To me, there is no single problem that is always a certain level.
For example, a splinter might typically be straightforward (self-limited or minor). But this specific patient had a splinter for 3 weeks and is now infected and filled with pus.
It all depends on the documentation of the particular patient's case at the time of treatment. You mention the example of spondylosis.
Patient A with spondylosis may be experiencing some mild pain, otherwise healthy. Stating that problem is more than low seems like a stretch.
Patient B with spondylosis may be experiencing significant pain, numbness and bladder incontinence. Calling that problem moderate seems appropriate. Possibly even high if there is severe exacerbation.
Even a patient with cancer could have problem level of low, moderate or high. And it will fluctuate during the course of illness and treatment depending on response to treatment and side effects.
To me, you have to level each particular service based on the documentation of status of the problem at the time of care, not simply by what the problem is.
Don't forget that number and complexity of problems addressed is only 1 of 3 elements for overall MDM. You need not just the problem level, but also data level and risk level.
I recommend going back to the
basics of the AMA guidelines. When the new guidelines came out in 2021, I must have referenced that document literally hundreds of times. Read and re-read and re-read the definitions. If your providers are consistently calling a problem higher than you think it is, it is also possible they are not DOCUMENTING well enough.