Alpha-Fetoprotein and Acetylcholinesterase, Amniotic Fluid with Reflex to HbF

Test Code

91615

CPT Codes
82106, 82664<br><strong>This test code is for non-New York patient testing. For New York patient testing, use test code 91399.</strong>

Includes

If the AFP MoM is ≥2.0 and reported as positive, then Fetal Hemoglobin, Amniotic Fluid will be performed at an additional charge (CPT code(s): 83033).

Preferred Specimen

2.4 mL amniotic fluid collected in a sterile leak-proof container

Minimum Volume

1.2 mL

Instructions

Avoid contaminating the fluid with blood.
Gestational age (13-24 weeks) must be provided for interpretation of results. Indicate gestational age, collection date, clinical indications and the AFP and MoM results, if available, on the test requisition.

Transport Temperature

Room temperature

Specimen Stability

Room temperature: 14 days
Refrigerated: 21 days
Frozen: 1 year

Methodology
Chemiluminescence (CL) • Gel Electrophoresis • Reflex: Radial Immunodiffusion (RID)

Setup Schedule

See individual assays

Clinical Significance

Alpha-fetoprotein (AFP) utility in the early detection of fetal open neural tube defects (NTD) has been widely confirmed. The severity of a neural tube defect can range from moderate, such as spina bifida, to severe and non-life-compatible, such as anencephaly. Acetylcholinesterase(AChE) is an enzyme that hydrolyzes the neurotransmitter acetylcholine. In a fetus with an open neural tube defect, AChE leaks directly into the amniotic fluid from fetal CSF, causing unexpectedly high levels of amniotic fluid AChE. However, a major cause of borderline amniotic fluid AFP elevations and/or false positive AChE results is contamination of the sample with fetal blood. Therefore, reflex testing for the presence of fetal hemoglobin (HbF) should be performed on samples with elevated AFP results, and in particular when acetylcholinesterase is weak positive or not detected at all. It is important to remember that many fetal anomalies, including neural tube defects and ventral wall defects, may also lead to fetal bleeding.

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.