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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 -
Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Nervous/Mental Conditions, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:
A. consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and
B. appropriate with regard to standards of good medical practice; and
C. not solely for the convenience of the Member, his or her Provider; and
D. the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.
For the definition of Medically Necessary, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
05/01/2013: New policy added. Approved by Medical Policy Advisory Committee.
08/03/2015: Code Reference section updated for ICD-10.
12/31/2015: Policy guidelines updated to add medically necessary and investigative definitions. Code Reference section updated to revise code description for CPT code 83789 with an effective date of 01/01/2016.
06/07/2016: Policy number added.
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