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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.
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The indications for performing intramuscular autologous bone marrow cell therapy primarily include the following conditions:
The procedure for intramuscular autologous bone marrow cell therapy involves several detailed steps:
Post-procedure care for patients undergoing intramuscular autologous bone marrow cell therapy includes monitoring for any immediate complications related to the injection sites and assessing the overall response to the therapy. Patients should be evaluated for improvements in symptoms such as rest pain and the status of ischemic ulcers. Follow-up appointments are essential to track the progress of limb perfusion and to conduct further ABI measurements. The healthcare team may also provide guidance on rehabilitation and lifestyle modifications to support recovery and improve vascular health.
| Short Descr | IM B1 MRW CEL THER CMPL | Medium Descr | AUTO BONE MARRW CELL RX COMPLT BONE MARRW HARVST | Long Descr | 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 | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 156 - Injections and aspirations of muscles, tendons, bursa, joints and soft tissue |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2012-01-01 | Added | First appearance in code book |
| 2011-07-01 | Added | Code implemented |
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