Lead Screening in Children – Exploratory Measure Tip Sheet
The percentage of children 2 years of age who had one or more capillary or venous lead blood test for lead poisoning by their second birthday.
In 2021, the Lead Screening in Children measure, is an Exploratory Measure, and will not qualify for payment. Data will be available quarterly for providers to track their member’s compliance in 2021. The Alliance is reviewing this measure for consideration for payment in 2022. For additional information refer to the 2021 CBI Tech Specifications.
CPT Code: 83655
- Exposure to lead in children can cause damage to the brain and other vital organs, as well as intellectual and behavioral deficits.
- Research suggests that there is no safe blood lead level (BLL) and its effects are irreversible. Chelating agents which intend to remove lead may reduce fatality rates, but have not demonstrated to improve IQ or behavioral consequences of lead exposure. (https://www.cdc.gov/nceh/lead/prevention/default.htm).
- Children exposed to lead have no obvious symptoms, as such, lead poisoning often goes unrecognized.
- Elevated blood lead levels primarily affect children with a lower socioeconomic status and from minority communities because of the increased risk of housing-related exposure (USPSTF).
- Conduct an environmental assessment prior to blood lead screening of children at risk for lead exposure. These assessments can include toys, pottery, cosmetics, folk remedies, food, and candy. In some subpopulations, imported products, foods, and folk remedies may be more commonly found and are a more substantial contributor to lead exposure.
- Screening Types:
- Initial screen: point of care testing; capillary
- Confirmatory testing: venous sample
- The Bright Futures Periodicity Schedule recommends screening children at 12 months and 24 months and risk assessments to be performed up to 6 years of age, with appropriate action to follow, if positive. If there is no evidence of prior screening, the DHCS requires screening once between 24 to 72 months.
- The DHCS requires that providers give oral or written anticipatory guidance to parents/guardians of a child at each periodic health assessment from 6 – 72 months which includes information related to the harms of lead.
- Network providers are not required to perform a blood lead screening test if either applies:
- In the professional judgment of the provider, the risk of screening poses a greater risk to the child member’s health than the risk of lead poisoning. This must be documented in the medical record.
- If a parent/guardian, or other person with legal authority withholds consent to the screening, the provider must obtain a signed statement of voluntary refusal, or document the reason for the not obtaining a signed statement in the child’s medical record (ex. when services are provided via telehealth modality or party declines to sign).
- The CDC recommends screening all immigrant, refugee and internationally-adopted children when they arrive in the U.S. due to their increased risk.
- Help parents identify if their child has been exposed or has continuous exposure (paint chips, regular visits to houses built before the 1950s, lead in soil, water, pottery and candies from other countries, etc.) and encourage parents to avoid possible lead exposures.
- Monitor all children with a confirmed BLL ≥5 µg/dL for subsequent increase or decrease in BLL until all recommended environmental investigations and mitigation strategies are complete.
- Primary prevention is the most important and significant strategy for reducing BLLs.
- Provide nutritional guidance and recommend a well-balanced diet. Calcium, iron, and vitamin C play a specific role in minimizing lead absorption.
- Accumulation of lead can begin during pregnancy; conduct initial and follow-up screening of pregnant and lactating persons.
- When interacting with affected families offer simple information about the meaning of BLL results, and relevant and culturally sensitive messages about the impact of lead levels.