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.

Tendon Repairs

Question:

Can you provide additional clarification regarding correct selection for your tendon repair? AMA states code selection should be where the tendon is repaired not the originating area of the tendon.

Answer:

We appreciate you reaching out. AMA guidance is correct for repairing of tendons.  CPT code selection for tendon repairs with grafts are based on the recipient site not the donor site. 

*This response is based on the best information available as of 11/06/25.

X-Ray Documentation

Question:

Is it required to have the specific x-ray views noted in the documentation or will the code description of the number of views be sufficient?

Answer:

Thank you for asking KZA! The specific views performed must be documented in the radiology findings. 

Best practice wording example: "X-ray of the left knee obtained 3 views" based on CPT nomenclature.

Clinical Examples in Radiology Fall 2024 describe the views as (eg, AP, lateral, and sunrise, and posteroanterior) views but state "code selection depends on the number (not the type) of views."

Findings: Joint space narrowing with osteophyte formation, no acute fracture. Impression: Degenerative joint disease." 

It is important to document clinical history and confirmed or definitive diagnosis(es). 

*This response is based on the best information available as of 10/23/25.

Shoulder Capsulorrhaphy

Question:

I am looking for guidance regarding CPT codes 23462, 23465, 23466. I am not really finding anything. I have a provider that is doing all three procedures. Per NCCI edits, it indicated that only 23466 should be charged. Is this because it says any type multi-directional? Does that mean this code would include multiple capsulorrhaphies? I am trying to figure out if only code 23466 should be charged, or if there are instances when more than one open capsulorrhaphy code could be charged? Thank you.

Answer:

Thank you for asking KZA! CPT codes 23466, 23465 and 23462 are mutually exclusive per NCCI edits. They all represent capsulorrhaphy for instability- just different techniques. Even if the surgeon performs elements of more than one technique you should code the single most comprehensive/definitive procedure performed. Reporting more than one capsulorrhaphy code is not appropriate here since these procedures are alternative methods to treat the same pathology in the joint. 

*This response is based on the best information available as of 10/09/25.