ICD-10, and CPT E/M Code Updates for 2023

2023 e/m changes September 30, 2022

Do you want to learn more about the 2023 CPT® Evaluation and Management (E/M) changes? In the CPT® book, the E/M section has been updated significantly.

This article discusses the ICD-10 and CPT E/M Code Updates for 2023.

CPT® Evaluation and Management (E/M) Code Updates

As of January 1, 2023, changes have been made to the CPT Evaluation and Management (E/M) codes by the American Medical Association (AMA). Moreover, E/M codes for office/outpatient visits were updated in 2021 to reduce documentation and focus on medical decision-making. The full details have not yet become public, but a summary of proposed changes is listed below:

The tables below include the following CPT E/M code changes, effective January 1, 2023:

Deleted CPT E/M Codes

AMA 2023 E/M Updates

Evaluation and Management (E&M) Visits

With the continued update of CPT® coding and related guidelines, the AMA CPT® Editorial Panel approved revised coding and updated guidelines for Other E&M visits that will take effect on January 1, 2023. The AMA proposes adopting most of these changes in coding and documentation for other E&M visits, which include:

  • Hospital Inpatient/Observation
  • Emergency Department
  • Nursing Facility
  • Home or Residence Services
  • Cognitive Impairment Assessment

These changes will be effective January 1, 2023, similar to the final rule they approved in the CY 2021 PFS final rule for office/outpatient E&M visits. Among the changes to this revised coding and documentation framework are changes to CPT code definitions, including: 

  • New description times (where relevant).  
  • Interpretive guidelines for medical decision-making at different levels have been revised.  
  • Code level selection for medical decision-making (except for emergency department visits and cognitive impairment assessments, which are not timed).  
  • The history and exam to determine code level will no longer be used (instead, a medically appropriate history and exam will be required).

The AMA proposes maintaining the current billing policies that apply to E&Ms while considering any revisions necessary for future rulemaking. Furthermore, they suggest introducing Medicare-specific coding for payment of Other E&M prolonged services, as the Centers for Medicare & Medicaid Services (CMS) did for Office/Outpatient prolonged services in CY 2021.

The following list below contains some “key” revisions to the 2023 E&M code descriptors and guidelines.

  • There will be a deletion of observation CPT® codes (99217-99220, 99224-99226) and a merging of them with the existing hospital care codes (99221-99223, 99221-99233, 99238-999239) and updated code descriptions.
  • With the removal of some confusing guidelines, including the definition of “transfer of care,” consultations will get a facelift. In keeping with the deletions at level one due to MDM duplication, the low-level office (99241) and inpatient (99251) consultation codes will be deleted to align with the four levels of MDM.
  • As with the revisions to office visits in 2021, nursing facility and home and residence services will also undergo modifications.

The AMA says E/M code changes will simplify physician notations and reduce burnout. With the new code changes, finding the correct code should be more accessible, streamlining administrative processes. Consequently, direct care workers and facility staff can interact with patients more.

To help with the impending changes, the AMA also offers several resources

Summary of the 2023 ICD-10-CM Code Updates

Furthermore, the Centers for Disease Control and Prevention (CDC) recently released the ICD-10-CM code set for the fiscal year 2023, along with the ICD-10-CM Official Coding and Reporting Guidelines, which introduce new codes and guidelines for reporting dementia, head injuries, and long-term drug treatment. The 2023 ICD-10-CM update will add 1,176 new codes, revise 28, and delete 287. For patient encounters and discharges, physicians must use these codes between October 1, 2022, and September 30, 2023.

Eighty-three new ICD-10 codes were added to Chapter 5 (Mental, Behavioral and Neurodevelopmental disorders [F01-F99]); the table below shows a sample of its code updates.

In total, 69 new codes are available for dementia associated with or without psychological symptoms. Here are a few of the new dementia codes:

Other Examples of ICD-10-CM Code Updates for 2023

Stay On Top of ICD-10 and CPT E/M Code Updates

Whenever codes are revised, and new rules come into effect, it is crucial that providers check with their EHR vendors to ensure that their systems are aligned. Make sure your EHR vendor’s coding applications will adhere to the new evaluation and management code updates for 2023.

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