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What changes will 2023 bring in E/M Coding? An overview for Medical Billers and Medical Coders

Last year amidst PHE we didn’t encounter as many annual coding changes as we thought we would have. However, this year, AMA has made very distinct and significant changes when it comes to E/M billing and coding guidelines that are worth sharing at this point as the new year approaches fast.

Starting 2023, we can expect new codes, revisions, deletions and updates made to previously used various categories and facets of E/Ms. This includes services rendered in observation department to home and domiciliary services. To top it off we have alteration made to prolonged services as well (yet again).

In this article, we elaborate and try to make these changes easy to go through for the readers as we head into next year!

Hospital Observation Services:

To begin with, AMA definitely have deleted the previously used observation codes (initial, subsequent and discharge) and merged them into the corresponding impatient E/M codes (initial, subsequent and discharge).

Inpatient and Outpatient (Office) Consultation Services:

A consult is only used once per stay per specialty and group. Medicare still doesn’t recognize these codes very few private payers might. In that case, if a consultation is performed by another physician or other qualified health care professional, and then the same consultant performs an encounter once the patient is admitted by the other physician or other qualified health care professional, report the consultant’s inpatient encounter with the appropriate subsequent care code (99231, 99232, 99233).

Emergency Department Services:

Emergency Department codes were not deleted or replaced.

Code 99281 has a descriptor change. It is now defined as “Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional.”

However, few other things are to be highlighted here that no distinction is made between new and established patients when it comes to the emergency department visits. When selecting a level of service in 2023, use medical decision-making. Time is not a factor in ED visits. No other significant updates were determined for ED visits.

Home or Residence Services:

Domiciliary, rest home or custodial care services codes are now deleted. To report services to patients in those facilities, use the home or residence services codes. For new patients, these are codes 99341, 99342, 99344, 99345. Code 99343 is deleted. There are four levels of new patient home or resident services. There are also four levels of established patient home or residence services, using codes 99347—99350. The AMA states that if selecting a code based on time, you may not include travel time. Revisions to other codes are in keeping with AMA’s guideline changes for E/M leveling using time or medical decision making (MDM). For example, the emergency department codes 99281-99285, initial and subsequent nursing facility care codes 99304-99310, and home services codes 99341-99342, 99344-99350 are revised to require a medically appropriate history “and/or” exam and MDM, instead of all three key components.

Inpatient and Outpatient (Office) Prolonged Services:

Prolonged Services (Inpatient/Outpatient) codes also went through some notable changes going in 2023. For starters four prolonged codes 99354-99357 (two inpatient and two outpatient) are deleted and replaced by previously introduced prolonged code 99417 and a new code 993X0 will be updated and take effect soon and full-full-fledged prolonged code that can be used along aside inpatient services.

However, expect the placeholder codes to evolve and also produce a G-code that will work for Medicare and Medicare following payers in near future. This is similar to what they have done with 99417 and G2212 code in recent years.

Note: Codes that contain an 'X' (e.g., 993X0) are placeholder codes that are intended, through the first three digits, to give readers an idea of the proposed placement in the code set of the potential code changes. These codes are not used for claims reporting and will be removed and not retained when the final CPT Datafiles are distributed on August 31st of each year.

AltuMED is a Healthcare Revenue Cycle Management technology and solutions company. Our technologically advanced Practice Management Software, PracticeFit optimizes the Medical Billing workflows for Medical Practices, Labs and Third-Party Medical Billing Companies helping them collect maximum revenue. Find out more.

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