From the Research
The appropriate diagnosis code for an elevated apolipoprotein B (apo B) test to link to an order for a coronary calcium score would be R79.89 (Other specified abnormal findings of blood chemistry). This code covers abnormal blood chemistry findings including elevated apo B levels. Alternatively, you could use E78.2 (Mixed hyperlipidemia) or E78.4 (Other hyperlipidemia) if the patient has been diagnosed with a lipid disorder. When ordering a coronary calcium score based on elevated apo B, it's essential to document that this test is being ordered for cardiovascular risk assessment in a patient with evidence of dyslipidemia.
Key Points to Consider
- Apolipoprotein B is a more accurate predictor of cardiovascular risk than LDL cholesterol alone because it represents the total number of atherogenic particles, as supported by recent guidelines 1.
- Each atherogenic lipoprotein particle contains exactly one apo B molecule, making it a direct measure of the number of potentially harmful particles circulating in the bloodstream.
- A coronary calcium score provides direct visualization of subclinical atherosclerosis and can help guide intensity of lipid-lowering therapy.
- The most recent and highest quality study 1 emphasizes the role of apolipoprotein B in the clinical management of cardiovascular risk in adults, highlighting its superiority over LDL-C in risk assessment.
- It is crucial to consider the discordance between apo B and LDL-C or non-HDL-C levels when assessing cardiovascular risk, as discordantly high apo B levels may be associated with increased risk of subclinical atherosclerotic cardiovascular disease, as noted in studies such as 2 and 3.