The reverberations of the 2021 evaluation and management (E/M) documentation guidelines have barely subsided, yet we are already on the verge of witnessing further changes in this segment of CPT® for 2023 – and this time, the implications stretch beyond mere office visits. If your healthcare institution conscientiously adopted the 2021 E/M guidelines, there’s no need to be alarmed. The impending modifications have been designed to simplify the coding of E/M services within your practice or facility, rather than to complicate matters.
Under the current guidelines, there exists a dichotomy between office visits and services rendered within a facility. “In 2023, we will finally be utilizing a unified guidance,” states an informed source.
In a bid to standardize the assessment of E/M code levels, revisions to code descriptors and guidelines are expanding beyond physician office and outpatient E/M services. Here’s what we have garnered thus far.
Please be aware: This presentation was delivered prior to the finalization of CPT 2023, indicating that additional code changes beyond the ones described here may emerge.
Inpatient and Observation Care Services
For Calendar Year (CY) 2023, the codes for observation care discharge (99217), initial observation care (99218, 99219, 99220), and subsequent observation care (99224, 99225, 99226) are slated for removal.
The codes and guidelines pertaining to initial hospital care (99221-99223), subsequent hospital care (99231-99233), observation or inpatient hospital care (99234-99236), and hospital discharge (99238-99239) are being revised to encompass observation care services. Notably, changes are also in store for the heading and guidelines within the Hospital Inpatient Services subsection.
Both office consultation code 99241 and inpatient consultation code 99251 are set to be deleted for CY 2023. In a manner akin to the deletion of E/M code 99201, CPT® will provide instructions on which codes to use in lieu of the ones being deleted.
Moreover, the other codes (99242-99245, 99252-99255) and associated guidelines within this section will be revised, including headings, necessitating a thorough review.
Emergency Department Services
While the codes for emergency department visits (99281-99285) remain unaltered, it is advisable to anticipate guideline revisions for CY 2023.
Nursing Facility Services
Code 99318, pertaining to nursing facility assessment, will be removed, and all other codes (99304-99310, 99315-99316) and guidelines within CPT® 2023’s Nursing Facility Services will be revised.
Home and Residence Services
The subsection titled Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services in CPT® 2023 will be discontinued, along with the inclusion of new patient codes 99324-99328 and established patient codes 99334-99337.
Guidelines governing Domiciliary, Rest Home (e.g., Assisted Living Facility), or Home Care Plan Oversight Services will be modified, and the supervision codes 99339-99340 will be eliminated.
Additionally, code 99343 for home visits is slated for deletion. The remaining home visit codes (99341-99345, 99347-99350) and the accompanying usage guidelines will undergo revision.
This preliminary glimpse into the impending E/M coding landscape empowers your office or facility to ensure that everyone is well-prepared to embrace the changes by January 1, 2023. Although there is ample time, it’s advisable not to delay.
The successful integration of the 2023 E/M guidelines hinges upon the following factors:
- Refinement of E/M guidelines
“While you may intend to create a flawless coding structure, it’s only through implementation, monitoring, and witnessing its utilization in the medical practice that you’ll gain true insight,” warns experts.
Upon the release of revised code descriptors, engage with your providers to ensure a shared understanding, especially if certain aspects seem unclear.
3. Continuous education
“Education, combined with audits and re-education, will yield the desired results,” emphasizes professionals.