Learn about the 2023 CPT® E/M changes
Are you prepared to discover the 2023 CPT® E/M changes? The CPT® book’s Evaluation and Management (E/M) section has undergone a considerable overhaul. 25 codes will no longer be used. The introductory instructions have been updated to reflect changes to five separate code groups. Services that last a long time are getting yet another update. The American Medical Association’s E/M revisions are discussed in this article, but Medicare’s proposed acceptance of these codes and policies is not mentioned. This will be covered in a subsequent article. These are the codes that will be removed. Codes for hospital observation services (99217–99220, 99224–99926) Codes for consultation 99241, 99251 99318 Nursing facility service Services for domiciliary care, rest homes (like boarding homes), or custodial care, 99324–99328, 99334–99337, 99339, or 99340 Code for resident or home services 99343 Codes for prolonged services 99354–99357 Initial as well as follow-up services There is a new component named initial and subsequent services for hospital inpatient, observation care, and nursing facility codes. It holds true for both brand-new and returning patient visits. The AMA asserts: “For the purpose of differentiating between initial or later visits, professional services are defined as those face-to-face services provided by physicians and other trained health care professionals who may report assessment and management services. During the patient’s admission and stay in an inpatient, observation, or nursing facility, an initial service is one that the patient has not previously received from the doctor, another qualified health care professional, or another doctor or other qualified health care professional who belongs to the same group practice.” [1] These codes are used by doctors and other certified medical professionals with emergency and medical care as part of their scope of practice. It outlines the requirements for doctors and other licensed healthcare workers who perform in the same group practice and belong to the same specialization and subspecialty. The organization may only bill one initial service during an inpatient, observation, or nursing facility stay, and follow-up services are billed with subsequent visits. This is different from the way groups are reporting observation or inpatient services. When partners are filling in for one another, the practitioner who provides the initial service is responsible for billing for that service. On subsequent days, the fill-in physician reports a subsequent visit. It adheres to the Medicare requirement that doctors in the same group who practice the same specialty should be paid and billed jointly. Choosing a service level based on 2023 CPT® E/M adjustments According to the plan, the AMA has expanded the framework for office and outpatient visit code selection to include the remaining E/M services that were determined by history, exam, medical judgment, or time. By 2021, this framework will be in place. The change impacts the following services: Services for hospital inpatients and observers (One set of codes will utilized for both observation and inpatient care.) Advisory services Hospital emergency services (Time should not be a consideration when Choosing an ED visit) Hospital nursing services House or home services Time or medical judgment may determine the level of E/M service for the aforementioned code groups. (Time does not affect the decision to visit the ED.) The number and complexity of issues that must be resolved during the encounter, the volume and/or complexity of data that must be reviewed and analyzed, and the likelihood of complications, morbidity, or death associated with patient care are all factors that must be considered when selecting a code. This page provides an overview of the 2023 CPT® E/M Changes. On Doctor Papers, more resources go over choosing the level of service. Those resources will be updated to reflect the modifications made by the AMA to their discussion of medical decision-making. Services for hospital inpatients and observers Since the observation codes 99217–99220 and 99224–99226 have been eliminated; the same codes will be used to report services for both inpatients and patients under observation. Two sets of codes exist. When a patient is admitted and discharged on the same day of the year, one group is used, 99234–99236. The second set is for patients whose stay exceeds one calendar day. For the initial service, dial 99221–99223; for following visits, dial 99231–99233; and for discharge services, dial 99238 and 99239. When the prerequisites for consultation are satisfied, according to CPT®, a consulting physician may report codes 99252–99255 in an inpatient environment. So naturally, Medicare no longer accepts these codes, and many private insurance companies have stopped doing so. The CPT® reiterates in the recommendations for this part that advanced practice nurses and physician assistants are regarded as practicing in the same specialty and subspecialty as physicians when they collaborate with them. Therefore, the AMA has also modified its recommendations for admitting a patient from another facility of care. Although it is unlikely that Medicare or other parties will abide by this advice, the AMA recommends it. When the patient is admitted as an inpatient or placed on observation status at the hospital during an encounter at a different site of service, “the services at the initial site can be reported separately” (like a hospital emergency room, office, or nursing home). To indicate a significant, individually identifiable service was performed on the same date by the same doctor or other qualified health care professional, modifier 25 may be added to the other assessment and management service. [2] The AMA adds that changing from inpatient to observation or from observation to inpatient does not count as a new stay for a patient. That is, if the patient’s status changes, only bill for an additional initial service. The same day of the week for both admission and discharge Whether the patient is an inpatient or receiving observation-level treatment, the codes 99234–99236 are used for hospital inpatient or observation care and contain the admission and discharge on the same day. According to CPT, there must be two encounters—admission and discharge—in order to report these services. Therefore, the patient should be mentioned twice in the record. In addition, although CMS acknowledges
