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DESCRIPTIONOrganic acid disorders (OAs) are a group of rare inherited conditions. They are caused by enzymes that do not work properly. A number of enzymes are needed to process protein from the food we eat for use by the body. Problems with one or more of these enzymes can cause an organic acid disorder. People with organic acid disorders cannot break down protein properly. This causes harmful substances to build up in their blood and urine. These substances can affect health, growth and learning.
Organic acid disorders are inherited in an autosomal recessive manner and affect both males and females. Symptoms often appear in the first few weeks of life. Symptoms can include a lack of appetite, vomiting, seizures, lack of energy, muscle irritability, and low body temperature. Illness can be triggered by infections or by fasting. If left untreated, organic acid disorders may cause serious medical problems including brain damage, coma and even death.
Organic acid tests are also being utilized to identify metabolic blocks or problems with detoxification, gut dysbiosis, or oxidative stress. One such test used for this purpose is the Organix Profile (Metametrix). Per the manufacturer, “the Organix Comprehensive Profile provides a view into the body's cellular metabolic processes and the efficiency of metabolic function. Identifying metabolic blocks that can be treated nutritionally allows individual tailoring of interventions that maximize patient responses and lead to improved patient outcomes. Organic acids are metabolic intermediates that are produced in pathways of central energy production, detoxification, neurotransmitter breakdown, or intestinal microbial activity. Marked accumulation of specific organic acids detected in urine often signals a metabolic inhibition or block. The metabolic block may be due to a nutrient deficiency, an inherited enzyme deficit, toxic build-up or drug effect.”
The manufacturer of the Organix Profile also states, “Conventional medical doctors use a complete blood count (CBC) and a metabolic panel (MP) as general screening tools to help rule out health problems in their patients. In addition to these standard laboratory tests, functional medicine practitioners use an organic acid test to identify imbalances occurring in the body that may well precede abnormal findings on a CBC or an MP. Organic acids are products of metabolism that can sensitively identify nutrient deficiencies that lead to metabolic roadblocks. Traditionally, they were used for detection of neonatal inborn errors of metabolism, including mitochondrial disorders. Routine testing of organic acids is a relatively newer tool and may not be readily used by mainstream physicians. Abnormal concentrations of organic acids in the urine can provide a functional marker for metabolic effects of micronutrient inadequacies, genetic polymorphisms, impaired enzyme function, toxic exposure, neuroendocrine activity, and intestinal bacterial overgrowth. As such, organic acid testing can indicate the functional need for specific nutrients, diet modification, antioxidant protection, detoxification, and other therapies. Because impairments in some cellular functions may not show up until an increased stress or inadequate nutrient status impairs the enzyme function, an assessment of organic acids is recommended each time the patient has a physical, just like a CBC or MP.”
The Organix Profile is used to test for the following:
Another test is the Organic Acids Test (OAT) (The Great Plains Laboratory, Inc.), which is utilized to evaluate intestinal yeast and bacteria. Per the manufacturer, the OAT provides a metabolic “snapshot” based on the products the body discards through the urine. These small, discarded organic acid molecules are byproducts of human cellular activity, the digestion of foods, and the metabolism of gastrointestinal flora. At certain levels, organic acids in urine may be indicators of toxicity or “markers” of the function of metabolic pathways. Levels of yeast or gastrointestinal bacteria metabolites are compared to normal levels of human metabolites, providing an assessment of yeast and bacterial activity.
POLICYScreening for organic acid disorders may be considered medically necessary in symptomatic newborns and infants.
Organic acid testing is considered not medically necessary for all other indications, including but not limited to -
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY05/01/2013: New policy added. Approved by Medical Policy Advisory Committee.
SOURCE(S)Metametrix Clinical Laboratory article, “What are Organic Acids?” 2009 Metametrix, Inc (http://www.metametrix.com/files/learning-center/articles/What-Are-Organic-Acids.pdf)
Hayes Medical Technology Directory
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
Not Medically Necessary Codes