Adjustments to evaluation and management codes will require a period of adaptation.
Within the CPT 2023 update, medical coders will encounter 101 fresh codes interspersed within the existing code set. However, it is the modified and removed codes that demand your utmost scrutiny.
Deleted CPT® 2023 Codes
To comprehend the altered evaluation and management (E/M) codes, we must begin by examining the codes that have been omitted from that segment of CPT® 2023. Prepare yourselves!
• Beneath the Hospital Observation Services section, the codes for observation care discharge services (99217), initial observation care (99218-99220), and subsequent observation care (99224-99226) have been removed.
• Within the Consultations category, the code for office consultation (99241) and inpatient consultation (99251) are no longer included.
• The code for other nursing facility services (99318) has been eliminated. Codes pertaining to domiciliary, rest home, or home care plan oversight (99339 and 99340) have been removed, along with custodial care codes (99334-99337) for established patients and (99324-99328) for new patients in those settings.
•Under the Home Services heading, the code for home visits involving new patients (99343) has been deleted.
• Additional codes that have been removed include the prolonged services add-on codes (99354-99357).
Moreover, several Category III codes have been expunged for the year 2023.The services represented by these codes may have either transitioned to become Category I codes or were considered outdated. Additionally, laparoscopy codes (49652-49657) have also been removed.
Revised CPT 2023 Codes
The adjustment of E/M observation codes, among others, prompted the American Medical Association (AMA) to revise the descriptions of numerous codes within the E/M section. As an illustration:
Within the Hospital Inpatient Services category, the codes for initial hospital care (99221-99223), subsequent hospital care (99231-99233), observation or inpatient care services (99234-99236), and hospital discharge services (99238-99239) have been altered to incorporate “inpatient or observation care.”
The office or other outpatient consultation codes (99242-99245) and inpatient consultation codes (99252-99255) under the Office or Other Outpatient Consultation heading are revised to include “office or other outpatient consultation.”
Revisions to other codes conform to AMA’s guideline modifications for E/M leveling based on time or medical decision making (MDM). For instance, the emergency department codes (99281-99285), initial and subsequent nursing facility care codes (99304-99310), and home services codes (99341-99342, 99344-99350) are modified to necessitate a medically appropriate history “and/or” examination and MDM, rather than all three key components.
The nursing facility discharge codes (99315-99316) are altered to specify that the time must be “on the date of the encounter.”
The prolonged service code (99417) is revised to clarify that this code is intended for an outpatient E/M service, as opposed to an “office or other outpatient” E/M service. Worth noting is that the phrase “on the date of the primary service” has been removed.
Additionally, in the E/M section, there are slight adjustments to the descriptors of interprofessional telephone/internet/electronic health record consultation codes (99446-99449, 99451), cognitive assessment and care plan services code (99483), and transitional care management codes (99495-99496).
New CPT 2023 Codes
In the E/M section, there is one final alteration: While code 99417 will now apply to prolonged services within the outpatient setting, a novel code, 99418, will encompass prolonged services for inpatient or observation care (instead of 99356-99357).
Within the Surgery segment of CPT® 2023, new codes have emerged across various subsections. For instance:
Within the Integumentary subsection, three fresh codes are designated for absorbable mesh implantation and suture removal.
The Musculoskeletal System subsection introduces just one new code for total disc arthroplasty. In the Cardiovascular subsection, surgeons have five additional codes for reporting percutaneous pulmonary artery revascularization through stent placement (33900-33904) and two new codes for reporting percutaneous arteriovenous fistula creation in the upper extremity (36836-36837).
Coders might find themselves grappling with a plethora of 17 new codes in the Digestive subsection. These codes document procedures such as esophagogastroduodenoscopy (43290-43291), repair of anterior abdominal hernias (49591-49618), repair of parastomal hernias (49621-49622), and removal of total or near total non-infected mesh or other prosthesis (49623).
The Female Genital System subsection introduces just a single new code: 55867 for Laparoscopy, surgical prostatectomy, simple subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy), including robotic assistance if performed.
Coders will be surprised to find only three new codes in the Auditory System subsection, namely CPT® codes 69729-69728, which describe procedures for implantation, replacement, or removal of an osseointegrated implant.
The Radiology section brings forth a solitary new code, 76883, which pertains to diagnostic ultrasound encompassing nerves and their accompanying structures along the entire anatomical path within one extremity, including comprehensive real-time cine imaging with image documentation.
The Pathology and Laboratory section showcases a substantial expansion with 11 fresh codes spanning various tests.
The Medicine section has also been enhanced with 10 new codes encompassing vaccines, specialized ophthalmological services, cardiac catheterization, quantitative pupillometry, multi-family group behavior management, and remote therapeutic monitoring.
Lastly, a series of new Category III codes have been introduced to document emerging technology, services, and procedures.