New E/M Coding Updates and Guidelines 2023

The American Medical Association has released the CY 2023 CPT code set and these updates will be effective beginning January 1, 2023. 

Office visits, hospital visits, home services, and preventive medicine services are examples of Evaluation and Management (E/M) services. Understanding how to properly document and code these high-volume services is critical, as even minor errors in E/M coding can lead to major compliance and payment issues. The updated E/M guidelines for 2023 are being welcomed by physicians and providers of medical billing and coding services because they aim to simplify and streamline coding and documentation for E/M services.

The new E/M guidelines for 2023 expand on the flexibility of the 2021 office/outpatient E/M coding and documentation rules.

2023 E/M Code Updates Minimize Documentation Burden

The updated guidelines for coding and documenting E/M services aim to make it easier for medical practices and other facilities to code and document E/M services.

The following factors will be used to determine the level of E/M services:

• The MDM level as defined for each service OR The practitioner's time spent includes face-to-face and non-face-to-face time
• The history and exam are no longer used to determine the level of code.
• Hospital Observation Services E/M codes were deleted and inpatient Hospital Services E/M codes were revised to include the:

Observation Care Services

• 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.
• 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).
• Retention of revised observation or inpatient care services, including admission and discharge services (CPT codes 99234 through 99236).

Consultations

• Consultation codes are retained with some revisions to the code descriptors.
• Specific 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 the 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 is allowed to be reported in addition to ED service for clinical change

Nursing facility services

• Nursing facility guidelines are 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.
• When the principal physician’s team member performs care before the required comprehensive assessment, using subsequent visits is allowed.
• 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.

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 are 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.

A new appendix with a taxonomy that offers guidance for categorizing AI-powered medical service applications, such as expert systems, machine learning, or algorithm-based solutions, is also part of the 2023 CPT code set. Additionally, there are new codes that take into account the use of remote monitoring services and emerging virtual care technology in therapy.

To assist practitioners in successfully implementing changes to code and documentation guidelines into their practices, medical billing and coding outsourcing companies keep up to date with changes to such policies.