Hepatic Function Panel

Test Code

10256

CPT Codes
80076

Includes

Total Protein, Albumin, Globulin (calculated), Albumin/Globulin Ratio (calculated), Total Bilirubin, Direct Bilirubin, Indirect Bilirubin (calculated), Alkaline Phosphatase, AST, ALT

Preferred Specimen

1 mL serum collected in an SST (red-top) tube

Minimum Volume

0.5 mL

Instructions

Administration of STRENSIQ may interfere in certain assays and may falsely elevate values. For patients receiving STRENSIQ, consideration should be given to using alternate methods.

Transport Temperature

Refrigerated (cold packs)

Specimen Stability

Room temperature: 24 hours
Refrigerated: 72 hours
Frozen: Unacceptable

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Hemolysis • Received frozen

Methodology
See individual tests

Setup Schedule

Set up: Tues-Sat; Report available: 2-5 days

Clinical Significance

This panel may be helpful in assessing liver injury, diagnosing liver diseases, and monitoring treatment of liver diseases and adverse effects of hepatotoxic drugs [1]. This panel includes total protein, albumin, globulin (calculated), albumin/globulin ratio, total bilirubin, direct bilirubin, indirect bilirubin (calculated), alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT).

ALT, AST, ALP, and bilirubin are common liver chemistry analytes that can be used to evaluate liver injury. ALT is a more liver-specific marker than AST. The latter also is present in the peripheral circulation during episodes of skeletal, cardiac, and smooth muscle injury. Elevated ALT and AST levels disproportionate to ALP levels indicate hepatocellular injury; elevated ALP and bilirubin levels disproportionate to ALT and AST levels indicate cholestatic injury. In the absence of identifiable risk factors, ALT or AST levels above the upper limit of the normal range are associated with increased liver-related mortality [1]. Evaluation of direct and indirect bilirubin levels is helpful for assessing the possibility of hepatocellular disease [1]. Elevated direct bilirubin levels imply hepatocellular dysfunction or cholestasis.

Albumin is a marker of liver synthetic function; low levels may indicate liver disease of more than 3 weeks' duration [1]. Total protein levels reflect the sum of albumin and globulins and may aid in the diagnosis of disorders involving the liver, kidney, or bone marrow.

This panel may be useful in evaluating individuals who are taking hepatotoxic drugs as well as those with viral hepatitis, symptoms or signs of chronic liver disease, conditions associated with a high risk of developing liver disease, lifestyle risk factors for nonalcoholic fatty liver disease, or a family history of liver disease [2].

Because many liver diseases cause characteristic abnormalities in selected liver chemistry analytes, results of individual analytes in this panel may aid in differential diagnosis. An abnormal test result may need to be confirmed by repeat testing and/or performing a clarifying test. For example, measurement of gamma-glutamyl transferase activity (not included in this panel) can help determine whether an elevated ALP result reflects hepatic disease [1].

Note that liver enzymes are markers of liver injury, not direct measurements of hepatic function. Bilirubin, albumin, and prothrombin time are markers of liver synthetic function [1,2].

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

References
1. Kwo PY, et al. Am J Gastroenterol. 2017;112(1):18-35.
2. Newsome PN, et al. Gut. 2018;67(1):6-19.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.