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

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

Test Code

12736
80053, 85049
CPT Code is subject to a Medicare Limited Coverage Policy and may require a signed ABN when ordering.
12736
80053, 85049
CPT Code is subject to a Medicare Limited Coverage Policy and may require a signed ABN when ordering.
Not offered in Quest Nichols Institute - Chantilly, VA | Quest Diagnostics Nichols Institute (IFD) – San Juan Capistrano | Quest Nichols Institute -San Juan Capistrano, CA. Please provide SERVICE AREA INFORMATION to find available tests you can order.
In-home collection may be available in your area for purchase through Quest Mobile.

Clinical Significance

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

Test Resources

Test Summary

Liver Fibrosis, Fibrosis-4 (FIB-4) Index Panel

Test Details

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)

Methodology

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

Reference Range(s)

See Laboratory Report

LOINC® Codes, Performing Laboratory

Service Area must be determined
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)

Methodology

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

Reference Range(s)

See Laboratory Report
Service Area must be determined

Preferred Specimen(s)

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

See individual tests

Setup Schedule

Service Area must be determined
1 mL serum collected in a serum separator tube (SST) and one full tube whole blood collected in an EDTA (lavender-top) tube
0.5 mL serum • 1 mL EDTA whole blood or 0.5 mL microtainer-lavender
Serum separator tube (SST) and EDTA (lavender-top) tube
Room temperature
Serum
Room temperature: 72 hours
Refrigerated: 72 hours
Frozen: Unacceptable

Plasma
Room temperature: 48 hours
See individual tests
Service Area must be determined
Not offered in Quest Nichols Institute - Chantilly, VA | Quest Diagnostics Nichols Institute (IFD) – San Juan Capistrano | Quest Nichols Institute -San Juan Capistrano, CA. Please provide SERVICE AREA INFORMATION to find available tests you can order.
In-home collection may be available in your area for purchase through Quest Mobile.
Test Details

Clinical Significance

Test Resources

Reference ranges are provided as general guidance only. To interpret test results use the reference range in the laboratory report.

The CPT codes provided are based on AMA guidance and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

This material contains content from LOINC® (http://loinc.org). The LOINC Table, LOINC Table Core are copyright © 1995-2019, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license.

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