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 all three codes for a single analysis would constitute unbundling,- says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

Experts Recommend Pricing

Although CMS has not yet established payment levels for 8210x, several professional societies and laboratory experts recommended pricing for the test at CMS- annual laboratory public meeting for payment of new clinical laboratory tests. The speakers at the public meeting overwhelmingly recommended crosswalking the test to 83950 (Oncoprotein, HER-2/neu), which pays $89.99 on the Clinical Laboratory Fee Schedule (national limit amount).

Pricing 8210x at the same level as 83950 is appropriate for four reasons, Logue says:

1. Both 8210x and 83950 represent the analysis of oncoproteins.
2. 83950 is the only code listed as -oncoprotein- in CPT.
3. Both codes are highly specific tumor markers.
4. Both are diagnostically important analytes for cancer detection.