# Stem Cell Harvesting & Injections



## dstruve (Jan 4, 2018)

Anyone harvesting stem cells and injection them into joints?? I have questions about the procedures and billing.
donnas@nwiabone.com

Thanks.


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## AlanPechacek (Jan 10, 2018)

For what it is worth, the use of *"Stem Cells"* in Orthopedics is a two stage procedure:  the first being the harvesting/collecting of the cells from a "source/site" in the patient's body and preparing them for injection, and the second stage is the injection into a recipient area, usually a joint.  The most common "source" of Stem Cells is Bone Marrow, but since this is usually going to be an office procedure, most Orthopedic Surgeons are not going to do a Bone Marrow Aspiration in their office as it is too difficult and too painful for the patient.  An alternative current method is to harvest the Stem Cells from subcutaneous fat using a device designed for office use.  Once this procedure/process is complete, only the portion containing the Stem Cells is injected into the recipient site.  Since the cells are from the patient, this is an *Autograft*.  The section of CPT covering this is *Bone Marrow* *or Stem Cell Services/Procedures* under *Hemic and Lymphatic System, General*.  Unfortunately the codes read as though the Stem Cells are derived from Hematopoietic/Blood sources (only), and CPT doesn't appear to have caught up with other possible sources, i.e. subcutaneous fat.  They also read as though only the blood cells are going to be used, even though the section is for "Stem Cells" as well.  With all of this being said, the best code I could find for Harvesting and Preparing Stem Cells for Orthopedic use is *38206: "Blood-derived hematopoietic progenitor cell harvesting for transplantation,* *per collection, autologous*, which I would "translate" into *"Harvesting and Preparing Stem Cells for Transplantation."*
     The next step is the *Injection Procedure* which is probably most often the knee joint for arthritis, maybe other joints/sites.  This would usually be *20610, Major Joint*.  Since this is a "Staged Procedure," I would add *Modifier 58* to the injection code.  If injected into another site (tendon, ligament, soft tissue, etc.) then another code would apply.
     As for the materials, equipment, kit used, I don't know necessarily how you would charge for it/them.  You would probably have to check with the vender/salesman for a code.

I hope this helps you get started.  This is a new area of Orthopedic "Care."

Respectfully submitted, Alan Pechacek, M.D.


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## dstruve (Jan 11, 2018)

Thank you for your response! So far I have been told to use 0232T, which we use for our PRP injections so I thought that sounded a little strange when harvesting bone marrow is a whole different process. I just want to have a handle on this before my docs start doing it. So researching like crazy.


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## AlanPechacek (Jan 17, 2018)

Even though "*Stem Cells*" and "*Platelet Rich Plasma (PRP)*" are similar in their uses/application in Orthopedics, they are not quite the same animals, and have to be considered and coded differently.   For the most part, in Orthopedics, *PRP* will be derived from whole blood, i.e. venapuncture, but whole blood is not a source of *Stem Cells*.  Bone marrow can be used to acquire both Stem Cells and PRP.   According to *CPT* if Bone Marrow is used as a source of *Autologus* "*Platelet Rich Stem Cells*," then *0232T* is to be used.  But as I mentioned before, there are alternative sources for Stem Cells besides Bone Marrow (i.e.subcutaneous fat).

Alan Pechacek, M.D.


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