Get Ready for E/M Coding in 2023
A proactive approach will keep the revenue flowing as you implement more changes to the Evaluation and Management section of CPT®.
The dust hasn’t even settled on the 2021 evaluation and management (E/M) documentation guidelines and we’re looking at more changes to this section of CPT® in 2023 — and not just for office visits this time. If your healthcare organization has done its due diligence to implement the 2021 E/M guidelines, you need not panic. The changes coming down the pike should make coding E/M services in your practice or facility easier, not harder. AAPC Chief Product Officer Raemarie Jimenez, CPC, CDEO, CIC, CPB, CPMA, CPPM, CCS, explains why in her HEALTHCON 2022 general session “2021 E/M Lessons Learned.”
With the current guidelines, there is a split between office visits and facility. “In 2023, we will finally be using one guidance,” she said.
To level-set and standardize E/M code level determination, revisions to code descriptors and guidelines will extend beyond physician office and outpatient E/M services. Here’s what we can tell you, so far.
Note: This presentation was given before CPT 2023 was finalized. There may be additional code changes beyond what is described in this article.
Inpatient and Observation Care Services
Observation care discharge (99217), initial observation care (99218, 99219, 99220), and subsequent observation care (99224, 99225, 99226) are deleted for Calendar Year (CY) 2023.
Initial hospital care (99221-99223), subsequent hospital care (99231-99233), observation or inpatient hospital care (99234-99236), and hospital discharge (99238-99239) codes and guidelines are revised to include observation care services. There are also revisions to the Hospital Inpatient Services subsection heading and guidelines.
Office consultation code 99241 and inpatient consultation code 99251 are deleted for CY 2023, as well. As when E/M code 99201 was deleted, CPT® will direct you to the codes you should use in place of these newly deleted codes.
The other codes (99242-99245, 99252-99255) and guidelines in this section are revised, including headlines, so you will need to review these changes carefully.
Emergency Department Services
There are no changes to the codes for emergency department visits (99281-99285), but expect revisions to the guidelines for CY 2023.
Nursing Facility Services
Nursing facility assessment code 99318 is deleted, and all other codes (99304-99310, 99315-99316) and guidelines under Nursing Facility Services in CPT® 2023 are revised.
Home and Residence Services
The Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services subsection of CPT® 2023 is deleted, along with new patient codes 99324-99328 and established patient codes 99334-99337.
Domiciliary, Rest Home (e.g., Assisted Living Facility), or Home Care Plan Oversight Services guidelines are revised, and supervision codes 99339-99340 are deleted.
Home visit code 99343 is also deleted. And the remaining home visit codes (99341-99345, 99347-99350) are revised, as are the guidelines for using those codes.
There are revisions in the E/M guidelines to reflect the above changes, and the Levels of Medical Decision Making (MDM) table is revised.
How to Prepare
Having this preliminary look at the future of E/M coding allows your office or facility to ensure everyone is ready to implement the changes on Jan. 1, 2023. Time is on your side, but don’t delay. Successful adoption of the 2023 E/M guidelines requires:
- Refinement of the E/M guidelines
“You can go out with the best intention to make a perfect coding structure, but until you implement it, monitor it, and see how it is being used in the medical practice, you’re not going to know,” Jimenez warns.
Read the revised code descriptors (when they’re released) and, if you don’t understand what they’re saying, talk to your providers and try to come to an understanding that’s agreeable for everyone involved.
“You need to be comfortable having these conversations with your provider and doing proactive things to understand some of the nuances that you’re not familiar with,” Jimenez said.
- Ongoing education
“Education, followed by auditing and re-education is going to give you the results you want,” Jimenez said.
Watch for More Education
This is a preliminary view of the 2023 E/M guidelines. AAPC will continue to inform its members, as appropriate. Check out AAPC’s upcoming education, including sessions at HEALTHCON Regional in Denver, Colo., (or virtually), Aug. 3-5.
AMA, February 2021: CPT® Editorial Summary of Panel Actions,