Program Operations Manual System (POMS)
TN 31 (08-20)
DI 23022.953 Fulminant Giant Cell Myocarditis
COMPASSIONATE ALLOWANCES INFORMATION
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FULMINANT GIANT CELL MYOCARDITIS
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ALTERNATE NAMES |
Fulminant GCM; Fulminant Myocarditis; Fulminant Non-ischemic Dilated Cardiomyopathy
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DESCRIPTION
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Giant Cell Myocarditis (GCM) is a rare, autoimmune, cardiovascular disorder that causes inflammation of the heart
muscle, ventricular tachycardia (a rapid heartbeat that starts in the ventricles)
and often progresses to heart failure. Fulminant Giant
Cell Myocarditis is a form of GCM that occurs suddenly and without warning. The cause of this disease
is unknown.
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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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Clinical laboratory tests;
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Cardiac magnietic resonance imaging (MRI); and
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Biomarkers of cardiac injury.
Physical findings: People with fulminant GCM may have a medical history significant for autoimmune diseases
such as:
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Collagen vascular disease;
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Inflammatory bowel disease;
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Wegener granulomatosis; or
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Symptoms of fulminant GCM include fever and other signs of infection including:
ICD-9:
422.91
ICD-10: I42.8
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PROGRESSION
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Fulminant GCM has a poor prognosis and frequently requires heart transplantation or
immunosuppression for long term survival. This disease most often occurs in people
over 50 years of age. Mortality is associated with heart failure and ventricular arrhythmia.
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TREATMENT
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Immunosuppressive drug therapy is initially used to treat fulminant GCM. Damage caused
by heart muscle destruction and eventual heart failure eventually requires heart transplantation.
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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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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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4.05
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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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