Evaluation and Management 2023 Updates
What You Need to Know
Changes to 2023 Evaluation and Management (E/M) coding will impact CDM files, coding, documentation, charge capture processes, and various information systems.
This article outlines new revisions to E/M codes for 2023 and addresses several questions we believe professionals will encounter when they learn of the changes.
Brief History of E/M Changes
Over the past few years, AMA and CMS have collaborated on E/M code family refinement. The goals of updates include:
- Reducing administrative burden
- Improving payment accuracy
- Updating the code set to reflect current medical practice
Changes in E/M code set date back to the 2020 MPFS Rule and have continued annually. CPT® Symposium attendees heard a preview of these updates in 2018 and 2019 from a special physician committee dedicated to code set redesign. A year later, CPT Symposium attendees received a detailed summary of the updates at 2019’s Symposium. With the exception of the Prolonged Service(s) code for office visits (99417), final updates from AMA’s presenters were consistent with the CMS MPFS Final Rule’s details.
What’s New for 2023?
As a part of the continuing CPT Editorial Panel E/M improvement process, additional new E/M code changes will occur in 2023. These changes include a new code, revised and deleted E/M codes, and significant guideline revisions.
The preview information below is from AMA CPT website publications (preliminary until officially released).
What Codes are Deleted?
The table below illustrates the codes to be deleted by AMA effective 12/31/2022:
| 99217–99220 | Observation care discharge day management & Initial observation care, per day |
|---|---|
| 99234 | Observation or inpatient hospital care, for the evaluation and management of a patient, including admission and discharge on the same date |
| 99241 | Office consultation for a new or established patient, minor |
| 99251 | Inpatient consultation for a new or established patient, minor |
| 99318 | Evaluation and management of a patient involving an annual nursing facility assessment |
| 99324–99238 | Domiciliary or rest home visit for the evaluation and management of a new patient |
| 99334–99337 | Domiciliary or rest home visit for the evaluation and management of an established patient |
| 99339–99340 | Individual physician supervision of a patient in home, domiciliary or rest home (eg, assisted living facility) |
| 99354–99357 | Prolonged Services |
What Codes are Revised?
The table below illustrates the CPT code ranges with planned descriptor changes effective 01/01/2023:
| 99221–99223 | Initial Hospital Inpatient and Observation Care Services |
|---|---|
| 99231–99239 | Subsequent Hospital Inpatient and Observation Care Services, and Hospital discharge day management |
| 99242–99245 | Office consultations |
| 99252–99255 | Inpatient consultations |
| 99281–99285 | Emergency department visit |
| 99304–99310 | Nursing Facility Services |
| 99315–99316 | Nursing Facility Discharge Services |
| 99341 | Home or residence visit for the evaluation and management of a new patient |
| 99342 | Home or residence visit for the evaluation and management of a new patient |
| 99344 | Home or residence visit for the evaluation and management of a new patient |
| 99345 | Home or residence visit for the evaluation and management of a new patient |
| 99347–99350 | Home or residence visit for the evaluation and management of an established patient |
| 99358 | Prolonged evaluation and management service before and/or after direct patient care |
| 99359 | Prolonged evaluation and management service before and/or after direct patient care, each additional 30 minutes |
| 99415+ | Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting |
| 99416+ | Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, each additional 30 minutes |
| 99417 | Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service) |
+Facilities may not report 99415, 99416
What Are the New Codes?
There is one planned new CPT code for the 2023 E/M code series. CMS has not issued 2023 coding guidance, so we will wait to confirm whether the new code from CPT will be accepted, or whether alternative coding will be utilized.
Temporary code (a placeholder code format is currently displayed until formal code release):
| #★✚●993X0 | Prolonged inpatient or observation evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the inpatient and observation Evaluation and Management service. |
|---|
Begin Planning Now
Early review and planning is essential. The official release of the 2023 E/M CPT-4 updates will include code updates, guideline changes, and terminology refinements.
We hope our customers take the necessary time to plan ahead for changes related to Charge Master files, charging mechanisms, documentation templates, order sets, coding, and billing. Additionally, teams should prepare for staff and provider training as done with past years’ E/M updates.
Hospital Revenue Integrity and CDM Teams will want to put processes in place to ensure correct CDDM content, coding, charge capture, and accurate claims data (based on payer requirements).
