Liver Fibrosis, Hepatic Function Panel with Fibrosis-4 (FIB-4) Index

Test Code
30710


CPT Codes
80076, 85049

Includes
Hepatic Function Panel: Total Protein, Albumin, Globulin, Albumin/Globulin Ratio, Total Bilirubin, Direct Bilirubin, Indirect Bilirubin, Alkaline Phosphatase, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT)
Platelet Count
FIB 4 Index


Preferred Specimen
1 mL serum collected in a serum separator tube (SST) and whole blood full EDTA (lavender-top) tube


Minimum Volume
0.5 mL serum • 0.5 mL microtainer-lavender or 1 mL EDTA whole blood


Other Acceptable Specimens
Whole blood from a full EDTA (tan-top) tube


Instructions
Note: If drawn with lead testing, EDTA (tan-top) is required


Transport Temperature
Serum: Refrigerated (cold packs)
Whole blood: Room temperature


Specimen Stability
Serum
Room temperature: 24 hours
Refrigerated: 72 hours
Frozen: Unacceptable

Whole blood
Room temperature: 48 hours
Refrigerated: Unacceptable
Frozen: Unacceptable


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


Methodology
Spectrophotometry (SP) • Electronic Sizing and Counting/Cytometry/Microscopy

Setup Schedule

Set up: Mon-Sat; Report available: 1-3 days



Clinical Significance
The FIB-4 index is a simple non-invasive approach using selected laboratory measures (AST, ALT, platelet count) in combination with patient age to assess if an individual is at higher risk for advanced liver fibrosis (F3-F4).




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.