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Coronary Testing Quick Reference

Member Forum >> Coronary Disease & Cholesterol Protocol >> Coronary Testing Quick Reference

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Posted: 4/23/2020 3:23:51 PM
Edited: 11/19/2023 12:37:52 PM (18)
 

Coronary Testing Quick Reference

Edition: 2023-11-19
Note: Although this article is public, not all links within it are.

This page provides some test ordering detail in support of program protocols:
♥ Special Protocols: ⎆Coronary Disease {members}
♥ Special Protocols: ⎆Cholesterol, Total and LDL {members}

Most of the core tests recommended:
♥ Forum: ⎆…program goals {public}
are tests for coronary health, and see that blog article for targets for TG (triglycerides) and HDL (high density lipoproteins). Note that total cholesterol and the so-called “LDL-C” are not on the list. Their omission is not an oversight. If there is specific concern about cardiac health, the three tests discussed here have been found to be of use.

This information may be needed by your empowering healthcare provider, or by you (regional regulations permitting).
⇩NMR Small LDL-P
⇩Lipoprotein(a)
⇩Coronary Calcium Score


 NMR Small LDL-P

With respect to the tests listed in Program Marker Targets (linked above), be aware that you may be the first patient to ever ask your doctor one for at least one of the tests on that list, the NMR Small LDL-P. It’s actually just the most useful of several markers on an NMR Advanced Lipoprotein panel.

The target value for this (via NMR) is:
  ≤ 200 nmol/L
This test must be drawn fasting, and when weight has been stable for at least 30 days.

Here is the CPT Code:
83704 Lipoprotein, Blood; Quantitation Of Lipoprotein Particle Numbers And Lipoprotein Particle Subclasses (e.g., By Nuclear Magnetic Resonance Spectroscopy)

Verify that what’s being ordered under this code is not via electrophoresis, VAP or IMS-MS (Ion Mobility, such as CardioIQ®). These assay methods can be useful for tracking progress, but the program target does not apply.

It is therefore not CPT Codes 83700, 83701, 83718, 83721, 91604, 94220, or 92145.

Lab Order Codes for NMR vary by lab and test provider. Prices also vary, and tests may be bundled with a standard lipid panel, or be offered in other bundles with possibly interesting tests like Lp(a).
⊥ LabCorp: ⎆123810, ⎆884247 (their Pixel service doesn’t seem to offer)
⊥ Life Extension: ⎆LC123810 (drawn at LabCorp)
⊥ Quest: ⎆37847
⊥ RequestATest: ⎆123810⇱ Return to ToC


 Lipoprotein(a)

This is a genetically-biased marker, associated with increased cardiac risk. When the value is elevated (and historical program thresholds varied by assay method), there is a program supplement adjustment suggested. The goal of the adjustment, by the way, is to reduce the atherogenicity of the Lp(a), and not to reduce it per se.

⎆More on Lipoprotein(a) {members}
⎆Update on Lp(a) {members}

The target value for this, via NMR, is:
  ≤ 30 mg/dL
  ≤ 75 nmol/L
This test must be drawn fasting, and when weight has been stable for at least 30 days.

The CPT Code is:
83695 Lipoprotein (a)

Lab Order Codes vary:
⊥ LabCorp: ⎆120188 (their Pixel service doesn’t seem to offer)
⊥ Life Extension: ⎆LC120188
⊥ Quest: ⎆34604
⊥ RequestATest: ⎆120188⇱ Return to ToC


 Coronary Calcium Score (CCS)

Also Known as:
♥ CT calcium scan {the procedure},
♥ CAC (coronary arterial calcium),
♥ Heart Scan

Although not one of the suggested routine core markers, a Computed Tomography calcium scan is extremely valuable in:

  • establishing a baseline cardiac risk, and
     
  • tracking annual progress in slowing, arresting and reversing a non-zero score.

The target value for this is:
  0 (zero) score in Agatston or Hounsfield units
If the score is non-zero, the target is to manage score growth to +10% per year or less (and fully arresting it or reversing it is within reach).

It might have been the core marker in the legacy Track Your Plaque program here, and is still of keen interest to newer members arriving with actual, suspected or merely presumed atherosclerosis.

The scan may not be available or fully informative in all cases, such as with stents present, in the wake of CABG, and may be inadvisable due to factors like recent other radiation exposure. In such cases, other proxies may be needed (such as CIMT, or coronary stress ultrasound, which are beyond the scope of this QR at present).

Blog articles:
♥ PCM: ⎆WBB: Why you should get a CT heart scan {public}
♥ PCM: ⎆UdB: What is better than a CT heart scan? {public}
♥ PCM: ⎆WBB: Do statins reduce heart scan scores? {public}
♥ PCM: ⎆UdB: How to Reduce Your Heart Scan Score {public}
♥ PCM: ⎆IHB: The hidden signs of high blood pressure {members}

Heart Scan Workshop:
⎆Part 1 {public},
⎆Part 2 {members},
⎆Part 3 {members}

Obtaining a Heart Scan

The CPT Code for this test is:
75571 Calcium Scoring--CT

It is definitely not the CT angiogram, stress nuclear study, nor codes 75572, 75573, or 75574. If a contrast agent or catheterization is involved, all stop, you are not getting the correct test. If you have an elevated HR, a sedative may be offered. Fasting is not required.

Although you can arrange a CCS on your own in most US states, a heart scan cannot today be ordered from an on-line service. It must be arranged with a regional clinic possessing a scanner. If not covered by your carrier, out-of-pocket fees range from US$50 to $500, including radiologist report, with $100 being a typical "loss leader" price that keeps the scanner and staff utilization rates up. The status of Medicare coverage for 75571 was unclear at the latest update to this article.

Although the main result you want from the report is the total Agatston score, also insist on detail down to at least score-by-vessel. Ideally, you also want a report of the diameter of the ascending aorta, notation on amounts of any calcium in the ascending aorta, on aortic valves, or mitral valve; also, notes on epicardial fat and any lung nodules.

Short-interval repeated scans are not recommended, due to radiation, and due to realistic rates of change being hard to detect for a test subject to 8% scan-to-scan variation. For a zero score, and being on program, with otherwise optimal markers, waiting 5 years to repeat suffices. For a non-zero score, wait a year after implementing all corrective measures (and this process itself can take some time).⇱ Return to ToC


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Tags: Advanced,Agatston,cac,CCS,CT calcium,electrophoresis,IMS-MS,LDL,LDL-P,Lipoprotein,Lp(a),lpa,NMR,panel,particles,score,Small,VAP

Bob Niland

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Posted: 4/23/2020 3:25:12 PM
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Posted: 12/31/2020 2:17:53 PM
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