Tuberculosis (TB) Risk Assessment – Exploratory Measure Tip Sheet

This is an exploratory measure; there is no payment for 2021 and 2022. For additional information, refer to the 2021 and 2022 CBI Technical Specifications.

ICD-10 Code: Z11.1: “encounter for screening for respiratory tuberculosis.”

Approximately 30-40% of persons exposed to Mycobacterium tuberculosis (TB) will become infected with the germ[i]. For persons that have been infected with TB or Latent Tuberculosis Infection (LTBI) if they go untreated, the lifetime risk of developing active Tuberculosis is approximately 5% to 10%.[ii] Primary care clinicians can change the fate of those members infected with TB but never treated for it.  There are 13 million persons estimated to be living with LTBI.[iii]

The CDC and U.S. Preventive Services Task Force (USPSTF) recommend screening for LTBI in populations at increased risk. Risk for TB generally falls into two groups, first they are likely to be exposed to someone with active TB disease, or second, they themselves have health conditions that are associated with an increased risk of progression from LTBI to TB disease. Some of your patients may be at higher risk than others including:

• Patients from countries where TB disease is common, or those who have traveled to these areas and spent a month or longer there. Countries included are most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia.
• Patients who have spent time with someone who has TB disease
• People that have resided in settings where TB is more common (e.g. homeless shelters, correctional settings, or nursing homes, etc.).

Also, at risk are those with certain conditions:

• Patients that are immunosuppressed from medications, other treatments or health conditions
• Patients diagnosed with Diabetes Mellitus
• Patients that received solid organ transplants
• Recent test convertors (defined as persons with negative baseline testing results who have an increase of 10 mm or more in the size of the Tuberculin Skin Test (TST) reaction, or previously tested negative with a TB blood test and now have tested positive within a 2-year period).

[i] Centers for Disease Control and Prevention. Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 2005;54(No. RR-12): 1-81. https://www.cdc.gov/mmwr/PDF/rr/rr5412.pdf

[ii] Ibid, page 12.

[iii] US Preventive Services Task Force. Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(9):962–969. doi:10.1001/jama.2016.11046

• Use the risk assessment tool for asymptomatic children to screen for risk for latent TB prior to testing. Recommended screening tool: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/TBCB-CA-Pediatric-TB-Risk-Assessment.pdf
• Add flag to electronic health record to remind for annual screening.
• Identify foreign-born patients and screen them ahead of US born patients.
• Use interferon-gamma release assays (IGRAs) or the “blood test” for any TB testing needed with the exception that it should not be used for children less than two years old.
• Post this guide in your clinic’s staff work areas: https://tinyurl.com/yys8zohg
• Develop a nursing workflow for screening, testing and following up on patients with LTBI.
• Educate patients and clinic staff about TB with available handouts, tip sheets, guides and toolkits. The CDC has developed several educational resources posted to their website, including select materials that are free to order: https://www.cdc.gov/tb/publications/default.htm