CPT® Code 0263T

Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure including unilateral or bilateral bone marrow harvest

Intramuscular autologous bone marrow cell therapy is a specialized medical procedure designed to treat patients suffering from peripheral artery disease (PAD), particularly when the condition is complicated by severe limb ischemia. This therapy is considered when amputation is the only other viable treatment option for the patient. The procedure involves several critical steps, beginning with the preparation of harvested bone marrow cells. Prior to the actual bone marrow harvest, it is essential to document arterial segment pressures of the dorsal pedis and tibial arteries using Doppler-guided techniques, ideally three months in advance. This assessment helps in evaluating the severity of the arterial occlusion. Additionally, a routine angiography is performed immediately before the harvest to pinpoint the exact location of any stenosis or occlusion within the limb. During the procedure, an incision is made over the anterior superior iliac spine to access the bone marrow. A specialized bone marrow needle, attached to a syringe, is then used to aspirate the bone marrow from the medullary canal. The aspirated bone marrow is subsequently placed in a centrifuge to concentrate the bone marrow cells, which are crucial for the therapy. Once prepared, these concentrated bone marrow cells are re-injected intramuscularly into the affected areas of the leg, specifically targeting the stenotic and/or occlusive sites. Ultrasound guidance may be utilized during this injection process to enhance accuracy. Following the therapy, important clinical assessments such as ankle-brachial index (ABI) measurements, evaluation of rest pain, and the status of ischemic ulcerations are conducted to monitor the effectiveness of the treatment. This comprehensive approach ensures that the complete procedure, including both the unilateral or bilateral bone marrow harvest and the subsequent injections, is performed effectively.