Accurate spinal surgery coding remains a critical concern for healthcare providers aiming to secure proper reimbursement while ensuring compliance. In 2025, updates in coding guidance and evolving clinical practice continue to shape best practices. This post examines the current landscape, recent controversy around CPT 62380, and practical tips for coders and surgeons.

Spotlight: Why Spine Surgeons Want to Remove CPT 62380

A recent Becker’s Hospital Review article highlights why certain spine surgeons are advocating for the removal of CPT 62380. The argument is that this code frames endoscopic spine procedures as not being “real” surgery, which creates ambiguity around credentialing and valuation. Other CPT codes for decompression already account for anatomical complexity and procedural nuance, making CPT 62380 seem redundant or demeaning.

Broader Coding Guidelines & Regulatory Context (2025)

A. Medicare NCCI Policy (Chapter IV)
According to Medicare’s 2025 NCCI Policy Manual (Chapter IV: Musculoskeletal Surgery CPT 20000–29999), coders must:

• Report the most specific code when available.
• Avoid unbundling by not submitting multiple CPT codes when one comprehensive code exists.

B. ICD-10-CM Official Guidelines (FY 2025)
Coders rely on updated ICD-10-CM rules effective October 1, 2024. These guidelines help ensure accurate diagnosis sequencing, proper use of modifiers, and adherence to HIPAA-mandated conventions.

C. Specialty Practice Coding Reference
The Spine Society outlines 2025-specific updates on National and Local Coverage Determinations (NCDs and LCDs), including notes on vertebral augmentation, cervical and lumbar fusion coverage, essential for spine-specific coding nuances.

Procedure Spotlights & Billing Tips

A. Sacropelvic Fixation
For procedures like SI joint fusion:

• CPT 27279 (percutaneous/minimally invasive) – ~$790
• CPT 27280 (open approach) – ~$1,343
• Add-on code 22848 for pelvic fixation – ~$349

These codes highlight the importance of differentiating between approach (open vs MIS) and configuring add-ons accurately.

B. Spinal Cord Stimulation (SCS)
A 2025 Medicare reimbursement guide lists CPT codes like 63650 and 63655, including RVUs, global periods, and facility vs non-facility rates, for physicians, ASCs, outpatient, and inpatient settings.

C. Billing Guidance Caveat
A payer advisory emphasizes verifying coverage and coding rules before submission—coverage of a specific code does not guarantee reimbursement. Transparency and accuracy are mandatory in federal submissions.

Best Practices for Coders & Providers

• Select the most specific, accurate code (avoid one-size-fits-all options like CPT 62380 unless justified).
• Avoid unbundling; don’t report multiple codes if one covers the full service.
• Stay compliant with ICD-10-CM guidelines, particularly for sequencing and modifier accuracy.
• Verify payer-specific rules, especially for procedures like spinal fusion or SCS.
• Document thoroughly, especially for advanced techniques (e.g., endoscopic approaches) to support code selection and counter credentialing ambiguities.

Conclusion

Staying current with spinal surgery coding guidelines is vital, not just for financial viability, but also for clinical validation and regulatory compliance. As the debate around removal of CPT 62380 illustrates, the coding landscape is evolving, requiring careful navigation, precise documentation, and proactive updating.

Ready to streamline your Spinal Surgery Coding & Billing Services? Schedule a Consultation today or contact us at [email protected] or (888) 747-3836 x0, to learn how TriumpHealth specializes in helping Optimizing Spinal Surgery Coding billing, and compliance processes, so you can focus on delivering results for your patients.