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Alpha-Fetoprotein Triple Marker Screen 2.0 MoM

Last Modified: 8/21/2012 7:25:51 AM


  Medicare Medical Necessity Restrictions May Apply
Medical Necessity Documentation:

AFP ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
HCG ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
Specimen Requirements: 3.0 mL Serum from a Red Top Tube split into 2 Plastic Vials
Collection Instructions: Collect specimen between 14 - 22 weeks gestation. 

Icteric or grossly hemolyzed specimens are not acceptable. 

Alpha-Fetoprotein 2-part Request Form must accompany the specimen (See Addendum A - AFP Form Example)
Minimum Volume: 1.5 mL
Transport & Storage: Temperature/Stability: 72 hours Ambient
7 days Refrigerated
2 months Frozen (Preferred)
Reference Range: Refer to Interpretive Results
Test Comments: Ongoing research suggests that approximately 60% of Down syndrome (DS) pregnancies and 60% of trisomy 18 pregnancies can be detected. This use is considered to be investigational. Follow-up testing is recommended for patients when the calculated second trimester risk of Down syndrome risk is 1 in 270 or greater. Normal serum AFP levels for neural tube defects (NTD) are less than 2.0 multiples of the median (MoM). Normal values exclude approximately 95% of cases of anencephaly, 80% of cases of spina bifida, and 85% of ventral wall defects. Closed dysraphic states and small defects generally constitute the group in which total exclusion is not possible.COMMENT: TMS fails to detect about 30% of DS cases in women 35 years old and 10% in those 40 years old, as well as approximately 30% of trisomy 18 and 50% of other chromosomal abnormalities. CVS or amniocentesis is the test recommended by the American College of Medical Genetics for women over 35 years old.
Methodology: Multiple
Clinical Significance: Screening for indication of fetal anomalities including Down syndrome (DS) and Neural Tube Defects (NTD)
Custom Panel: No

PRODUCTION SCHEDULE

Turn Around Time: 6 to 10 days
Days Performed: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed: Quest Valencia (SLI)
PHL Test Code: TR2A
Send Out Test Code: 3110
Alternate Test Names: Maternal Screen 2.0; Triple Test
Included Tests:

AFP; AFP MoM; Comments; Date of Birth; Date of LMP; Date of Ultrasound; Down Syndrom Interpretation; Down Syndrome Risk; Down Syndrome Screen; Down Syndrom Interpretation; Screen; hCG; hcG MoM; Insulin Dependant Diabetes; Method of Estimation; Number of Fetuses; Open Spina Bifida Interpretation; Open Spina Bifida Risk; Open Spina Bifida Screen; Race; Trisomy 18 Screen; uE3 (unconjugated Estriol); uE3 (unconjugated Estriol) MoM; Weeks of Gestation; Weight
CPT Coding: 82105, 82677, 84702

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