Program Operations Manual System (POMS)
TN 31 (08-20)
COMPASSIONATE ALLOWANCES INFORMATION
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AORTIC ATRESIA
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ALTERNATE NAMES |
Aortic Valve Atresia; Aortic Valve Stenosis
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DESCRIPTION
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Aortic Atresia is a rare congenital heart defect in which there is no opening from the left ventricle
of the heart into the aorta. This type of obstruction interrupts blood flow from the
left ventricle of the heart to the body. Because of this blockage, the only other
way for blood to flow to the rest of the body is through another structure in the
heart called the ductus ateriosus. Aortic atresia usually occurs in combination with
other heart defects, such as hypoplastic left heart syndrome. This combination is
the most frequent cause of congestive heart failure and death in the neonatal period
(the first 28 days of life).
Infants with aortic valve atresia surviving into adulthood may develop problems with
their heart functioning later in life due to worsening of the condition. Over time,
the surgical treatments that were used at infancy to repair the aortic heart valve
may leave scar tissue behind, increasing the chances of abnormal heart rhythm (arrhythmia)
and an area for infection called SBE (subacute bacterial endocarditis).
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING |
Diagnostic testing:
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Cardiac catheterization; and
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Cardiac magnetic resonance imaging (MRI).
Physical findings: The physical findings associated with aortic atresia include:
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Cyanosis (blue-tinged skin);
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Dyspnea (shortness of breath);
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Rapidly progressive heart failure with hepatomegaly (enlarged liver); and
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ICD-9: 747.22
ICD-10: Q25.2
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PROGRESSION |
A diagnosis of aortic atresia is usually made shortly after birth. Disease progression
is variable based on the severity of the congenital heart defects and the response
to medication and surgical interventions.
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TREATMENT
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The treatment of aortic atresia is based on the severity of the condition. Infants
are usually treated with medications to keep the ductus arteriosis open, and staged
surgical intervention. Adults should be monitored by a cardiologist to assess the
need for medication, surgery, and for heart infections (endocarditis) throughout their
lifetime.
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SUGGESTED PROGRAMMATIC
ASSESSMENT* |
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;
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Imaging studies of the heart; and
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Blood laboratory testing including hematocrit, arterial blood gases, or arterial O2
saturation.
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Suggested Listings for
Evaluation: |
DETERMINATION |
LISTING
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REMARKS |
Meets |
4.06 |
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104.06 A, B, C, or D
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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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