1. CPT coding confusion and/or misunderstanding of strict coding guidelines and criteria that must be followed
2. Higher payer scrutiny on spinal discectomy procedures overall
3. CPT code changes for bone grafting for aspiration only versus for spinal arthrodesis procedures
4. CPT code changes for how and which growing number of medical devices are used in spinal procedures
5. Increasing complexity of shoulder procedure codes requiring support documentation about the type and number of parts of the shoulder involved in the procedure
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