Facility-based Coding Changes for 2023 November 9, 2022

ama coding guidelines

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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ICD-10, and CPT E/M Code Updates for 2023 September 30, 2022

2023 e/m changes

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.

Tap Into Our Expertise

At 5 Star Billing 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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