Pathology/Lab Coding Alert

Question: When our lab runs an AFP-L3 serum test for liver cancer marker, how should we code it?

Tennessee Subscriber

Answer: Report the test as 82107 (Alpha-fetoprotein [AFP]; AFP-L3 fraction isoform and total AFP [including ratio]).

Although an elevated total serum AFP might indicate hepatocellular carcinoma (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 don't use AFP-L3 as a screening test; rather, it is a diagnostic test for patients with an elevated total AFP who might have liver cancer.

Caution: If your lab reports 82107 for determining total AFP and percent L3 isoform, don't additionally report the component codes 82105 (Alphafetoprotein [AFP]; serum) and 82491 (Chromatography, quantitative, column [e.g., gas liquid or HPLC]; single analyte not elsewhere specified, single stationary and mobile phase). Using all three codes for a single analysis would constitute unbundling.

-- Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors-Anatomic Pathology Services in Jonesboro, Ark.