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.

Reporting Modifiers with Unlisted Codes

Question:

Can modifiers be reported with unlisted CPT codes?

Answer:

Yes, modifiers can be appended to unlisted CPT codes.

In 2024, CPT clarified this by updating the introduction guidelines for unlisted procedures and services. These updates were further explained in the January 2024 issue of CPT Assistant, which addressed the new and revised text and the standardization of reporting unlisted CPT codes across the CPT code set.

Illustration of modifiers that may be appropriately applied includes:

• Laterality modifiers – e.g., RT (right), LT (left)

• Bilateral procedure modifier – 50

• Role-based modifiers – e.g., 62 (two surgeons), 80 (assistant surgeon), 82 (assistant surgeon when qualified resident not available), AS (non-physician surgical assistant)

• Multiple or distinct procedure modifiers – e.g., 51 (multiple procedures), 59 (distinct procedural service)

• Global modifiers – e.g., 58 (staged or related procedure), 78 (return to operating room for related procedure), 79 (unrelated procedure or service)

This is not an all-inclusive list of modifiers that may be appropriately applied to unlisted CPT codes. For complete and up-to-date information, one should refer to current CPT guidelines and payer-specific policies.

Please note: Modifiers that describe an alteration of a service or procedure, such as modifier 52 (reduced services), are not appropriate for use with unlisted codes. The same applied to modifier 22 (increased procedural services).

*This response is based on the best information available as of 9/22/25.