AMA Plans Another E/M Overhaul in 2023

The AMA released their CPT Editorial Summary on March 5th.  It contains a number of proposed E/M changes to several categories/service types that will have a major impact on many different provider types.  The AMA summary also indicates planned revisions to the Levels of Medical Decision (MDM) table but provides no detail at this time.  The new coding changes are scheduled to be implemented January 1, 2023.   

Significant E/M code changes for the following service types include:

  • Inpatient/Observation – Deletion of observation codes 99217-99226 with added language to the initial and subsequent inpatient codes 99221-99223 and 99231-99233.  This would be more beneficial to the physicians with regards to reimbursement as the current observation codes are poorly reimbursed.
  • Consultations for Inpatient/Outpatient – Deletion of 99251 and 99241 which similarly reflect the deletion of level one services that went into effect this year for 99201.
  • Prolonged Services – 2 new codes 908X0 and 903X0, deletion of 99345 -99357 and revision of codes 99417 and 99483.  As of 2021, codes 99345-99357 cannot be used with office visits. The proposal also indicates revisions to the service heading and guidelines. 
  • Emergency Department – Revision of codes 99281-99285 and guidelines but no specifics at this time.
  • Home Health/Residence – Deletion of 12 E/M codes and revision of 8 E/M codes with guideline revisions in both areas.  The proposal appears to consolidate these services as many are repetitive.

In total, the number of proposed E/M code changes include:

Service setting/typeNew codesDeleted codesRevised codes
Hospital inpatient, including observation0711
Emergency department005
Nursing facility017
Domiciliary, rest home (eg, boarding home), or custodial care090
Domiciliary, rest home (eg, assisted living facility), or home care plan oversight020

While this summarizes the proposed E/M coding changes, there are notable code changes in other areas that should be reviewed.

The AMA summary is located at:

HBE’s team of coding and compliance experts is available to assist you external reviews of your documentation, coding and reimbursement as well as providing customized education and training for your staff.  We are also available to provide assistance with conducting risk assessments, internal investigations and policy and procedure development.  

DISCLAIMER:  This newsletter contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations are general and specific questions should be directed to professional counsel

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