A new year is right around the corner and that means changes to evaluation and management (E/M) codes and documentation.
The 2023 E/M changes include almost 400 editorial revisions to common procedural terminology (CPT) codes. Managed by the American Medical Association (AMA), the CPT changes include 93 revisions, 75 deletions and 225 new codes, all of which take effect on January 1, 2023.
Here’s an overview of what to expect with the 2023 E/M guidelines.
1. Reducing Administrative Burden Is a Primary Goal
Administrative work is one of the main sources of physician burnout today. That’s why the AMA has spent the last few years trying to reduce the burden around E/M coding.
Deleted and Merged Codes
Keeping with that trend, the AMA consolidated and deleted many E/M codes for 2023. For example, the AMA deleted some observation codes (99217-99220, 99224-99226) and merged them with existing hospital care codes (99221-99233, 99238-99239).
The AMA also removed “rest home” and “domiciliary” as home care settings — instead, there is just one set of codes for the patient’s residence.
E/M Leveling
The AMA also made 2023 E/M changes that give more flexibility around selecting the correct E/M code based on the level of service. Since 2021, providers could document E/M visits based on the level of medical decision-making (MDM) or the total time spent on the day of service. Some of the revisions in the 2023 guidelines align with this effort.
For example:
- The 2023 E/M guidelines include changes to some inpatient and observation code descriptions to reflect the total time spent on the service date or the MDM level.
- Some nursing facility (99304-99310), emergency department (99281-99285) and home service codes (99341-99342, 99344-99350) will require a medically appropriate history and/or MDM and exam. Previously, those codes required all three.
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Prolonged Care Codes
There is also a lot of attention on prolonged care codes in 2023. The AMA deleted prolonged care codes 99354-99357. Additionally, you will be able to report prolonged care code 99417 with outpatient consult code 99245, home visit codes 99345 and 99350, and cognitive assessment code 99483 in 2023. Currently, you can only use code 99417 with office/outpatient codes 99205 and 99215.
2. 200+ Code Additions in Surgery, Radiology, Pathology and More
Alongside many revisions and deletions, the CPT 2023 code set includes 225 new codes. Some highlights include:
- 11 new codes for tests under the Pathology and Laboratory section
- 10 new codes under the Medicine section, including codes for cardiac catheterization, multi-family group behavior management and remote therapeutic monitoring. One of the remote monitoring changes is a new code (98978) to report cognitive behavioral therapy monitoring.
- 17 new codes for the Digestive surgery subsection, including 15 new CPT codes (49591-49623) for anterior abdominal hernia repair services. These codes reflect the evolved technology and techniques used to repair abdominal hernias.
- Five new codes under the Cardiovascular surgery subsection, including reporting percutaneous pulmonary artery revascularization by stent placement (33900-33904) and reporting percutaneous arteriovenous fistula creation in the upper extremity (36836-36837).
- One new diagnostic ultrasound code (76883) under the Radiology section.
- Nearly 50 new Category III codes for emerging technology and services.
3. New Taxonomy Resource
The 2023 E/M code set also includes a new appendix with a taxonomy for artificial intelligence/augmented intelligence (AI) applications. The AMA hopes this resource will guide how to classify AI-powered medical services, including machine learning, expert systems and algorithm-based solutions. The taxonomy classifies the AI solutions as either autonomous, augmentative or assistive.
“This shared understanding will help guide the CPT editorial process for describing the range of AI products and services,” AMA President Jack Resneck Jr., MD, said in a release.
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Don’t Let Coding Changes Affect Your Reimbursements and Revenue
With nearly 11,000 CPT codes in use today, it’s easy to feel overwhelmed by the annual revisions, deletions and additions. Although changes are in place to reduce the administrative burden of coding, a skilled professional will ensure you avoid costly mistakes and get reimbursed in full.
When you partner with Gentem for insurance billing and revenue cycle management (RCM), we take on the administrative burden of coding and filing claims. Our certified professional coders (CPCs) review every claim to make sure you’re avoiding denials and rejections while maximizing reimbursements. Using Gentem’s proprietary, AI-powered software, our team stays on top of every claim until you get paid.
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