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, AMA updates E/M billing and coding guidelines for the new year.
New E/M codes and updates are expected in 2023, covering a range of services from observation to home care. 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:
AMA deleted observation codes and merged them into inpatient E/M codes.
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. Report consultant's subsequent care code if seeing admitted patient.
Emergency Department Services:
Emergency Department codes were not deleted or replaced.
Code 99281 has a descriptor change. Emergency department visit defined as non-physician evaluation.
No distinction between new and established patients for 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. Use home/residence service codes for patients in those facilities. 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. Established patient home services use codes 99347-99350. The AMA states that if selecting a code based on time, you may not include travel time. AMA revised E/M codes using time or MDM. Emergency, nursing facility, & home services codes revised to require history/exam and MDM.
Inpatient and Outpatient (Office) Prolonged Services:
Prolonged services codes updated for 2023. Prolonged inpatient/outpatient codes deleted, replaced by 99417 and new 993X0 codes. Expect new prolonged service codes, including a G-code, for Medicare and other payers. This is similar to what they have done with 99417 and G2212 code in recent years.
Note: Placeholder codes with 'X' indicate proposed code changes. Placeholder codes with 'X' are not used for claims and will be removed annually.
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