DecisionHealth, DecisionHealth - 2026 Issue 5 (May)

Q&A: Expect denials when spinal code descriptions overlap

Question: I am seeking clarification on the appropriate CPT code assignment for a case involving L3–L4 decompression and L4–L5 synovial cyst excision. According to American Academy of Orthopaedic Surgeons (AAOS) coding policy, lumbar decompression code 63047 should be separately reportable at a different level when billing code 62367 for excision of the synovial cyst. In addition, the AMA CPT Assistant states that the codes may be separately reported at different levels when addressing separate problems (CPT Assistant, Dec. 2025). Why are we receiving a denial stating that they are bundled?

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