# INJECTION TO FEMUR OF iLIAC CREST BONE MARROW ASPIRATE CONCENTRATE



## Diana2032 (Apr 7, 2017)

Good afternoon,

I was wondering if any one can help me, my provider (a children's orthopedist) harvested bone marrow aspirate concentrate from the iliac crest and injected the material to the femur area lacking regenerate. She is coding for the aspiration with CPT 38220 and the unlisted CPT 27599 (femur) for the injection. I've done some research and CPT code 38220 should only be coded for the purpose of *bone grafting* and for bone marrow aspiration for platelet rich stem cell injection use 0232T. The only problem I'm having with 0232T is the fact that the description reads "Injection, *platelet rich plasma*, any site, including image guidance, harvesting and preparation when performed". Although, the provider did use image guidance I'm not so sure with the fact that the description of CPT code 0232T reads "platelet plasma" and what the provider is injecting is "bone marrow aspirate". I do know bone marrow produces blood cells however, I don't think we could use the terms "bone marrow" and "platelet rich plasma" interchangeably for the purpose of CPT code assignment. I'm also aware that this procedure is considered experimental. Any type of guidance would be kindly appreciated.

Thank you.


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## AlanPechacek (Apr 14, 2017)

Without the Operative Report to review, your query is difficult to answer.  The "answer" to your dilemma is determined by the femoral lesion being treated (Bone Cyst(?) or other) and what was done to the Bone Marrow Aspirate after it was obtained/harvested.  If it was injected "as is" then it was used as a "Bone Graft."  If it was "prepared" in some way, such as centrifuging it into separate components, and only a portion of the aspirate was used for injection into the lesion, the it is closer to Platelet Rich Plasma.  However, in general, Platelet Rich Plasma (PCP) is derived from whole blood by drawing the blood, centrifuging it to separate the plasma from the cells, etc., then using only that portion of the "blood" containing the Platelets and Plasma as the material injected into the lesion.  My best guess is that your physician did a "Bone Graft" using the "Bone Marrow."

You are correct in that PCP Injections are still in an "experimental" phase of development and use.  There are a few places where it does appear to be useful such as Achilles Tendonitis, maybe Tennis Elbow (Lateral Epicondylitis), and Patellar Tendonitis (Jumpers Knee).  It has been tried in many locations where it has not proven effective, such as part of a Rotator Cuff Repair procedure.  In other words, the "School's still out," and there are some unanswered questions about the preparation process.

Hopefully this helps.  Read the Operative Report carefully, and if you still are uncertain, ask your physician to clarify the procedure.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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## Diana2032 (Apr 18, 2017)

Thank you so much for your guidance Dr. Pechacek. I re-reviewed the operative report and the bone marrow was injected "as is" without any preparation. The diagnosis code submitted was "achondroplasia, short stature". Per the indications paragraph in the operative report: "The right side shows a deficit of some regenerate lateral and posterior at the right femur and this will be addressed by harvesting BMAC and then injecting this around the femur in this area to assist with encouraging bone growth", this paragraph leads me to believe that the procedure performed was a bone graft vs. PRP injection.


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