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#S51263: NASH Fibrosure [550140] 10/1/2014
Components
  Name Method Reference Range Units
Fibrosis score   < .22    
Fibrosis stage      
Steatosis score   < .31    
Steatosis grade      
NASH score   0.25 - 0.25    
NASH grade      
Height     Inches  
Weight     LBS  
Alpha 2-Macroglobulins, Qn   110 - 276   mg/dL  
Haptoglobin   34 - 200   mg/dL  
Apolipoprotein A-1   Male: 110 - 180
Female: 110 - 205  
mg/dL  
Bilirubin, Total   < 1.3   mg/dL  
GGT   Male: < 66
Female: < 61  
IU/L  
ALT (SGPT) P5P   Male: < 56
Female: < 41  
IU/L  
AST (SGOT) P5P   < 41   IU/L  
Cholesterol, Total   100 - 199   mg/dL  
Glucose, Serum   65 - 99   mg/dL  
Triglycerides   < 150   mg/dL  

Specimen Requirements
  Type Volume Temperature Instructions
PRIMARY
1 Serum Foil Wrapped 3 (3) mL3 (3) mL   Frozen - 6 Month(s)/Refrigerated - 72 Hour(s)  

Clinical Utilities
This test is a noninvasive assessment of liver status in patients with nonalcoholic fatty liver disease (NAFLD). Quantitative results of 10 biochemicals in combination with age, gender, height, and weight are analyzed using a computational algorithm to provide a quantitative surrogate marker (0.0-1.0) of liver fibrosis (Metavir F0-F4), hepatic steatosis (0.0-1.0, S0-S3), and nonalcoholic steatohepatitis (NASH) (0.0-0.75,N0-N2). The absence of steatosis (S<0.38) precludes the diagnosis of NASH.

Collection Instructions
Separate serum from cells within one hour of collection. To
avoid delays in turn around time when requesting multiple
tests on frozen samples, please submit separate frozen
specimens for each test requested.

Rejection Criteria: Gross hemolysis; gross lipemia; improper
labeling; nonfasting specimen.
Setup Schedule
Monday-Friday

Reported (Analytical Time)
7 days

CPT Codes
83883,83010,82172,82247,82977,84460,84450,82465,82947,84478

The CPT codes provided 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 payer being billed.

Notes
Patient should be fasting for at least 8 hours. Methodology: Chemistry marker plus math calculation