**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.