Fibrosis Score


**Note 1:** Physician statement of fibrosis score can be used to code this data item when no other information is available. However, code 7 when the physician statement of fibrosis score is not based on histologic examination of the liver. **Note 2:** AJCC 8th edition chapter 22 (Liver) and the CAP protocol for Hepatocellular Carcinoma use the term “fibrosis score.” Chapter 23 (Intrahepatic Bile Ducts) describes it as “nontumoral hepatic parenchymal fibrosis/cirrhosis.” Both AJCC and CAP recommend the Ishak Score system. Ishak uses a scale of 0-6 with 6 indicating cirrhosis. Other pathological scoring systems in use include the Batts-Ludwig system, which uses scores of 0-4, and the METAVIR system which uses scores of F0-F4. **Note 3:** FIB-4 is NOT a pathological fibrosis score of 4. It is a scoring method using the patient’s age and relevant lab values to calculate a score. The medical record may show something like “FIB-4 = 3.52.” Do not code FIB-4 values in this data item. **Note 4:** AJCC classifies Ishak fibrosis scores 0-4 (none to moderate fibrosis) as F0, and Ishak fibrosis scores 5-6 (cirrhosis/severe fibrosis) as F1. This is not the same as METAVIR score F0 or F1. **Note 5:** If a fibrosis score is stated but the scoring system is not recorded, consult with the physician. If no further information is available, code 9.




NAACCR #3835


Code Description
0 Ishak fibrosis score 0-4 No to moderate fibrosis METAVIR score F0-F3 Batt-Ludwig score 0-3
1 Ishak fibrosis score 5-6 Advanced/severe fibrosis METAVIR score F4 Batt-Ludwig score 4 Developing cirrhosis Incomplete cirrhosis Transition to cirrhosis Cirrhosis, probable or definite Cirrhosis, NOS
7 Clinical statement of advanced/severe fibrosis or cirrhosis, AND Not histologically confirmed or unknown if histologically confirmed
8 Not applicable: Information not collected for this case (If this item is required by your standard setter, use of code 8 will result in an edit error.)
9 Not documented in medical record Stated in medical record that patient does not have advanced cirrhosis/advanced fibrosis, not histologically confirmed or unknown if histologically confirmed Fibrosis score stated but cannot be assigned to codes 0 or 1 Fibrosis score stated but scoring system not recorded Fibrosis Score not assessed or unknown if assessed