Facility-based Coding Changes for 2023

ama coding guidelines November 9, 2022

Using facility-based coding guidelines is essential to consistently provide codes for hospital visits and encounters. Furthermore, the facility-specific guideline also captures all reimbursements owing to the organization.   

This article covers the major changes in Evaluation and Management (E/M) coding for facility-based services for 2023 based on the American Medical Association (AMA) announcement.

Facility-Based E/M Changes Announced by AMA

The AMA CPT Editorial Panel recently added some changes to its Guidelines for E/M Services. Moreover, the update consists of code revisions, additions, and deletions that will take effect on January 1, 2023.

The change affects the following services:

  • Hospital Inpatient and Observation Care Services 
  • Consultation Services
  • Emergency Department Services 
  • Nursing Facility Services
  • Home or Residence Services 

The AMA coding guidelines provide physicians and medical practices a head start in preparing for the 2023 E/M coding changes. These guidelines also provide authoritative resources to anticipate the operational, infrastructure, and administrative adjustments that will result from the coming transition.

By doing so, physicians and other users will benefit from the administrative relief from the E/M code changes.

To align with new E/M coding standards, the AMA revised the CPT coding guidelines across all care settings and services. 

Hospital Inpatient and Observation Care Services

Consultation Services

Emergency Department Services

Nursing Facility Services

Home or Residence Services

Prolonged Services

There are two ways to choose the level of E/M services for the above categories of codes: based on medical decision-making or by time. Time does not play a role in selecting ED visits. 

The basis for code selection is the three elements of medical decision-making (MDM):

  • The number and complexity of problems discussed during the encounter.
  • The analyzing and reviewing of a large amount or complexity of data.
  • The patient’s risk of complications, morbidity, or mortality. 

Current Procedural Terminology (CPT) Code 99223 

The Comprehensive Error Rate Testing (CERT) reviews have revealed significant improper payments resulting from incorrect coding or inadequate documentation of CPT code 99223. It also has the highest level of initial inpatient hospital care.

The evaluation and management of a patient’s first initial hospital care require three key components:

  • A comprehensive history
  • An in-depth examination
  • High-level or complex medical decision-making

Are you looking for more details? 

These code sets will be in effect on January 1, 2023. Print out the AMA guidance and keep it next to your CPT® book for 2022. You can also see what the changes are for those sections that are included.

With the aid of the downloadable CPT Data File 2023, healthcare providers can import the updated codes into their existing IT systems.

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