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E/M Changes Coming Our Way in 2023!

Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
2022-07-12

Changes are one thing we can count on being consistent; even though this is one we have been anticipating, it is time to prepare, and we will have some work to do. The AMA released the new 2023 E/M Guidelines early to help us prepare for the change effective January 1, 2023.  

Beginning in January 2023, the E/M section will once again be revised. The AMA is listening to physicians’ concerns and making changes to help alleviate the administrative burden even further; the 2021 changes simplified code selection based on either time or medical decision-making. The early release will assist in setting the proposed Medicare physician fee schedule, which is usually out in early July, and will give us time to get familiar with them and prepare for the changes before the release date. We will see several deleted codes and new definitions and changes in some code descriptions, be sure to review all 2023 changes announced by the AMA; see the complete summary here. 

Changes in Emergency Department visits:

The CPT Editorial Panel revised the Emergency (ED) visit’s specifically (99281-99285) to align with CMS and the principles used with “Office or other Outpatient Visits.”

Important revisions coming in the 2023 rules and descriptions:

Removing the key components such as history, examination, and medical-decision-making (MDM) will be selected based on MDM only for services provided after January 1, 2023.

New and established patients have no distinction; any CPT code in the ED section may be used.

The observation discharge code (99217) will no longer be used.  We will now report with the hospital or observation discharge codes (99238-99239), or if there is an admission and discharge on the same day, the correct code selection will be (99234-99236).

Additional language was added to the initial and subsequent Inpatient codes (99221-99233 and 99231-99233).

Prolonged services will have a new CPT code and guidelines 993X0.

Observation codes will no longer be used (99217-99226); the observation codes will be merged with the initial and subsequent hospital codes 99221-99223, 99231-99233, and 99238-99239).

For example, the description for code 99221 will state: “Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low-level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.”

Deletion of codes

While some codes will be revised, others will be deleted; please refer to the final changes when the AMA releases them; this article is information only.  

Section

Deleted

Consider

Revised

Emergency Department Services

99281-99285 and guidelines

Observation Care Discharge Services

99217

99238, 99239

Initial Observation Care

99218, 99219, 99220

99221, 99222, 99223

99221-99223, 99231-99239, and guidelines

Subsequent Observation Care

99224, 99225, 99226

99231, 99232, 99233

Office or Other Outpatient Consultations

99241

99242

Inpatient or Observation Consultations

99251

99252

99242-99245, 99252-99255, and guidelines

Other Nursing Facility Services

99318

99307, 99308, 99309, 99310

99304-99310, 99315, 99316 and guidelines

Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services (NEW PT)

99324, 99325, 99326, 99327, 99328

99341, 99342, 99344, 99345

99341, 99342, 99344, 99345, 99347-99350 and guidelines

Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services (EST PT)

99334, 99335, 99336, 99337

99347, 99348, 99349, 99350

Assisted Living Facility), or Home Care Plan Oversight Services

99339, 99340

99437, 99491, or principal care management codes 99424, 99425

Home or Residence Services (NEW PT)

99343

99341, 99342, 99344, 99345

Prolonged Services

99354, 99355, 99356, 99357

99417, 993X0

99358, 99359, 99415, 99416, 99417 and guidelines

References