What are the E/M Coding Changes Coming in 2023?

by | Published on Oct 17, 2022 | Medical Billing, Medical Outsourcing

E M Coding and Documentation Guidelines
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The American Medical Association (AMA) has released CPT® Evaluation and Management (E/M) Code and Guideline Changes that will go into effect January 1, 2023 Evaluation and Management (E/M) services include office visits, hospital visits, home services, and preventive medicine services. Understanding how to properly document and code these high-volume services is important as even small mistakes in E/M coding can result in major compliance and payment issues. The updated E/M guidelines for 2023 aim to simplify and streamline coding and documenting for E/M services and are being welcomed by physicians and providers of medical billing and coding services. The existing 2021 guidelines implemented by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) allow healthcare providers to document E/M visits based on medical decision-making (MDM) or total time. This was a major departure from the previous guidelines that required them to address three elements in the patient’s progress notes: patient history, physical exam and medical decision making for code selection). The new E/M guidelines for 2023 build on the flexibilities of the 2021 office/outpatient E/M coding and documentation rules.

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2023 E/M Code Updates Reduce Documentation Burden

The goal of the updated guidelines for coding and documenting E/M services is to make coding and documenting E/M services easier for medical practices and other facilities.

  • Level of E/M services will be based on the following:
    • The level of the MDM as defined for each service
    • OR
    • Time spent by the practitioner includes face-to-face and non-face-to-face time
  • History and exam no longer used to select the level of code
  • Hospital Observation Services E/M codes deleted and inpatient Hospital Services E/M codes revised to include Observation Care Services:
    • Hospital observation CPT codes (99217-99220 and 99224- 99226) have been deleted and merged into the existing hospital care CPT codes (99221-99223, 99221-99233, and 99238-99239)
    • The code descriptors have been revised to account for the structure of total time on the date of the encounter or level of medical decision-making when selecting code level
    • Retention of revised observation or inpatient care services, including admission and discharge services (CPT codes 99234 through 99236)
  • Consultations:
    • Consultation codes retained with some revisions to the code descriptors
    • Certain guidelines deemed confusing by the AMA have been deleted, including the definition of “transfer of care”
    • Lowest level office (99241) and inpatient (99251) consultation codes have been deleted to align with four levels of MDM
  • Revision of Emergency Department Services E/M codes 99281-99285 and guidelines:
    • Retention of the existing guideline that time cannot be used as a key criterion for code level selection
    • Revisions to the code descriptors to reflect the code structure approved in the office visit revisions
    • Modification of medical decision making (MDM) levels to align with office visits and maintain exclusive MDM levels for each visit
    • Critical care allowed to be reported in addition to ED service for clinical change
  • Nursing facility services
    • Nursing facility guidelines is revised with a new “problem addressed” definition of “multiple morbidities requiring intensive management,” to be considered at the high level for initial nursing facility care
    • Code 99318 (annual nursing facility assessment) is deleted. This service will be reported using codes 99307, 99308, 99309, and 99310 (subsequent nursing facility care services) or Medicare G codes
    • When the principal physician’s team member performs care before the required comprehensive assessment, using subsequent visit is allowed
  • Home or residence services
    • Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines
    • Domiciliary or rest home CPT codes (99334 through 99340) are deleted and have been merged with the existing home visit CPT codes (99341-99350)
    • When selecting code level using time, do not count any travel time
    • Home or Residence Services E/M code 99343 is deleted
  • Prolonged Services Codes
    • Direct patient contact prolonged service codes (99354-99357) are deleted and these services will be reported using code 99417 (office prolonged service), or 993X0, the new inpatient or observation or nursing facility service code
    • New code 993X0 to be analogous to the office visit prolonged services code 99417
    • Codes 99358 and 99359 retained and used when a prolonged service is provided on a date other than the date of a face-to-face evaluation and management encounter with the patient and/or family/caregiver

The 2023 CPT code set also includes a new appendix with a taxonomy that provides guidance for classifying AI-power medical service applications, including expert systems, machine learning, or algorithm-based solutions. There are also new codes to account for emerging virtual care technology and remote monitoring service use in therapy.

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Medical billing and coding outsourcing companies stay up to date on changes to code and documentation guidelines and can help practitioners successfully incorporate them into their practices. Experts can help practices makes the most of E/M billing guidelines that allow physicians to bill for previously unreimbursed services, leading to higher revenues for longer patient visits.

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Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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