Question Billing 22633 with 63267

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Has anyone come across billing a L4-5 TLIF (22633) with a extradural cyst removal in the same L4-5 interspace (extradural but adherence to the dura)? These codes are bundled per NCCI rules and our provider is stating that they are at "different locations" and we should append modifier -59.

I've seen Karen Zupko guidance that they could be coded together but it does not specify for Medicare patients.

If he also performed laminectomy, facetectomy or foraminotomy to decompress then I would go with 63052 since this is the same interspace as the TLIF at L4/5 in your description. If you are bound by NCCI guidelines then the 63267 at the same level is bundled and modifier 59 would not be supported.