The American Academy of Family Physicians (AAFP) has initiated an educational process for members concerning the 2023 coding changes to E/M services in hospitals, nursing homes, and other settings, which took effect last January 1, 2023. Moreover, this topic will likely be covered in future updates and resources, so keep an eye out for them.
Refer to this PDF file for an overview of these coding changes.
Medicare Changes for 2023
The most significant updates to Medicare for 2023 will be codes, payments, and policies. You can check them out below:
The 2023 Inpatient Evaluation and Management (E/M) Changes
In 2023, the American Medical Association (AMA) revised its inpatient e/m codes to align with its office and outpatient coding guidelines. Meanwhile, the documents of patient history and physician exam will no longer affect the level of service. Choose the level of service based solely on the medical decision-making process or the physician’s time spent on the encounter. These changes apply to hospitals, nursing homes, and patients’ residences.
The following codes have been revised in hospital settings:
Initial hospital inpatient or observation care (CPT codes 99221 – 99223) (note the codes for initial observation care [note that CPT codes 99224 -99226] have been deleted);
Subsequent hospital inpatient or observation care (CPT codes 99221 – 99233) (note CPT codes 99218 – 99220 have been deleted);
hospital inpatient or observation care services (including admission and discharge, CPT codes 99234 – 99236);
Hospital inpatient discharge services (CPT codes 99238 and 99239) (note CPT 99217 has been deleted); and
Emergency department services (CPT codes 99281 – 99285).
Regarding CPT coding, “nursing facility” includes skilled nursing facilities, treatment centers for mental health, and facilities for immediate care. Updates to these settings include:
initial nursing facility care (CPT 99304 – 99306);
Subsequent nursing facility care (CPT 99307 – 99310) (note that code 99218 has been deleted this year);
nursing facility discharge services (CPT 99315 and 99316);
Domiciliary, rest home or custodial care services, new patient (CPT 99341 – 99345) (note that codes 99324 – 99324 have been deleted); and
Domiciliary, rest home, or custodial care services, established patient (CPT 99347 – 99350) (note that codes 99334 – 99347 have been deleted).
Overall, the 2021 Evaluation and Management guidelines now apply to outpatients (CPT 99241 – 99245) and inpatients (CPT 99251 – 99255) consultations. It is noteworthy that Medicare has not provided reimbursement for consultations in recent years; however, some other payers do.
Note: All these codes are copyright by the American Medical Association.
The Payment Updates for Medicare in 2023
The Centers for Medicare & Medicaid Services (CMS) has declared that beginning January 1, separate coding and payment for chronic pain management services will be implemented, with nonphysician practitioners, such as physician assistants and nurse practitioners, eligible to provide this care. Accordingly, new HCPCS codes have been created to report chronic pain management and treatment, which includes holistic chronic pain care services. Among them are also assessing and monitoring, administering a tool or scale for measuring pain that is validated, developing, implementing, revising, and/or maintaining a treatment plan that focuses on the strengths, goals, clinical needs, and desired outcomes of the person.
Moreover, the CMS has dramatically expanded the scope of services available via telehealth during the COVID-19 public health emergency, with several of these services remaining available either temporarily or permanently through 2023. Such services may include:
Emotional/behavioral assessment
Psychological, and
Neuropsychological testing
Evaluation services
Audio-only services
The use of telehealth services for chronic care management and prolonged care will remain permanent for some time to come.
The Changes in Medicare Alternative Payment Program 2023
As a family physician, it is essential to be aware of the upcoming changes to Medicare’s Quality Payment Program (QPP) and Medicare Shared Savings Program (MSSP) for the 2023 period. In QPP’s Merit-based Incentive Payment System (MIPS), the MIPS Value Pathways will be a new reporting option. Twelve MVPs are available for clinicians to report, two of which will focus on primary care: promoting wellness and optimizing chronic disease management. The 2023 MIPS performance threshold will remain at 75 points, with eligible clinicians receiving payment increases or reductions of up to 9% on their Medicare Part B claims. Thus, this year won’t have an exceptional performance threshold.
These are the changes to the Medicare Shared Savings Program (MSSP):
New program entrants without performance-based risk experience may obtain Advance Investment Payments.
There will be a one-time payment of $250,000 followed by eight quarterly payments. In this case, the number of beneficiaries assigned to the Accountable Care Organization (ACO) serves as the basis.
During the term of the current agreement, CMS will recoup the payments from shared savings earned by the ACO.
The CMS will allow ACOs with no experience in performance-based risk to remain in the Basic track level A throughout the five-year agreement period. All participants will have the option of taking the Enhanced track.
The CMS is working to modernize the Medicare payment system by connecting payment updates to physician activities that promote improved quality of care, decrease healthcare costs, and participate in alternative payment models. With that, you can refer to AMA’s resources and tools to help physicians better respond to the changes in the physician fee schedule and Quality Payment Program (QPP).
The 2023 Medicare Physician Fee Schedule Final Rule
The Centers for Medicare & Medicaid Services (CMS) recently issued the finalized 2023 Medicare Physician Fee Schedule (MPFS) on November 1. They outline these various significant changes
Since the supplemental 3% increase in fee schedule payments had expired, the conversion factor decreased from $34.6062 to $33.0607.
There were changes in telehealth flexibilities similar to those in the Consolidated Appropriations Act of 2022. As part of this, specific telehealth flexibilities will continue for 151 days after the COVID-19 Public Health Emergency ends, which is currently scheduled to end on January 11, 2023. However, there may be further extensions.
The CMS made several updates to coding, work RVUs, practice expense RVUs, and the Quality Payment Program and Medicare Shared Savings Program.
Overall, the Medicare updates released recently will have a significant effect on patients and healthcare providers. Some critical updates providers should be aware of are the reduction in the fee schedule conversion factor and the changes to telehealth flexibilities.
Additionally, the modifications to the Quality Payment Program and the Medicare Shared Savings Program require providers to stay knowledgeable and adapt to changing healthcare conditions. Thus, staying on top of Medicare updates and regulations is key to ensuring financial sustainability while providing quality care to patients.
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You may have heard about ICD-10 2023 coding guidelines and why they are essential. According to the Centers for Medicare & Medicaid Services (CMS) coding guidelines, by 2023, there will be over 68,000 ICD-10 codes. As a result, coding becomes more complex, and healthcare practices must stay up-to-date on the 2023 coding changes.
Why is ICD important in healthcare?
There are several reasons why ICD-10-CM guidelines 2023 are important for healthcare practices.
The 2023 coding guidelines help providers code diagnoses and procedures accurately and consistently. Therefore, data reporting to health insurers and other organizations are more accurate.
The 2023 coding guidelines ensure consistency in sharing healthcare data across healthcare organizations.
The 2023 coding changes allow healthcare providers to maximize reimbursement and reduce overpayments and underpayments. This coding guideline is especially critical considering that medical billing errors cost up to $2 billion.
ICD-10-CM Updated Guidelines for April 2023 – New Codes and Highlights
ICD-10-CM 2023 Codes for Dementia
The latest coding guidelines 2023 for dementia reporting emphasize the importance of thorough and accurate documentation from the provider. When a patient is admitted to an acute care hospital or another inpatient facility setting with dementia at one severity level, but the severity level increases, assign one code for the highest severity level reported during the stay.
Pain disorders exclusively related to psychological factors (F45.41)
Meanwhile, the history of falling ICD-10 code is Z91. 81. It falls under the WHO category of Factors influencing health status and contact with healthcare services.
ICD-10-CM 2023 Codes for Maternal Care
Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A) include 200 new codes this year. The goal is to capture a large number of fetal disorders that need to be adequately captured in previous editions of the ICD-10-CM.
Below you will find some updates under the category of pregnancy and maternal care:
O35.00 – Maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified
O35.01 – Maternal care for (suspected) central nervous system malformation or damage in fetus, agenesis of the corpus callosum
O35.02 – Maternal care for (suspected) central nervous system malformation or damage in fetus, anencephaly
O35.03 – Maternal care for (suspected) central nervous system malformation or damage in fetus, choroid plexus cysts
O35.04 – Maternal care for (suspected) central nervous system malformation or damage in fetus, encephalocele
O35.05 – Maternal care for (suspected) central nervous system malformation or damage in fetus, holoprosencephaly
O35.06 – Maternal care for (suspected) central nervous system malformation or damage in fetus, hydrocephaly
O35.07 – Maternal care for (suspected) central nervous system malformation or damage in fetus, microcephaly
O35.08 – Maternal care for (suspected) central nervous system malformation or damage in fetus, spina bifida
O35.09 – Maternal care for (suspected) other central nervous system malformation or damage in fetus
O35.10 – Maternal care for (suspected) chromosomal abnormality in fetus, unspecified
O35.11 – Maternal care for (suspected) chromosomal abnormality in fetus, Trisomy 13
O35.12 – Maternal care for (suspected) chromosomal abnormality in fetus, Trisomy 18
O35.13 – Maternal care for (suspected) chromosomal abnormality in fetus, Trisomy 21
O35.14 – Maternal care for (suspected) chromosomal abnormality in fetus, Turner Syndrome
O35.15 – Maternal care for (suspected) chromosomal abnormality in fetus, sex chromosome abnormality
O35.19 – Maternal care for (suspected) chromosomal abnormality in fetus, other chromosomal abnormality
O35.A – Maternal care for other (suspected) fetal abnormality and damage, fetal facial anomalies
O35.B – “Maternal care for other (suspected) fetal abnormality and damage, fetal cardiac anomalies “
O35.C – Maternal care for other (suspected) fetal abnormality and damage, fetal pulmonary
O35.D – Maternal care for other (suspected) fetal abnormality and damage, fetal pulmonary anomalies, other fetus
O35.E – Maternal care for other (suspected) fetal abnormality and damage, fetal gastrointestinal anomalies, other fetus
O35.F – Maternal care for other (suspected) fetal abnormality and damage, fetal musculoskeletal anomalies of trunk
O35.G – Maternal care for other (suspected) fetal abnormality and damage, fetal upper extremities anomalies
O35.H – Maternal care for other (suspected) fetal abnormality and damage, fetal lower extremities anomalies
ICD-10-CM 2023 Codes for Endometriosis
Chapters 14 and 15 also contain several code updates. Moreover, the Diseases of Genitourinary System (Chapter 14) introduced 168 new codes to provide more specificity to the limiting legacy codes by adding anatomical positions, laterality, and depth.
Below are some of the chapter 14 new codes:
N80.00 – Endometriosis of the uterus, undefined
N80.02 – Uterine deep endometriosis
N80.10 – Ovarian endometriosis of unknown depth
N80.129 – Deep ovarian endometriosis, unidentified ovary
New Codes for Methamphetamine Overdose
Methamphetamine produces euphoria and stimulating effects and is highly addictive. An overdose of Meth can result in dangerous symptoms such as:
Agitation
Stomach pains
Seizures
Chest pain
Stroke
Kidney damage
Paranoia
Heart failure
Difficulty breathing
Methamphetamine poisoning, as well as meth-related adverse effects, will have a new ICD-10-CM 2023 code. The new code added to Chapter 19 is:
Code T43.65 Poisoning by the adverse effect of and underdosing of methamphetamines
Important Note: Chapter 19 Injury, Poisoning, Consequences of External Cause new guideline states that coders can assign an underdosing code even if the patient’s condition doesn’t change. According to the new guidelines, “Documentation that the patient is taking less of a medication than is prescribed or discontinued the prescribed medication is sufficient for code assignment.”
Other Changes in ICD-10-CM 2023 Coding Guidelines
There are fifteen new codes in category Z79 (long-term drug therapy). An updated guideline is available in Chapter 4 (Endocrine, Nutritional, and Metabolic Diseases):
If a patient is both taking insulin and an injectable non-insulin antidiabetic drug, enter the codes Z79.4 (long-term [current] insulin use) and Z79.85 (long-term [current] injectable non-insulin antidiabetic drugs).
If a patient is taking both oral hypoglycemics and an injectable non-insulin antidiabetic, use codes Z79.84 (long-term [current] use of oral hypoglycemic drugs) and Z79.85.
Tap Into Our Expertise
Aside from these changes, several new 2023 ICD-10-CM codes affect every specialty. Physicians looking to bill Medicare, Medicaid, and commercial payers will need to rely on the assistance of medical billing and coding service providers.
Worry no more! At 5 Star Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.
