The 2023 Evaluation and Management (E/M) guidelines will usher in highly anticipated E/M updates on January 1, 2023. These American Medical Association (AMA) changes to the 2021 E/M Office and Outpatient guidelines will impact many E/M services along with some prolonged services.
AMA President Jack Resneck Jr., M.D. stated in a press release, “The process for coding and documenting almost all E/M services is now simpler and more flexible. We want to ensure that physicians and other users get the full benefit of the administrative relief from the E/M code revisions. The AMA is helping physicians and health care organizations prepare now for the E/M coding changes and offers authoritative resources to anticipate the operational, infrastructural, and administrative workflow adjustments that will result from the pending transition.”
E/M Coding Categories Affected
The following areas will adopt the 2023 changes as we level based on medical decision-making (MDM) (or time if applicable):
- Hospital Inpatient and Observation Care Services
- Consultation Services
- Emergency Department Services
- Nursing Facility Services
- Home/Residence Services
Medical Decision-making
Medical decision-making is broken down into three elements which are taken into consideration when choosing the E/M level:
- Number and complexity of problems that are addressed during the encounter
- Amount and/or complexity of data to be reviewed or analyzed
- Risk of complications or morbidity or mortality of patient management
Total Time
As per the 2023 AMA E/M Guidelines, “Certain categories of time-based E/M codes that do not have levels of services based on MDM (e.g., Critical Care Services) in the E/M section use time differently. It is important to review the instructions for each category. Time is not a descriptive component for the emergency department levels of E/M services.” A complete list of activities that can be included in professional time can be found in the 2023 AMA E/M Guidelines.
Additional Changes
The deletion of the following codes will also take effect:
- Hospital observation service codes
- Consultation codes 99241 and 99251
- Nursing facility code 99318
- Domiciliary, rest home, and custodial care service codes
- Home/resident code 99343
- Prolonged service codes 99354-99357
In addition to the code improvements, AMA has made many changes to the definitions within the guidelines, which include but are not limited to:
- Stable chronic illness
- Acute uncomplicated illness or injury
- Stable acute illness
- Chronic illness with severe exacerbation/progression/or side effects or treatment
- Independent Historian
- Independent Interpretation
All updates are in green font on the AMA 2023 CPT E/M Services Guidelines, and a complete list of AMA resources is also available on the Implementing CPT Evaluation and Management revisions webpage.
Keeping You in Compliance
Although the guideline updates help lessen the burden on providers, documentation of medical necessity is critical to stay within compliance. To help keep you on top of the changes and within compliance, AQuity Coding Solutions will host a 1-hour webinar on the E/M Updates on December 13, 2022, from 1 p.m. to 2 p.m. ET. Anyone working in medical coding and auditing, or related medical coding services is encouraged to attend, and attendees receive 1 free AHIMA CEU after completion of a survey.
As with all new coding guidelines, a learning curve and increased physician queries are expected. You can always turn to AQuity for Medical Coding Services and Medical Coding Audits to ensure the highest level of coding accuracy and compliance. As a KLAS-recognized coding leader, coding well over 10 million charts annually, AQuity’s Coding team has the experience and deep domain expertise across all patient types, hospital, and provider settings.
Colleen Kolbeck, CPC-I, CPCO, CDEO, CPMA, CRC, CEDC, COC, CPC
Colleen has over 10 years of experience in the coding and auditing field. She is currently a Profee Audit Lead for AQuity Solutions and an AAPC Licensed Education Provider. She has vast experience with creating and presenting educational materials for coders, auditors, and providers. She currently lives in New Jersey.
