CPT® Code 0264T

1. Indications

The indications for performing intramuscular autologous bone marrow cell therapy include the following:

• Peripheral Artery Disease (PAD) Patients diagnosed with peripheral artery disease, particularly when it is complicated by severe limb ischemia.
• Severe Limb Ischemia Situations where limb ischemia is so severe that amputation is considered the only other viable treatment option.
• Assessment of Arterial Blockage The need for prior documentation of arterial segment pressures of the dorsal pedis and tibial arteries, which is performed using Doppler-guided techniques.

2. Procedure

The procedure for intramuscular autologous bone marrow cell therapy involves several key steps:

• Step 1: Pre-Procedure Assessment Prior to the therapy, a thorough assessment is conducted, which includes Doppler-guided arterial segment pressures of the dorsal pedis and tibial arteries. This assessment is typically performed three months before the bone marrow harvest to evaluate the severity of arterial blockage.
• Step 2: Angiography Immediately before the bone marrow harvest, a routine angiography is performed. This imaging technique is crucial for identifying the specific locations of stenosis and/or occlusion in the limb, providing essential information for the subsequent steps of the procedure.
• Step 3: Bone Marrow Harvest An incision is made over the anterior superior iliac spine to access the bone marrow. A bone marrow needle is then inserted into the medullary canal, and the bone marrow is aspirated into a syringe. This step is critical as it collects the necessary cells for the therapy.
• Step 4: Cell Concentration The aspirated bone marrow is placed in a centrifuge, where it is processed to concentrate the bone marrow cells. This concentration is essential for maximizing the therapeutic potential of the cells during injection.
• Step 5: Intramuscular Injection The concentrated bone marrow cells are then re-injected intramuscularly into the stenotic and/or occlusive sites in the leg. Ultrasound guidance may be utilized during this injection to ensure precise placement of the cells.

3. Post-Procedure

After the completion of the intramuscular autologous bone marrow cell therapy, several post-procedure care steps and evaluations are conducted. It is important to monitor the patient for any immediate reactions to the injections. Additionally, ankle-brachial index (ABI) measurements, rest pain levels, and the status of ischemic ulcers are assessed both before and after the therapy to evaluate the effectiveness of the treatment. These evaluations help in determining the success of the procedure and guide any further management that may be necessary.