lead contamination during collection. A soap and water wash of the patient’s hands or feet and the collector’s hands (or the wearing of gloves) must be performed to minimize the chance of contamination. Alcohol cleansing alone is not sufficient.
If the screening test is 5 µg/dL or above, recalling a client for a diagnostic sample may be billed as a THSteps follow-up visit. If the screening test was rejected due to clotting, insufficient quantities, or perceived contamination, the provider must repeat the sample as a diagnostic test. Again, the provider may bill the visit and analysis as an E/M visit. Providers can submit the specimen to the DSHS Clinical Chemistry Laboratory using the appropriate DSHS Laboratory Specimen Submission form (the same way as for all other THSteps laboratory blood specimens). If the initial blood lead test is collected as part of a THSteps medical checkup, it must either be sent to the DSHS lab or performed in the provider’s office using point-of-care. The diagnostic and follow-up test for the same client may be sent to a private laboratory.
Refer to:
Pb-109: Reference for Blood Lead Retesting and Medical Case Management on the DSHS website for interpretation of laboratory test results and guidelines for follow-up for clients with elevated blood lead levels.
Subsection 5.3.11.6.6, “Required Laboratory Tests Related to Medical Checkups” in this handbook.
Subsection 5.3.9, “Newborn Examination” in this handbook.
Providers can find more information about the medical and environmental management of lead-poisoned children on the DSHS Texas Childhood Lead Poisoning Prevention Program (TX CLPPP) website at www.dshs.state.tx.us/lead or by calling 1‑800‑588‑1248.

Texas Medicaid & Healthcare Partnership
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