Program Operations Manual System (POMS)
TN 36 (09-20)
DI 23022.987 Transplant Coronary Artery Vasculopathy
COMPASSIONATE ALLOWANCES INFORMATION
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TRANSPLANT CORONARY ARTERY
VASCULOPATHY
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ALTERNATE NAMES
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Transplant Cardiac Allograft Vasculopathy; Cardiac Transplant Vasculopathy
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DESCRIPTION
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Cardiac transplantation is a type of therapy used in the treatment of end-stage heart
failure. Transplant Coronary Artery Vasculopathy
(CAV) is the second most common cause of death after malignancy for individuals receiving
a cardiac transplant.
Cardiac denervation at the time of heart transplantation usually prevents transplant
patients from experiencing angina which is an important warning sign for heart disease.
Because of this lack of early clinical symptoms, transplant patients with CAV typically
present late with silent myocardial infarction, loss of allograft function or sudden
death.
Due to diffuse nature of intimal thickening in CAV, coronary angiography is not as
sensitive and accurate as it is in native coronary artery disease (CAD).
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing:
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Intravascular ultrasonography (IVUS) is used to detect early coronary artery vasculopathy;
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Dobutamine stress echocardiography;
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Single proton emission CT (SPECT); and
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Physical findings:
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Dangerous changes in heart rhythm (arrhythmias);
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Non-specific graft failure;
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Generalized swelling (edema);
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General discomfort or ill feeling; and
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Pain or swelling in the chest close to the heart.
Immunosuppressive medications such as cyclosporine and corticosteroids that are used
to treat transplant CAV, may contribute to endothelial cell injury and intimal hyperplasia
(thickening of inner lining of coronary artery walls).
ICD-9: 414.06; 414.07
ICD-10:
T86.290
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PROGRESSION |
Although the progression of transplant CAV is variable, generally the course is progressive
with limited therapeutic options.
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TREATMENT
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The disease process of transplant coronary artery vasculopathy is progressive and
generally unresponsive to treatment. Revascularization is effective palliative therapy;
retransplantation offers a more definitive solution but is limited by organ shortages.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Clinical history and examination that describes the diagnostic features of the impairment;
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Cardiology consultation reports; and
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Imaging studies of the heart and blood laboratory testing.
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Suggested Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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4.02
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Listing level severity must be documented.
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4.04
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Listing level severity must be documented. |
4.05
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Listing level severity must be documented. |
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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