Oncology & Hematology Coding Alert

Let Updated Code Descriptors Guide Your Leveling

Published on Mon Sep 26, 2022

For the last two years, CPT^®has featured two different ways to calculate levels for certain E/M encounters. Since January 2021, you’ve calculated office/outpatient E/M service levels by meeting or exceeding two of the three MDM elements: the number and complexity of problems addressed at the encounter, the amount and/or complexity of data to be reviewed and analyzed, and the risk of complications and/or morbidity or mortality of patient management. For office/outpatient E/M visit coding you’ve also had the option of assigning a level based on the total time the provider has spent on face-to-face and non-face-to-face activities as defined by CPT^®guidelines on the same date as the encounter.

For the remaining E/M service categories, you’ve been calculating E/M levels using the old 1995/1997 documentation guidelines, using history, exam, and/or MDM or time, when appropriate, by applying the 50 percent counselling and/or coordination of care guideline.

Starting in 2023, you will have two ways to possibly calculate other E/M categories. Some codes, such as ED codes 99282-99285 (Emergency department visit …), require coding based on MDM. Other codes will give you the option to code based MDM or total time, whichever is more advantageous to the provider. You’ll now level office/outpatient consultation codes 99242-99245 (Office or other outpatient consultation …), initial and subsequent inpatient/observation care and same-day admission and discharge E/M services as described by revised codes 99221-99223 (Initial hospital inpatient or observation care, per day …), 99231-99233 (Subsequent hospital inpatient or observation care, per day …), and 99234-99236 (Hospital inpatient or observation care… including admission and discharge on the same date …) based on the new (2021) E/M code methodology.

For the full list of 2023 E/M code and guideline revisions, go to www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf.