CPT® Code 0264T

Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure excluding 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 therapy, it is essential to document arterial segment pressures of the dorsal pedis and tibial arteries using Doppler-guided techniques, which should be performed three months before the bone marrow harvest. This assessment helps in evaluating the severity of the arterial blockage. Immediately before the bone marrow is harvested, a routine angiography is conducted to pinpoint the exact location of any stenosis or occlusion within the limb. The harvesting process itself involves making an incision over the anterior superior iliac spine, where a bone marrow needle is inserted into the medullary canal to aspirate the bone marrow. Once collected, the bone marrow is processed in a centrifuge to concentrate the cells, which are then re-injected intramuscularly into the affected areas of the leg, specifically targeting the stenotic or occlusive sites. Ultrasound guidance may be utilized during the injection to ensure accuracy. Following the procedure, important measurements such as the ankle-brachial index (ABI), rest pain levels, and the status of any ischemic ulcers are taken both before and after the therapy to assess the effectiveness of the treatment.