Biomechanical Device Coding: Spine surgery has been one of the specialties hardest hit by recent CPT code bundling, NCCI edit updates, code revisions and additions, and RVU decreases. Most recently, biomechanical device coding changes were implemented, which impacts many spine surgery practice’s bottom lines. This change essentially states that all anterior instrumentation is now bundled with device anchoring. This will affect all operative anterior spinal procedures that involve instrumentation and caging. CMS has stated they will only allow use of modifiers to bypass these bundling edits if the surgeon performs additional anterior instrumentation unre¬lated to anchoring the device. However, clinical documentation must support the medical necessity and detail the procedure at great length. It is imperative that spine surgery practices understand the fundamentals of compliant coding and clinical documentation as it pertains to these changes.