Program Operations Manual System (POMS)
TN 32 (08-20)
DI 23022.475 Niemann-Pick Disease - Type C
COMPASSIONATE ALLOWANCES INFORMATION
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NIEMANN-PICK DISEASE - TYPE C
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ALTERNATE NAMES
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NPD; NPD-C; NP-C; NPC; NPD type C; Niemann-Pick type II; Sphingomyelinase deficiency;
Neuronal Cholesterol Lipidosis
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DESCRIPTION
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Neimann-Pick Disease - Type C (NPC) is one of 5 types of Niemann-Pick Disease (NPD) and is a genetic disorder that results
in progressive loss of nervous system function by affecting the membranes of nerve
cells. Mutations in either the NPC1 or NPC2 genes cause NPC. NPC may appear early
in life or develop in the teen or adult years.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING |
Diagnostic testing: A skin biopsy and (if available) DNA genetic testing is used to diagnose NPC. Additional
tests such as slit-lamp eye exam to assess vision loss, liver biopsy, MRI and psychometric
testing.
Physical findings: At birth, the infant may have:
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Dystonia (abnormal muscle contraction causing repetitive involuntary muscle movements);
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Inadequate weight gain (failure to thrive);
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Moderate enlargement of the spleen and liver (hepatosplenomegaly);
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Inability to look up and down;
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Difficulty in walking and swallowing;
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Progressive loss of vision and hearing;
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Slurred and irregular speech; and
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ICD-9: 272.7
ICD-10: E75.242
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TREATMENT
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There is currently no effective cure for this disease. Medicines are available to
control or relieve many symptoms such as cataplexy and seizures.
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PROGRESSION
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The life expectancy of people with NPC varies. Some people die in childhood while
others who appear to be less severely affected, live into adulthood. A child who shows
signs of NPC before age 1 may not live to school age. Those who show symptoms after
entering school may live into their mid-to-late teens, with a few surviving into the
20s.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Clinical examination that describes diagnostic features of the impairment;
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Laboratory tests showing intravesicular cholesterol storage is diagnostic of this
disorder;
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Molecular genetic testing utilizing sequence analysis that identifies mutations in
either NPC1 or NPC2 gene;
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If laboratory testing or molecular genetic testing results have are not available
or are non-diagnostic, then complete review of the clinical course and all of the
laboratory data on which the disorder is suspected will need to be reviewed; and
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To establish the severity of this disorder, complete physical, neurological, and mental
examinations may be needed if one of these examinations alone is insufficient to meet
a listing.
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Suggested Listings for Evaluation:
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DETERMINATION |
LISTING |
REMARKS
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Meets
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110.08
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Equals
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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