Comprehensive Summary of Liver, Kidney, Pancreas, Thyroid Function Tests and ICD-10 Coding

Liver Function Blood Test Components

• Bilirubin: Byproduct of red blood cell breakdown.

  • Conjugated (water-soluble): Indicates a liver problem.

  • Unconjugated (not water-soluble): Suggests the issue is not liver-related.

• Bilirubin (blood) – Adult:

  • Direct (conjugated) Normal Levels: $0.0-0.3 \text{ mg/dL}$

    • High levels: Indicate jaundice and hemolytic anemia.

  • $0.3-1.9 \text{ mg/dL}$

    • High levels: Indicate liver disease, gallstones, hepatitis, causing jaundice.

Liver Function Blood Test Components Laboratory Values

• ALT (Alanine Aminotransferase):

  • Specific to the liver.

  • Elevated levels indicate liver damage.

  • Normal Level: $10-40 \text{ IU/L}$

  • High levels: Indicate hepatitis, cirrhosis, liver necrosis.

• AST (Aspartate Aminotransferase):

  • Not specific to liver cells; found in muscle, heart, brain, and kidneys.

  • Normal Level: $10-34 \text{ IU/L}$

Liver Function Blood Test Components Laboratory Values

• ALP (Alkaline Phosphatase):

  • Normal Levels: $44-147 \text{ IU/L}$

  • High levels: Indicate leukemia, lymphoma, hepatitis.

  • Low levels: Indicate protein deficiency, malnutrition.

• GGT (Gamma glutamyl transpeptidase):

  • Enzyme elevated with alcohol consumption.

• Liver function tests can only detect damage when 85% of cells have been damaged; can't detect early damage.

Liver Function Blood Test Components Laboratory Values

• Total protein in blood: Measured because the liver produces protein.

• Albumin: The major protein produced by the liver.

• Total Protein:

  • Normal Level: $6.0-8.3 \text{ g/dL}$

  • High levels: Indicate pregnancy, chronic inflammation, HIV.

  • Low levels: Indicate hemorrhage, extensive burns, liver disease.

• Prothrombin time: The liver produces coagulation factors.

Liver Function Blood Test Components Laboratory Values

• Total blood cholesterol: Measure of LDL and HDL cholesterol components.

  • Good level: <200 \text{ mg/dL}

• LDL (Low-Density Lipoproteins):

  • "Bad" cholesterol because high levels lead to cholesterol buildup in arteries.

  • Good level: <100 \text{ mg/dL}

  • High levels: Linked to cardiovascular disease.

• HDL (High-Density Lipoproteins):

  • "Good" cholesterol because it carries cholesterol from other parts of the body back to the liver.

• HDL:

  • Good level (men): $40-49 \text{ mg/dL}$

  • Good level (women): $50-59 \text{ mg/dL}$

  • Carries lipids to the liver.

Cholesterol and Lipoproteins

• Lipoprotein Profile: Measures cholesterol levels in the blood, including HDL, LDL, triglycerides, and total cholesterol.

• HDL: Transports LDL back to the liver.

• Excess LDL: Sticks to artery walls, forming clogs.

• Liver Conversion: Liver converts HDL into bile salts.

• LDL Function: Delivers cholesterol to cells.

• HDL Function: Removes excess cholesterol from cells.

VLDL and Triglycerides

• VLDL (Very Low-Density Lipoprotein):

  • Composed of cholesterol, triglycerides, and proteins.

  • Transports cholesterol, triglycerides, and lipids around the body.

  • Contains the highest amount of triglycerides.

  • Normal Level: $5-40 \text{ mg/dL}$

  • High levels: Indicate a build-up of cholesterol on artery walls.

• Triglycerides:

  • Good Level: <150 \text{ mg/dL}

  • High levels: Linked to coronary artery disease.

Causes of Elevated Enzymes and Albumin/Protein Levels

• Causes of Elevated Enzymes: Alcohol, Hepatitis C or B, direct trauma to the liver, infestation with worms, drugs or toxins, liver cancer or liver mets, congenital abnormalities, autoimmune reactions.

• Albumin and Total Protein Levels:

  • Decreased total proteins along with abnormal liver function tests indicate inadequate protein production by the liver.

  • A decrease in albumin causes ascites or anasarca.

• Bilirubin Levels:

  • Excessive breakdown of RBCs leads to elevated bilirubin levels in the blood.

  • Elevated bilirubin in liver disease is conjugated, causing skin itching (pruritus), usually due to obstruction.

  • Elevated levels of unconjugated bilirubin are likely caused by hemolysis (e.g., sickle cell anemia or sepsis).

Prothrombin Time

• PT (Prothrombin Time):

  • Prothrombin is involved in the clotting pathway; low levels are associated with liver disease.

• Test Normal Ranges:

  • Bilirubin: $5 – 17 \text{ umol l}^{-1}$

  • ALP: $35 – 130 \text{ IU l}^{-1}$

  • AST: $5 – 40 \text{ IU l}^{-1}$

  • GGT: $10 - 48 \text{ IU I}^{-1}$

  • Albumin: $35 – 50 \text{ g I}^{-1}$

  • PT: $12 – 16 \text{ s}$

Kidney Blood Tests

• BUN (Blood Urea Nitrogen):

  • Nitrogen comes from protein breakdown.

  • Normal Level: $6-20 \text{ mg/dL}$

  • High levels: Indicate kidney damage or failure, dehydration.

  • Low levels: Indicate muscular dystrophy and myasthenia gravis.

Kidney Blood Tests

• Serum Creatinine:

  • Waste product from normal muscle wear and tear.

  • Levels vary depending on age, race, and body size.

  • Normal Level (men): $0.7-1.3 \text{ mg/dL}$

  • Normal Level (women): $0.6-1.1 \text{ mg/dL}$

  • High values: Indicate kidney failure/disease, UTI, shock.

  • Low values: Indicate liver failure, low dietary protein.

Kidney Blood Tests

• GFR (Glomerular Filtration Rate):

  • Measures how well kidneys remove wastes and excess fluid from blood.

  • Calculated from serum creatinine, age, and gender (adjusted for African American descent).

  • GFR: > 90

Kidney Blood Tests

• Urinalysis:

  • Standard test performed on hospital admission or as part of an annual physical.

  • Also done if a patient has symptoms related to abdominal pain or blood in the urine.

  • Requires one to two ounces of urine.

• Urine Culture:

  • Performed if a patient experiences symptoms of a urinary tract infection (UTI).

Pancreas Enzymes Blood Tests

• Amylase and Lipase: Two enzymes produced by the pancreas.

• Amylase (blood):

  • Breaks down carbohydrates into simple sugars.

  • Normal Value: $23-85 \text{ U/L}$

  • High values: Indicate acute pancreatitis, cholecystitis, pancreatic carcinoma.

  • Low values: Indicate pancreatic damage, carcinoma, kidney disease.

  • Amylase or lipase results more than three times normal levels indicate pancreatitis or damage to the pancreas.

Laboratory Values - Lipase

• Lipase (blood):

  • Digests fats into fatty acids, which are then absorbed by the small intestine.

  • Normal Levels: < 160 \text{ U/L}

  • High levels: Indicate celiac disease, acute pancreatitis, cholecystitis.

  • Low levels: Indicate chronic pancreatic damage.

Laboratory Values - Glucose Fasting

• Glucose Fasting:

  • Normal Level: $70-99 \text{ mg/dL}$

  • Prediabetic Level: $100-125 \text{ mg/dL}$

  • Diabetic Level: > 125 \text{ mg/dL}

  • High levels: Indicate diabetes, pancreatitis, pancreatic cancer.

  • Low levels: Indicate hypoglycemia, adrenal insufficiency, pancreatic tumor (insulinoma).

Thyroid Function Tests

• TSH (Thyroid Stimulating Hormone):

  • Screens for and diagnoses thyroid disorders or monitors treatment for hypothyroidism.

  • Normal Level: $0.4-4 \text{ mIU/L}$

  • High levels: Indicate hypothyroidism.

  • Low levels: Indicate Graves' disease.

• T3 (Triiodothyronine):

  • Normal Level: $100-200 \text{ mcg/dL}$

  • High levels: Indicate Graves' disease.

  • Low levels: Indicate thyroiditis.

• T4 (Thyroxine or Tetraiodothyronine):

  • Normal Level: $4.5-11.2 \text{ mcg/dL}$

  • High levels: Indicate Graves' disease, goiter.

  • Low levels: Indicate hypothyroidism, malnutrition.

Common Lab Tests

• ANA (Antinuclear Antibody Test):

  • Detects antinuclear antibodies (ANA) in the blood

  • Ordered for suspected autoimmune diseases like lupus, rheumatoid arthritis, or scleroderma.

• PTT (Partial Thromboplastin Time):

  • Evaluates the risk of excessive bleeding prior to surgery or monitors heparin anticoagulant therapy.

• Glycohemoglobin (Hemoglobin A1c):

  • Normal: $\leq 5.6$

  • Prediabetes: $5.7-6.4$

  • Monitors diabetes and aids in treatment decisions; usually performed with the first diagnosis and then 2 to 4 times per year.

A1c Test Results

• Diabetes: $6.5\%$

• Prediabetes: $5.7 \text{ to } 6.4\%$

• Normal: Below $5.7\%$

Common Lab Tests - Metabolic Panels & Blood Counts

• BMP (Basic Metabolic Panel):

  • A group of 7-8 tests used as a screening tool to check for conditions like diabetes and kidney disease.

  • Patient may be asked to fast for 10 to 12 hours prior to the test.

• CBC (Complete Blood Count):

  • Routine screening of blood that includes determination of RBC count, hematocrit, hemoglobin, and WBC count.

  • Determines general health, screens for disorders such as anemia or infections, as well as nutritional status and toxic substance exposure.

Common Lab Tests - Comprehensive Metabolic Panel & ESR

• CMP (Comprehensive Metabolic Panel):

  • A group of 14 tests that gives information about the kidneys, liver, electrolyte and acid/base balance, blood sugar, and blood proteins.

• ESR (Erythrocyte Sedimentation Rate):

  • A doctor may order this test to determine the cause of inflammation or to help diagnose and follow the course of joint or muscle pain.

Common Lab Tests - Infections and Glucose

• Flu (Influenza A and B Screen):

  • Used to determine whether flu-like symptoms are due to influenza A or B, or to other causes.

  • Testing may be done using a nasopharyngeal swab, nasal aspirate or wash, or a throat swab.

• Glucose Level:

  • Used to identify blood glucose level and to screen for, diagnose, and monitor diabetes, pre-diabetes, and hypoglycemia.

  • Patients with diabetes should monitor their glucose levels several times a day.

Common Lab Tests - Pregnancy, HIV, and Lipids

• hCG (Human Chorionic Gonadotropin):

  • Typically performed to confirm and monitor pregnancy, or if symptoms suggest issues of concern.

  • A urine sample is collected in the morning, or a blood sample is drawn.

• HIV Antibody (HIV 1/2 Ag/Ab 4th Generation with Reflex):

  • Test to determine if you are infected with HIV, should be performed three to six months after the patient thinks they may have been exposed to the virus.

• Lipid Panel (or Lipid Profile):

  • This group of tests can determine the risk of coronary heart disease and may be a good indicator of whether someone is likely to have a heart attack or stroke caused by blockage of blood vessels.

Common Lab Tests - Lyme Disease and Kidney Function

• Lyme Antibody w/Reflex Immunoblot:

  • If a patient shows symptoms of Lyme disease, the doctor may order this test to see if they have been exposed to the bacterium that causes Lyme disease.

• Microalbumin, Urine:

  • Performed annually after a diagnosis of diabetes or hypertension to screen for a possible kidney disorder.

  • Can be done using a random, timed, overnight, or 24-hour urine sample.

Common Lab Tests - Mononucleosis & Cervical Cancer Screening

• Mono:

  • If a patient has symptoms of mononucleosis, including fever, sore throat, swollen glands, and fatigue, the doctor may order this test to make a diagnosis.

• Pap Smear:

  • Should be performed annually for women who are over the age of 18 and/or sexually active to screen for cervical cancer and certain vaginal or uterine infections.

  • Cells are removed from the cervical area for testing.

Common Lab Tests - Prostate Health, Blood Thinners & Reproductive Health

• PSA (Prostate-Specific Antigen):

  • Test to screen for and monitor prostate cancer.

• PT (Prothrombin Time):

  • Used to check how well prescribed blood-thinning medications (anticoagulants) are working, or to help detect and diagnose a bleeding disorder.

• Semen Analysis:

  • Can be used to learn about the health of your reproductive organs, or after a vasectomy to determine if the operation was successful.

  • A semen sample is collected in a sterile, wide-mouth container provided by the lab.

Common Lab Tests - Stool Analysis & Uric Acid Levels

• Stool Culture:

  • Used to determine whether a patient has pathogenic bacteria in their gastrointestinal tract.

  • This test requires a fresh stool sample or one that has been placed in a specialized collection container.

• Uric Acid:

  • Used to detect high levels of uric acid or to monitor certain chemotherapy or radiation cancer therapies.

ICD-10 Overview

• ICD-10 (International Classification of Diseases, 10th Revision):

  • Published, copyrighted, and updated regularly by the World Health Organization.

  • As a sonographer, you may be responsible for entering the ICD-10 code on the billing sheet after completing the ultrasound exam.

ICD-10 Codes Explained

• ICD-10 codes are alphanumeric codes used by doctors, health insurance companies, and public health agencies worldwide to represent diagnoses.

• Every disease, disorder, injury, infection, and symptom has its own ICD-10 code.

• ICD-10 codes are used for everything from processing health insurance claims to tracking disease epidemics and compiling worldwide mortality statistics.

ICD-10 Code Structure

• ICD-10 codes are alphanumeric and contain 3-7 characters; each code describes a particular diagnosis in detail.

• The first 3 characters define the category of the disease, disorder, infection, or symptom.

  • Codes starting with M00-M99 are for diseases of the musculoskeletal system and connective tissue (like rheumatoid arthritis).

  • Codes starting with J00-J99 are for diseases of the respiratory system.

• Characters in positions 4-6 define the body site, severity of the problem, cause of the injury or disease, and other clinical details.

  • e.g., In the rheumatoid arthritis example, the fifth character defines the body site, and the sixth character defines whether it’s the left or right side. A three in the fifth character position denotes it’s a wrist that’s affected. A two in the sixth character position denotes it’s the left side of the body that’s affected.

• Character 7 is an extension character used for varied purposes such as defining whether this is the initial encounter for this problem, a subsequent encounter, or sequela arising as a result of another condition.

ICD-10 Case Studies

• ICD-10 codes are used to classify and code for diagnoses and procedures for billing, quality, and statistical purposes. The following are examples of how this information is used in the clinic setting.

1. Patient presents to the ER with fever, nausea, and mid-epigastric pain radiating to their back after returning from Mexico, where they only consumed tequila and beer. Labs indicate elevated amylase and WBCs.

• Diagnosis and ICD-10 code for billing?

1. Patient complains of right-sided pain. Lab work is negative, but ultrasound findings are present.

• Diagnosis and ICD-10 code for billing?

1. A 40-year-old obese woman presents to the ER with nausea, epigastric pain, and pain radiating to her shoulder after finishing a super-sized meal. EKG is normal, and an ultrasound is ordered.

• Diagnosis and ICD-10 code for billing?

1. Patient complains of dull right-sided flank pain and blood in their urine. An ultrasound is ordered.

• Diagnosis and ICD-10 code for billing?

1. A woman feels a lump in her left breast at the 3:00 position. The ultrasound reveals a mass measuring 3.5cm (L) x 4.cm (H) x 3.cm (W).

• Sonographic report and ICD-10 code?