Updates for Coding and Evaluation in 2023

The new guidelines released by the American Medical Association (AMA) for reporting Evaluation and Management (E/M) services will take effect on January 1, 2023. Per the CPT ® 2021 updates, these changes only apply to office and outpatient E/M codes.

In addition, these E/M coding changes aim to decrease the burden of medical coding. Check out this article to learn the updates for coding and evaluation in 2023.

Taking a Closer Look at (E/M) Codes

What are e/m codes? The evaluation and management (E/M) coding system uses CPT® codes ranging from 99202-99499 to represent the services provided by doctors and other qualified healthcare professionals. These medical codes relate to visits and services involving evaluating and managing patients’ health. Moreover, the AMA periodically reviews the evaluation and management codes as part of the CPT-4 system.

Physicians and other qualified healthcare professionals can submit E/M codes on claims to request reimbursement for their professional services from Medicare, Medicaid, and other third parties. It is also possible to bill for outpatient facility services using E/M service codes. On the other hand, a facility or practice may also use E/M codes internally to track and analyze services.

What services use evaluation and management codes?

Physicians cannot use e/m codes for services such as surgeries, procedural testing, diagnostic imaging, and radiologic imaging. Below are the services that fall under the umbrella of E/M include:  

• Hospital visits  
• Preventative medicine services
• Home care services  
• Office visits 

The broad definition of these codes makes them applicable to various services. It is possible to apply E/M codes when billing for a general follow-up appointment at an orthopedic surgeon’s office, just as it is possible to use them when a patient visits a general provider.  

AMA 2023 Evaluation and Management Changes

Are you eager to learn about the 2023 E/M changes?

There have been revisions to the CPT coding guidelines by the AMA across all care settings and services to comply with new E/M coding standards. Below are the updates by care setting or service are as follows:

Inpatient and Observation Care Services

• Deletion of observation CPT codes (99217 through 99220 and 99224 through 99226) and merged them into the existing hospital care CPT codes (99221 through 99223, 99221 through 99233, and 99238 through 99239)
• Revision of the code descriptors 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)

Source: American Medical Association

Consultations

• Retention of the consultation codes, with some editorial revision to the code descriptors
• Deletion of certain guidelines deemed confusing by the AMA, including the definition of “transfer of care”
• Deletion of lowest level office (99241) and inpatient (99251) consultation codes to align with four levels of MDM

Source: American Medical Association

Emergency Department Services

• Retention of the existing principle 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
• Modified MDM levels to align with office visits and maintain unique MDM levels for each visit
• Retention of existing CPT code numbers
• Updates to current practice that was not explicit in the CPT code set, which may be used by physicians and other qualified healthcare professionals other than ED staff
• Allowance of critical care to be reported in addition to ED service for clinical change

Source: American Medical Association

Nursing Facility Services

• Revision to nursing facility guidelines with a new “problem addressed” definition of “multiple morbidities requiring intensive management,” to be considered at the high level for initial nursing facility care
• Deletion of code 99318 (annual nursing facility assessment), which will be reported through the subsequent nursing facility care services (CPT codes 99307 through 99310) or Medicare G codes
• Updated standard so not all “initial care” codes are the mandated comprehensive “admission assessment” and may be used by consultants
• Allowance of the use of subsequent visit when the principal physician’s team member performs care before the required comprehensive assessment

Source: American Medical Association

Home or Residence Services

• Deletion of the domiciliary or rest home CPT codes (99334 through 99340), which have now been merged with the existing home visit CPT codes (99341 through 99350)
• Elimination of the duplicate MDM Level New Patient code (99343)

Source: American Medical Association

Prolonged Services

• Deletion of direct patient contact prolonged service codes (99354 through 99357), which will be reported through either the code created in 2021, office prolonged service code (99417), or the new inpatient or observation or nursing facility service code (993X0)
• Creation of a new code (993X0) to be analogous to the office visit prolonged services code (99417)
• Retention of 99358 and 99359 for use on dates other than the date of any reported ‘total time on the date of the encounter” service

Source: American Medical Association

How do the changes in 2023 E/M codes affect your practice and your patients?

Fortunately, the AMA states that the E/M code changes will simplify physician processes and lessen burnout. With the new e/m code changes, it should be easier to find the correct code. These code updates will make the administrative processes less time-consuming!

In the best-case scenario, healthcare providers and facility staff may be able to spend more time with patients.  

Conclusion

Providers must consult their EHR vendors after AMA codes are revised. Check with your EHR vendor to ensure the system’s coding applications comply with the new evaluation and management codes.  

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