More Changes Ahead For E/M: Review 2023 E/M Codes & Guidelines Here
More Changes Ahead For E/M: Review 2023 E/M Codes & Guidelines Here
January 2021 brought significant changes to the Evaluation and Management (E/M) codes for Office and Other Outpatient Services. As expected, these changes will soon be found in other subsections of E/M codes for 2023. AMA released a detailed document describing the 2023 E/M changes that will take effect on January 1, 2023.
The early release allows time for review and training on the changes and systems updates before the implementation date. Included are comprehensive updated E/M Service guidelines detailing items unique to the section. A brief description of changes to E/M subsections follows.
Hospital Inpatient and Observation Care Services
This subsection has been revised and renamed, with updated guidelines included. Codes for observation discharge services, initial and subsequent observation care have been deleted and included in inpatient care services. The new subsection is titled Hospital Inpatient and Observation Care Services. Codes are revised to mirror the office and other outpatient services codes, deleting reference to the level of history and examination, noting a medically appropriate history and/or examination and listing the level of medical decision making. If time is used for code selection, the amount of time that must be met or exceeded is listed for each code, rather than a range of time used in the office or other outpatient codes.
Consultations
The consultation codes also list the level of decision-making and delete references to the level of history and examination, substituting a medically appropriate history and/or examination. The total time that must be met or exceeded if using time for code selection is added to the code description. For office other outpatient consultations, code 99241 has been deleted with a cross-reference to 99242 as both codes included straightforward medical decision making. The same change is made in the inpatient or observation consultations, with code 99251 deleted with instructions to use 99252 for straightforward medical decision-making.
Emergency Department Services
These codes have also been revised to delete references to level of history and examination and include the level of medical decision-making. Time is not a descriptive component for these codes as the services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time. Medical decision-making is the only available method for selecting these codes.
Nursing Facility Services
Codes for Initial and Subsequent Nursing Facility Care have been revised to include the new description of medically appropriate history and/or examination and level of medical decision making. If using time on the date of the encounter, the number of minutes that must be met or exceeded is listed in the code description. Code 99318 for services involving an annual nursing facility assessment has been deleted, with instructions to report the appropriate subsequent nursing facility care code.
Domiciliary Care Services
Several codes in these subsections have been deleted with instructions to use the appropriate Home or Residence Service codes, which is the new title for Home Services. New guidelines provide information on how to use these codes for home or residence in a facility such as an assisted living facility or residential substance abuse treatment facility. Codes have been revised to include the level of medical decision-making and the total time that must be met or exceeded to use the code if time is used for code selection.
Prolonged Services
Several changes are made in this section, including guideline updates and deletion of the Prolonged Services With Direct Contact (Except with Office or Other Outpatient Services) subsection and a cross-reference to 99417 or a newly created code, 993X0. This code has yet to be finalized and will be listed along with code 99417 in a new subsection titled Prolonged Service With or Without Direct Patient Contact On the Date of an Evaluation and Management Service.
Code 99417 has been revised with additional guidelines and will be used for prolonged outpatient services. New code 993X0 will be reported for prolonged inpatient or observation E/M services; both codes will be used on the date of an E/M service. The subsection that includes codes 99358 and 99359 for prolonged E/M before and/or after direct patent care has been renamed Prolonged Services Without Direct Patient Contact to the new title, Prolonged Service on Date Other Than the Face-to-Face Evaluation and Management Service Without Direct Patient Contact, with revisions to the guidelines.
More 2023 E/M Changes to Come
Look for additional information on the code and guideline changes to be released leading up to the January 1, 2023, implementation date. Lessons learned from the 2021 Office and Other Outpatient changes will assist in using the new codes and facilitate a smooth transition.
Additional Resources for 2023 Coding Updates:
