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2023 CPT E/M Descriptors and Guidelines Updates March 29, 2023

2023 e/m changes

In cooperation with the American Medical Association (AMA), a set of new Current Procedural Terminology (CPT) coding guidelines for 2023 was published. These changes simplified medical coding for procedures related to evaluation and management (E/M), which took effect last January 1, 2023.

CPT® Evaluation and Management (E/M)Code and Guideline Changes

For a complete overview of the American Medical Association (AMA) changes, please click (PDF) file.

Why are CPT codes so important?

Providers and payers interact through CPT® — the language of medical billing and reimbursement.

The Current Procedural Terminology is an essential and expansive code set maintained by the American Medical Association (AMA). It is one of the essential code sets for medical coders to understand. Medical providers use the CPT coding guidelines to describe tests, surgeries, evaluations, and other procedures they perform on patients. There are thousands upon thousands of medical procedure codes in this code set, which are an integral part of the billing process. Healthcare providers use CPT codes to indicate what procedures they wish to be reimbursed for. 

Therefore, CPT codes are used in conjunction with ICD codes to present a complete picture of the medical process to payers. “The patient had these symptoms (represented by the ICD code), and we carried out these procedures (represented by the CPT code).

Learn more about the meaning of CPT codes.

2023 CPT E/M Descriptors and Guidelines Updates

The coding guidelines CPT 2023 changes are designed to align with E/M coding standards across care settings and services. Below are the 2023 CPT updates and some guidelines based on the care setting or service:

Inpatient CPT Codes and Observation Care Services

  • Deletion of observation CPT codes (99217 through 99220 and 99224 through 99226) and merged them into the existing hospital care CPT codes (99221 through 99223, 99221 through 99233, and 99238 through 99239)
  • Revision of the code descriptors to account for the structure of total time on the date of the encounter or level of medical decision-making when selecting code level
  • Retention of revised observation or inpatient care services, including admission and discharge services (CPT codes 99234 through 99236)

*In the guidelines for this section, CPT® emphasizes that when advanced nurse practitioners and physician assistants work with physicians, they are considered to be working in the same specialty as the physician. AMA guidelines have also been revised regarding the admission of patients from other hospitals. Although Medicare or other players may not adhere to this guidance, this is what the AMA suggests.

Suppose a patient is admitted to the hospital as an inpatient or for observation services during an encounter at another care site (e.g. emergency department, office, or nursing facility). In that case, the services provided at the initial location may be reported separately. Modifier 25 can be applied to other Evaluation and Management services to indicate that a discrete, noteworthy service was provided by the same physician or other qualified healthcare professionals on the same date.

The American Medical Association (AMA) advises that a patient’s status change from inpatient or observation to inpatient or observation does not constitute a new stay and should not be billed for an additional initial service.

Consultations

  • Retention of the consultation codes, with some editorial revision to the code descriptors
  • Deletion of certain guidelines deemed confusing by the AMA, including the definition of “transfer of care.”
  • Deletion of lowest-level office (99241) and inpatient (99251) consultation codes to align with four levels of MDM

*Obtaining a consultation requires a request from another healthcare professional or appropriate source and a written report. Both of these should be documented in the consultation note. CPT 2023 removed the concept of transfer of care as a lens through which to evaluate consultations.

These codes are not recognized by Medicare and will not change its policies.

Emergency Department Services

  • Retention of the existing principle that time cannot be used as a key criterion for code level selection
  • Revisions to the code descriptors to reflect the code structure approved in the office visit revisions
  • Modified MDM levels to align with office visits and maintain unique MDM levels for each visit
  • Retention of existing CPT code numbers
  • Updates to current practice that was not explicit in the CPT code set, which may be used by physicians and other qualified healthcare professionals other than ED staff
  • Allowance of critical care to be reported in addition to ED service for clinical change

*It is unnecessary to present a doctor or qualified healthcare provider when performing Code 99281.

Nursing Facility Services

  • Revision to nursing facility guidelines with a new “problem addressed” definition of “multiple morbidities requiring intensive management” to be considered at the high level for initial nursing facility care.
  • Deletion of code 99318 (annual nursing facility assessment), which will be reported through the subsequent nursing facility care services (CPT codes 99307 through 99310) or Medicare G codes
  • Updated standard so not all “initial care” codes are the mandated comprehensive “admission assessment” and may be used by consultants.
  • Allowance of the use of subsequent visits when the principal physician’s team member performs care before the required comprehensive assessment

*The American Medical Association (AMA) agrees with Medicare rules that a physician must provide the initial comprehensive visit in a skilled nursing facility. Further, the AMA states that initial nursing facility services can be conducted by a physician or other qualified healthcare professional, regardless of the length of stay, as long as it is done once per admission. For nursing facilities not classified as ‘skilled’ (distinguished by state law or regulation), a healthcare professional may report the initial comprehensive nursing facility visit if the state laws or regulations permit it.

Home and Residence Services

  • Deletion of the domiciliary or rest home CPT codes (99334 through 99340), which have now been merged with the existing home visit CPT codes (99341 through 99350)
  • Elimination of the duplicate MDM Level New Patient code (99343)

*The AMA recommends not including travel time in selecting a code based on time.

Prolonged Services

  • Deletion of direct patient contact prolonged service codes (99354 through 99357), which will be reported through either the code created in 2021, office prolonged service code (99417), or the new inpatient or observation or nursing facility service code (993X0)
  • Creation of a new code (993X0) to be analogous to the office visit prolonged services code (99417)
  • Retention of 99358 and 99359 for use on dates other than the date of any reported ‘total time on the date of the encounter” service

*The CPT® is making editorial modifications for prolonged clinical staff codes to 99415 and 99416. It is important to note Medicare does not pay for these codes. Beginning in 2023, the existing prolonged care code 99417, which currently only applies to 99205 and 99215, will now be reported with outpatient consult codes 99245, home visit codes 99345 and 99350, and cognitive assessment code 99483.

Note: The AMA owns the copyright on all the CPT 2023 e/m coding guidelines presented here.

Impact of AMA 2023 E/M Changes 

The AMA has released the 2023 Current Procedural Terminology (CPT®) code set, the nation’s foremost data-sharing terminology for medical procedures and services. Furthermore, the 2023 CPT code set includes modifications to the codes and guidelines for the majority of evaluation and management (E/M) services, offering relief from the burden of complexity.

Overall, the revisions to E/M codes for office visit services in 2021 are intended to simplify the coding and documentation process for other E/M services, allowing physicians and care teams to focus on providing high-quality care to patients without being burdened by time-consuming administrative tasks. 

Tap Into Our Expertise

The AMA released these 2023 CPT E/M code updates effective January 1, 2023. Would you like more information right now? We will continue to update our website content here in 5 Star Billing to inform you of coding changes as they occur. 

Are you having trouble with medical billing and coding? At 5 Star Billing Services Inc, our medical billing and coding services are of the highest quality. Save your money by outsourcing to a professional billing service.

Schedule a call with our experts today!


ICD-10-CM Updated Guidelines for April 2023 March 29, 2023

ICD 10 guidelines 2023

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.

Overall, the ICD-10-CM 2023 coding guidelines are important for healthcare practices because they aid in data reporting accuracy, facilitate patient data sharing, and reduce errors while optimizing reimbursement.

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.

The table below has the newly updated codes that help identify dementia with behavioral disturbances associated with Mental, Behavioral, and Neurodevelopmental Disorders (Chapter-5)

ICD-10 CodeDescriptionLevel
F01.A1Vascular dementiamild
F01.B1Vascular dementiamoderate
F01.C1Vascular dementiasevere
F02.A1Dementia in other diseases classified elsewheremild
F02.B1 Dementia in other diseases classified elsewheremoderate
F02.C1Dementia in other diseases classified elsewheresevere
F03.A1Unspecified dementiamild
F03.B1Unspecified dementiamoderate
F03.C1 Unspecified dementiasevere

ICD-10-CM 2023 Codes for Injuries to the Head 

A total of 86 new codes related to head injuries are available, including new codes for concussions. Here are three examples of codes for concussions:

  • S06.0XAA – Concussion with loss of consciousness status unknown, initial encounter
  • S06.0XAD – Concussion with loss of consciousness status unknown, subsequent encounter
  • S06.0XAS – Concussion with loss of consciousness status unknown, sequela

If the patient lost consciousness, the documentation should specify the concussion code.

ICD-10- CM 2023 Codes for Pain

The 2023 edition of ICD-10-CM R52 became effective on October 1, 2022. The list below shows the codes:

  • Acute and chronic pain, not elsewhere classified (G89.-)
  • Localized pain, unspecified type – code to pain by site, such as:
  • Abdomen pain (R10.-)
  • Back pain (M54.9)
  • Breast pain (N64.4)
  • Chest pain (R07.1-R07.9)
  • Ear pain (H92.0-)
  • Eye pain (H57.1)
  • Headache (R51.9)
  • Joint pain (M25.5-)
  • Limb pain (M79.6-)
  • Lumbar region pain (M54.5-)
  • Pelvic and perineal pain (R10.2)
  • Shoulder pain (M25.51-)
  • Spine pain (M54.-)
  • Throat pain (R07.0)
  • Tongue pain (K14.6)
  • Tooth pain (K08.8)
  • Renal colic (N23)
  • 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.

Schedule a call with our experts today!


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