From the Research
For Lyme disease screening, the appropriate diagnosis code to use is Z11.59, which represents "Encounter for screening for other viral diseases." When ordering Lyme disease testing for screening purposes in asymptomatic individuals, this code indicates that the test is being performed to detect potential infection in the absence of symptoms or known exposure. If the patient has symptoms suspicious for Lyme disease or a known tick bite, different codes would be more appropriate, such as Z20.8 (contact with or exposure to communicable diseases) or specific symptom codes. It's essential to note that many insurance companies may not cover Lyme disease screening in completely asymptomatic individuals without risk factors, as routine screening is not generally recommended by major medical organizations, as supported by studies such as 1. Documentation should clearly indicate the clinical reasoning for ordering the test, such as residence in an endemic area, outdoor activities in tick-habitats, or non-specific symptoms that could potentially be attributed to Lyme disease. The choice of diagnostic test is also crucial, with modified two-tier testing (MTTT) algorithms being approved by the US Food and Drug Administration (FDA) for the screening and confirmation of Lyme disease, as seen in studies like 2. Key considerations in selecting a diagnostic approach include the performance characteristics of the tests, such as sensitivity and specificity, as discussed in 3 and 4, and the clinical context of the patient. Given the most recent evidence from 2, which evaluated the performance of the Quidel Sofia Lyme fluorescent immunoassay as a first-tier test in an MTTT algorithm, it is clear that the diagnostic approach for Lyme disease continues to evolve, emphasizing the need for up-to-date clinical guidelines and practices. In real-life clinical practice, the decision to screen for Lyme disease and the choice of diagnostic code should be guided by the patient's risk factors, symptoms, and exposure history, always prioritizing the patient's morbidity, mortality, and quality of life outcomes. The use of diagnosis codes like Z11.59 for screening purposes in asymptomatic individuals without clear risk factors should be approached with caution, considering the recommendations from major medical organizations and the potential for insurance coverage issues. Ultimately, the diagnosis and management of Lyme disease require a thoughtful and evidence-based approach, incorporating the latest research findings, such as those from 5, to optimize patient outcomes.