Pathology/Lab Coding Alert

Liver cancer diagnosis gets boost from new lab code Measuring both total alpha-fetoprotein (AFP) and L3 fraction isoform can improve diagnosis of hepatocellular carcinoma--and a CPT 2007 code change will give your lab a new way to report it. New Code Describes Kit The Food and Drug Administration has approved a test kit for AFP-L3 analyte and total AFP, produced by Wako Chemicals USA. Effective Jan. 1, 2007, CPT will add a new code for the test: 8210x, (AFP-L3 fraction isoform and total AFP [including ratio]). An -x- substitutes for the last digit of the new code because the AMA has not announced the final code numbers.

The test analyzes serum AFP and AFP-L3 fraction with a calculated ratio. -Labs currently performing this test use two existing CPT Codes --for total AFP and quantitative chromatography--for reporting the L3 fraction,- says Joan Logue, BS, MT(ASCP), principal with Health Systems Concepts Inc. in Longwood, Fla.

For instance: A physician orders the AFP-L3 analyte test for a patient with an elevated serum AFP diagnosed with cirrhosis of the liver (571.x, Chronic liver disease and cirrhosis).

Old way: Until 2007, you-ll have to continue reporting this test using two codes: 82105 (Alpha-fetoprotein; serum) for the total AFP, and 82491 (Chromatography, quantitative, column [e.g., gas liquid or HPLC]; single analyte not elsewhere specified, single stationary and mobile phase) for the AFP-L3 fraction.

New way: Once the new codes go into effect, you can begin reporting the test with the single, new code: 8210x. Watch Indications for Test AFP-L3 is a specific marker for hepatocellular carcinoma (HCC). Although an elevated total serum AFP might indicate HCC, it is not a specific marker because it might occur in association with many other liver conditions.
 
That's why physicians use AFP-L3 as a risk marker for HCC in patients diagnosed with chronic liver disease. -Physicians won't use AFP-L3 as a screening test; rather, they-ll use it as a diagnostic test for patients diagnosed with HCC who have elevated total AFP,- Logue says. 

Components Can Stand Alone Even when the new code is available in 2007, you should continue to use 82105 and 82491 when the lab performs these tests individually--but not as part of an AFP-L3 analysis.
 
For example: A physician may periodically order total AFP as part of a liver-function evaluation for a patient diagnosed with hepatitis C. You should report the test using 82105.

Caution: If your lab reports 8210x for determining total AFP and percent L3 isoform, don't additionally report the component codes 82105 and 82491. -Using [...]