63267 or 22102?

Question:

A patient presents with lumbar discitis and osteomyelitis, and the provider performs a laminectomy with debridement of the disc and bone. Which CPT code is more appropriate in this scenario: 63267 or 22102?

Answer:

Thank you for asking!

In this case, the procedure involves a lumbar laminectomy with debridement of both disc and bone due to infectious pathology. CPT code 63267 is the correct choice, as it describes a lumbar laminectomy for excision or evacuation of an extradural intraspinal lesion other than a neoplasm. Code 22102 applies to the partial excision of the posterior vertebral component, which does not accurately reflect the work performed.

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

Still Unlisted?

Question:

I hope KZA can provide clarification. In the past, when coding EDAS for treatment of MoyaMoya disease, I used unlisted code 64999 compared to 61711. I have recently seen articles using 61711 only. Which would be the most appropriate code to use?

Answer:

Thank you for asking KZA!

Encephaloduroarteriosynangiosis (EDAS) is an indirect revascularization technique designed to improve blood flow to the brain without directly connecting blood vessels. Because CPT 61711 specifically describes a direct extracranial-to-intracranial arterial anastomosis, this does not accurately reflect EDAS technique.

You have been reporting this correctly. There is no CPT code for this, which is appropriately reported with unlisted CPT 64999.

If you’re seeing 61711 used in articles, it may be due to confusion with direct bypass procedures, such as STA-MCA bypass, which do fall under 61711. For EDAS, however, 64999 remains the most accurate and compliant choice.

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

63047 with 22633 for Interbody Fusion?

Question:

We would like some coding insight from KZA. Can you report CPT code 63047 with 22633 if you append modifier 51 to CPT code 63047 if the documentation supports the work done beyond that required for interbody fusion?

Answer:

Thank you for asking KZA!

CPT 63047 should not be reported with CPT 22633 at the same level/interspace.

Add-on codes (63052 & 63053) exist for decompression at the same level or interspace with a posterior lumbar interbody fusion (22630-22634). Remember, this is for decompression beyond preparation of the interspaces for fusion.

• 63052 – Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment

• 63053 – Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; each additional vertebral segment

In the submitted scenario, the appropriate code to report is CPT 63052 if your documentation supports additional decompression.

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

Halo Adjustment?

Question:

What CPT code should be used to adjust a Halo device without anesthesia on postoperative Days 1, 2, and 5? CPT code 20664 was used to bill for the initial application of the Halo device. These adjustments are being performed in preparation for an upcoming surgery.

Answer:

Thank you for reaching out to KZA!

CPT codes 20664 and 20661 both include the application and removal of the Halo device. Any adjustments made during the 90-day global period following the initial procedure are considered part of the global surgical package and are not separately reportable.

*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.

Clarification for TLIF with Contralateral Posterior Fusion Using Robotic Navigation

Question:

I am looking for guidance on a Transforaminal Lumbar Interbody Fusion (TLIF) case using robot/navigation. Placing a posterior fusion on the contralateral side of the spine from the TLIF. He is using the robot to plan a "false" screw then using robot to drill the opposite facet and then place bone graft into the facet. It requires additional time both before and after procedure. Would this be coded as 22612 along with 22633?

Answer:

Thank you for your question. If the contralateral posterior fusion is performed at the same level as the TLIF and is considered part of the same interspace, then CPT 22633 alone should be reported. This code already includes both the posterior interbody fusion and the posterolateral fusion at a single level. Even if robotic navigation is used to access the contralateral facet and place bone graft, it does not justify separate coding with 22612. 

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