CPT® Code 0265T

1. Indications

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

• Peripheral Artery Disease (PAD) - This therapy is indicated for patients diagnosed with PAD, particularly when it is complicated by severe limb ischemia.
• Severe Limb Ischemia - Patients experiencing severe limb ischemia, where amputation is considered the only viable treatment option, are candidates for this procedure.
• Documented Vascular Compromise - Prior to the procedure, it is essential to document arterial segment pressures of the dorsal pedis and tibial arteries, which may be performed using Doppler ultrasound techniques.

2. Procedure

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

• Step 1: Pre-Procedure Assessment - Before the bone marrow harvest, a routine angiography is performed to identify the location of any stenosis or occlusion in the limb. This imaging is crucial for planning the subsequent interventions.
• Step 2: Bone Marrow Harvest - An anterior incision is made over the anterior superior iliac spine to access the bone marrow. A specialized bone marrow needle is then inserted into the medullary canal, and the bone marrow is aspirated into a syringe. This step is vital for obtaining the necessary cells for therapy.
• Step 3: Cell Preparation - 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.
• Step 4: Intramuscular Injection - The concentrated bone marrow cells are then re-injected intramuscularly into the identified stenotic and/or occlusive sites in the leg. Ultrasound guidance may be utilized during this step to ensure accurate placement of the injections.
• Step 5: Post-Procedure Evaluation - Following the injections, ankle-brachial index (ABI) measurements, rest pain assessments, and evaluations of ischemic ulceration status are conducted to monitor the effectiveness of the therapy.

3. Post-Procedure

After the completion of the intramuscular autologous bone marrow cell therapy, patients are typically monitored for any immediate complications related to the procedure. Follow-up assessments are crucial to evaluate the effectiveness of the therapy, which may include repeat ABI measurements and assessments of limb pain and ulceration status. The recovery process may vary among patients, and ongoing evaluation will help determine the need for additional interventions or therapies. It is important for healthcare providers to provide appropriate post-procedure care instructions to ensure optimal recovery and outcomes.