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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