Comprehensive Metabolic Panel with FIB-4 Index with Reflex to ELF Score

Test Code

12736

CPT Codes
80053, 85049

Includes

Comprehensive Metabolic Panel: Albumin, Albumin/Globulin Ratio (calculated), Alkaline Phosphatase, ALT, AST, BUN/Creatinine Ratio (calculated), Calcium, Carbon Dioxide, Chloride, Creatinine with GFR Estimated, Globulin (calculated), Glucose, Potassium, Sodium, Total Bilirubin, Total Protein, Urea Nitrogen
Platelet Count
FIB 4 Index

If FIB-4 Index is ≥1.30, then Enhanced Liver Fibrosis (ELF) Score will be performed at an additional charge (CPT code(s): 81517)

Preferred Specimen

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

Minimum Volume

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

Transport Container

Serum separator tube (SST) and EDTA (lavender-top) tube

Transport Temperature

Room temperature

Specimen Stability

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

Plasma
Room temperature: 48 hours

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

See individual tests

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

Reference Range

See Laboratory Report

Clinical Significance

This reflex provides a cost-effective, medically justified, and guideline supported approach to evaluating a patient at risk of NAFLD with liver fibrosis. If the FIB-4 index is ≥1.30, the ELF score is performed.

Performing Laboratory

Quest Diagnostics-Seattle

1737 Airport Way S Suite 200

Seattle, WA 98134-1636

Last Updated: November 6, 2024

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.