New E/M Coding and Documentation Guidelines in 2023

A new set of Current Procedural Terminology (CPT) codes are to be released by the American Medical Association for 2023. The update aims to reduce the burden of coding regarding the E/M (evaluation and management) visits. The E/M coding and documentation changes can be termed as once-in-a-generation guidelines restructuring in 2023. With several deletions, alterations, and additions in the coding and documentation guidelines, many providers believe it will be a game changer.

This blog will provide concise guidelines for the new E/M coding and documentation released by the AMA.

The Deleted E/M CPT 2023 Codes

This revision will delete several codes, and new 2023 guidelines for the Evaluation and Management coding will transform the medical billing and coding industry. They are as follows:

Codes from 99217 – 99220 and 99224 – 99226 will be deleted under the hospital observation services. Though the 99217 code is for the services of observation care discharge, 99218 – 99220 codes are used for initial observation care. Not only this but codes ranging from 99224 – 99246 are used for subsequent observation care.

Broadly, these are meant for:

  • Code 99241 is used for an office consultation, and code 99251 for inpatient consultation, both of which fall under the Consultations heading, will be deleted.
  • Nursing facility services that fall under the 99318 codes will be deleted.
  • 99339 and 99340 codes associated with rest home, domiciliary, and home care plan will be deleted.
  • Codes for custodial care for established and new patients are to be deleted, i.e., 99334 – 99337 and 99324 – 99328, respectively.
  • Home visit code 99343 associated with new patients will be deleted under the Home Services header.
  • The add-on codes for the prolonged services 99354 – 99357 will be deleted.
  • 49562 – 49657 codes for Laparoscopy are also targeted.
  • Apart from these, several codes under Category III are expected to be deleted or either moved to Category I or made obsolete.

Revised E/M CPT 2023 Codes

With the deletion of the codes, the AMA had to revise the description of other codes for the E/M section. Some of the revisions that will be done include the following:

The Hospital Inpatient Services header is the first point of discussion on whether the revised codes now include inpatient or observation care. Similarly, the outpatient or office consultation codes will be modified to include ‘office or other outpatient consultation.’

The revisions further keep with the AMA’s guidelines that level the use of medical decision-making (MDM) and time. Likewise, even the prolonged service code is expected to be revised to specify that it will be used for an E/M outpatient, not for office or other outpatient services.

It must be noted that there are expectations for revisions in the description regarding the interprofessional telephone, electronic health record and internet consultation codes, cognitive assessments, and code for the care plan service.

New CPT 2023 Codes for E/M

Several new codes will be entered in the E/M section that overlooks several subsections. Some of them are like:

  • New codes for integumentary subsections will be added, and so are the codes for the Musculoskeletal System subsection, which is for the total disc arthroplasty.
  • Surgeons must now deal with five new codes in the Cardiovascular subsection to report percutaneous pulmonary artery revascularization by stent placement. Likewise, two new codes will be added for surgeons to report in the upper extremity about the percutaneous arteriovenous fistula creation.
  • In the digestive subsections, there are 17 new codes and three new codes in the Auditory System subsection that describes the replacement, implanting, or removal of an Osseo integrated implant.
  • Pathology and Laboratory, radiology, and even the medicine section have to deal with eleven, one, and ten new codes, respectively. 
  • Lastly, the new CPT codes for E/M have not ignored the emerging services, procedures, and technology and placed many new codes in Category III.

How To Get Equipped with New E/M Coding and Documentation?

The changes, deletion, revising, and addition of new codes for documentation in the E/M, effective from January 1, 2023, will be challenging for every medical coder and biller. Any failure to abide by these changes and guidelines will result in a claim denial, delay, or rejection, which will mean a loss of revenue. When efficient running of the service with effective care is at the forefront of any hospital, learning these new guidelines by the facility’s staff means reducing the time to offer help to patients and better running of the hospital.

So, why not allow the experienced medical billing and coding services to take care of the patients and other admin jobs? Partner with a medical billing and coding company like 24/7 Medical Billing Services, which will take care of the medical billing by adhering to the new E/M coding and documentation guidelines in 2023. There will be no revenue loss; instead, you will get a successful claim on time so your facility can run smoothly.

Read more : 10 Reasons To Outsource Your Medical Billing

Let us know what you need!

Error: Contact form not found.