Hip and Pelvis X-Ray

Question:

Can someone please answer the question of if the AP pelvis view is counted as a few when coding hip codes. For example, AP pelvis then 2 individual pictures of each hip AP & Lat; would this be coded as a 73523 (1V pelvis + 2V LT + 2V RT) or would this be coded as 73521 (AP and Lateral Views)? How would you code AP pelvis and 1V of LT Hip? 73501 since it is 1V Hip including AP Pelvis or 73502? There is conflicting information about whether you count the Pelvis as a view and whether you count the individual views done for each side.

Answer:

Thank you for reaching out. If you are performing AP pelvis then 2 individual pictures of each hip AP & Lat; you would code 73523 Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views.  This is consistent with the AMA's Clinical Examples in Radiology guidelines from fall of 2015.

*This response is based on the best information available as of 01/22/26.

Help! Can You Clarify Radiology Documentation Requirements?

Question:

We are just looking for clarification of the Interpretation for Radiology services. We have been including them in our E/M notes for years. Can you please explain exactly what it is payors like UHC are requesting/requiring? Are they wanting a report of that Radiology exam on a separate form altogether?

Answer:

You're not the only one who has been including the interpretation in the E/M.

CPT guidelines in the introductory section of the radiology chapter 70000-79999 states a written report signed by the interpreting individual is considered "an integral part of a radiologic procedure or interpretation." This means radiology interpretation requires formal, separate documentation—not just findings mentioned within an E/M note. The written report must contain interpretive findings and documentation of the imaging performed.

The CPT exception is if the CPT code includes imaging. For example, CPT 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting includes image guidance. Since the imaging is part of the procedure, you document the imaging guidance within your procedure note rather than as a separate radiology report.

This is also consistent with CMS where the payment conditions for radiology services where Medicare Claims Processing Manual Chapter 13 - Radiology Services and Other Diagnostic Procedures states: "The interpretation of a diagnostic procedure includes a written report.”

*This response is based on the best information available as of 01/22/26.

A Tale of Two Pulleys: Can 26055 and 26160 Share the Same Bill?

Question:

Hello, I am inquiring about a bundling scenario my Physician and I are having some differences on and I wanted to get an opinion from you on it. We have cases where the trigger finger will be released at the level of the A1 pulley and the surgeon will lift the edge of the wound and take some dissection towards the A2 pulley and then excise said cyst from the A2 pulley. Our surgeon is wanting this unbundled for being separate issues and I am looking at it being done from the same incision seeing problems with Insurance. I will leave the documentation so nothing is left out for decision factor. Thank you in advance for your help.

After incision at distal palm overlying A1 pulley, veins protected, etc.:

".... The A1 pulley was incised longitudinally out to the proximal A2 pulley. proximally the fascial pulley was similarly divided. tendons were inspected, synovitis noted on the flexor tendons which was identified and debrided. Fraying tendon not present. There was no recurrent triggering with active flexion. In the area where the patient noted a mass was explored. This was along the proximal digital crease. By elevating the dorsal edge of the wound, dissection was taken out and a small retinacular cyst was noted to be coming off the A2 pulley. This was sharply excised...." They go on the close the incision

Answer:

I can appreciate the dilemma in this scenario.

In reviewing the AMA vignette for CPT code 26055, it describes releasing the trigger finger of the A1 pulley while "taking care to maintain the integrity of the A2 pulley." The American Academy of Orthopaedic Surgeons Global Service Data (GSD) states the "incision or resection of flexor tendon sheath, distant site (eg, 26055)" is not included in CPT 26160.

From a CPT perspective both can be billed together with supporting documentation, including the diagnosis header and indications paragraph of two distinct issues at different sites. Subset modifier XU (non-overlapping structure) would need to be appended.

*This response is based on the best information available as of 01/08/26.

Collagen Patch

Question:

I would like to get your opinion on what A6023 documentation is needed for billing out collagen patches.  Should they be noting the sizes and changes of the wound at follow-up visits?

Answer:

Excellent question! CMS is very clear that documentation for the application of A6023 Collagen dressing, sterile, size more than 48 sq in, each requires a physician's signed order, details on the wound's type, location, size, drainage, and specifics about the dressing used (type, size, and frequency of change). The documentation must also demonstrate the medical necessity for the collagen dressing, which, for Medicare, requires the product to be listed on the Product Classification List (PCL) following a Coding Verification Review (CVR).

*This response is based on the best information available as of 12/18/25.

Removal of a Patellar Tendon Ossicle/Tibial Tubercle Ossicle

Question:

Is there another CPT that code can be used for the removal of a patellar tendon ossicle/tibial tubercle ossicle or is an unlisted procedure code the only option? Any help you can provide will be greatly appreciated!

Answer:

Thanks for reaching out. Current CPT guidance for a patella tendon ossicle or tibial tubercle ossicle removal is unlisted CPT 27599.

*This response is based on the best information available as of 12/04/25.

0232T

Question:

Hi. We would like a little guidance on what is included in the PRP code 0232T. If the PRP injection is rendered in a tendon and a tendon fenestration/tenotomy is performed, is the fenestration included in the PRP code? Also, if PRP is being utilized to hydrodissect a tendon, is the hydrodissection included in the PRP injection?

Answer:

Thank you for asking KZA!

After creating platelet-rich plasma (PRP) from a patient’s blood sample, that solution is injected into the target area, such as an injured knee or a tendon. In some cases, the clinician may use ultrasound to guide the injection. The purpose is to promote and/or accelerate the healing process of the tendon and tissue regeneration. 

Both fenestration and hydro-dissection are also performed to promote healing of the tendon and surrounding tissue, and when performed in conjunction with PRP injection, should not be reported separately.  

*This response is based on the best information available as of 11/20/25.