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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: 5/11/2020 8:50:01 PM (7)
 

Coronary Testing Quick Reference

Edition: 2020-05-11
Note: Although this article is public, not all links within it are.

This page provides some test ordering detail in support of program protocols:
Undoctored Protocols: Coronary Disease (members)
Undoctored Protocols: Cholesterol, Total and LDL (members)

In a sense, all of the the core tests recommended:
♥ Undoctored Blog: Undoctored 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)
CT Calcium Scan


NMR Small LDL-P

The tests listed in Undoctored Program Goals (linked above) are all program core. 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

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

It is not CPT Code 83700, 83701, 83718, nor 83721

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: 123810u21f1_north_west_arrow_to_corner 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.

More on Lipoprotein(a) (members)

The target value for this, via NMR, is:
  ≤ 30 mg/dL
  ≤ 75 nmol/L

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: 120188u21f1_north_west_arrow_to_corner Return to ToC


CT Calcium Scan

Also Known as a Heart Scan; and although not one of the suggested routine core markers, a Computed Tomography calcium scan, or CAC (Coronary Arterial Calcium), is extremely valuable in:

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

The target value for this is:
  0 (zero) Agatston score

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).

Undoctored Blog articles (public):
Why you should have a CT heart scan
What is better than a CT heart scan?
Scanned . . . or scammed?
Do statin drugs slow or stop the increase in heart scan scores?
How to Reduce Your Heart Scan Score

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.

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.u21f1_north_west_arrow_to_corner Return to ToC

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Bob Niland

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Posted: 4/23/2020 3:25:12 PM
Edited: 5/11/2020 8:45:12 PM (1)
 
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