E/M Proposed Changes for 2023
By now we are all aware of the E&M changes that happened in 2021. Hold on to your hats people, the AMA is proposing another overhaul for January 1st, 2023. The changes range from the inpatient/observation codes to Emergency room codes. Here's a breakdown of the proposed changes.
Inpatient/Observation – Do your providers drive you crazy by entering incorrect E&M charges on their hospital patients? Well say farewell to observation codes 99217-99236. Since providers are often unsure of a patient’s inpatient vs observation status, for 2023 the AMA is simplifying things by adding language to the initial and subsequent inpatient codes 99221-99223 and 99231-99233 that will also cover observation patient visits. So regardless of the patient status, the code range remains the same. Brilliant and about time, do you agree?
Consultation for Inpatient/Outpatient - Codes 99251 and 99241 will be deleted in keeping with the seldom-reported Level 1 services. We already saw this change for 2021 with the office and other outpatient visits, and the deletion of the Level 1 new patient office visit, 99201, so this change was expected. And as we already know, most payers don’t cover the consultation codes anyway.
Prolonged Services - There will be two new codes added to prolonged service. The new codes are 908X0 and 903X0. Codes 99345 through 99357 will be deleted and there will be a revision to codes 99417 through 99483. Effective in 2021 code 99345 through 99357 cannot be used in the office setting. Section headings and guidelines are also scheduled for revision.
Emergency Department – Language revisions to the code descriptors for codes 99281 through 99285 have been proposed, but to date the AMA has not released further details about these changes.
Home Health/Residence – A total of 12 deletions have been proposed for 2023. This section has many repetitive or similar codes in the portions that include home health, domiciliary care, rest home, and assisted living care. The proposal will streamline these services into a single tabbed section for home health services.
Below is a complete chart showing the codes that are proposed to be either deleted or revised.
For more information, here are a few resources for you:
AMA Plans Another E/M Overhaul in 2023 - Healthcare Consulting from HBE Advisors
February 2021: CPT® Editorial Summary of Panel Actions (ama-assn.org)
E/M’s Deleted and Revised
Accepted deletion of codes 99217, 99218, 99219, 99220, 99224, 99225, 99226; revision of codes 99221, 99222 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239 to include observation care services; and revision of the Hospital Inpatient Services subsection including heading and guidelines
Accepted deletion of codes 99241, 99251; revision of codes 99242, 99243, 99244, 99245, 99252, 99253, 99254, 99255; and revision of the Consultations section including headlines and guidelines
Accepted revision of codes 99281, 99282, 99283, 99284, 99285; and revision of the Emergency Department subsection guideline
Accepted deletion of code 99318; revision of codes 99304, 99305, 99306, 99307, 99308, 99309, 99310; and revision of the Nursing Facility Services subsection guidelines.
Accept deletion of codes 99324, 99325, 99326, 99327,99328, 99334, 99335, 99336, 99337, 99339, 99340, 99343; revision of codes 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350; deletion of the Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services subsection including guidelines, revision of the Domiciliary, Rest Home (eg, Assisted Living Facility), or Home Care Plan Oversight Services subsection including guidelines and; revision of the Home Services section including heading, guidelines
Accepted addition of codes 908X0, 993X0; deletion of codes 99345, 99355, 99356, 99357; revision of codes 99417, 99483; revision of the Prolonged Service With Direct Patient Contact (Except with Office or Other Outpatient Services) subsection guidelines, Prolonged Service Without Direct Patient Contact heading and guidelines, Prolonged Clinical Staff Services With Physician or Other Qualified Health Care Professional Supervision guidelines, and the Prolonged Service With or Without Direct Patient Contact on the Date of an Office or Other Outpatient Service heading and guidelines
*Evaluation and Management Guidelines-Accepted revision of the Evaluation and Management (E/M) guidelines to reflect changes in table above as appropriate; deletion of the subsection regarding Concurrent Care and Transfer Care; and revision of the Levels of Medical Decision (MDM) table.