AMA has issued an early release of the 2023 E/M changes. The AMA had previously indicated they would be revising a significant portion of the E/M service codes and instructions. The early release allows organizations the extra time that will be needed in order to educate coders and providers, update templates and make necessary changes to policies and procedures.
As anticipated the new guidelines for hospital based E/M services now closely align with the guidelines for outpatient, office E/M services. The new guidelines should be a welcome change for providers as they reduce their documentation burden. The 2023 guidelines include the following:
- New instructional guidelines for each section of E/M (i.e. emergency department, observation, inpatient, consultations, nursing facility, domiciliary)
- Removal of history and exam as key components for code selection. The performance and documentation of a medically appropriate history and exam is still required.
- Code selection will be based on the amount of documented medical decision making or time with the exception of emergency department encounters which will be reported based on medical decision making only.
- A significant number of service codes have been deleted.
- There are no longer separate codes to describe inpatient and observation services.
- Codes are associated with new minimum times.
- Creation of new prolonged service code 993X0 to describe prolonged services in an inpatient or observation setting.
- Revision of outpatient consultation service codes.
The changes for 2023 are extensive. While many of the concepts and guidelines will now mirror the outpatient, office rules, we anticipate successful implementation of the new guidelines will be time and labor intensive. The HBE team is available to provide you expert assistance with this transition to minimize revenue impact and promote compliance.
| Emergency Department | ||
| Code | Description | Time |
| 99281 | Emergency department visit for the evaluation and management of a patient that might not require the presence of a physician or other qualified health care professional. | Not applicable |
| 99282 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. | Not applicable |
| 99283 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level medical decision making. | Not applicable |
| 99284 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level medical decision making. | Not applicable |
| 99285 | Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level medical decision making. | Not applicable |
| Initial Hospital or Observation Care | ||
| Code | Description | Time |
| 99221 | Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. | 40 minutes, minimum |
| 99222 | Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient which requires a medically appropriate history and/or examination and moderate level medical decision making. | 55 minutes, minimum |
| 99223 | Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient which requires a medically appropriate history and/or examination and high level medical decision making. | 75 minutes, minimum |
| Subsequent Hospital or Observation Care | ||
| Code | Description | Time |
| 99231 | Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. | 25 minutes, minimum |
| 99232 | Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient which requires a medically appropriate history and/or examination and moderate level medical decision making. | 35 minutes, minimum |
| 99233 | Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient which requires a medically appropriate history and/or examination and high level medical decision making. | 50 minutes, minimum |
| Hospital or Observation Discharge Care | ||
| Code | Description | Time |
| 99238 | Hospital inpatient or observation discharge day management. | 30 minutes, or less |
| 99239 | Hospital inpatient or observation discharge day management. | 31 minutes, minimum |
| Hospital or Observation Care Admission and Discharge Same Day | ||
| Code | Description | Time |
| 99234 | Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. | 45 minutes, minimum |
| 99235 | Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level medical decision making. | 70 minutes, minimum |
| 99236 | Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level medical decision making. | 85 minutes, minimum |
| Inpatient or Observation Consultations | ||
| Code | Description | Time |
| 99251 | Deleted | Deleted |
| 99252 | Inpatient or observation consultation, for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. | 35 minutes, minimum |
| 99253 | Inpatient or observation consultation, for a new or established patient, which requires a medically appropriate history and/or examination and low medical decision making. | 45 minutes, minimum |
| 99254 | Inpatient or observation consultation, for a new or established patient, which requires a medically appropriate history and/or examination and moderate level medical decision making. | 60 minutes, minimum |
| 99255 | Inpatient or observation consultation, for a new or established patient, which requires a medically appropriate history and/or examination and high level medical decision making. | 80 minutes, minimum |
| Initial Nursing Facility Care | ||
| Code | Description | Time |
| 99304 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. | 25 minutes, minimum |
| 99305 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate medical decision making. | 35 minutes, minimum |
| 99306 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level medical decision making. | 45 minutes, minimum |
| Subsequent Nursing Facility Care | ||
| Code | Description | Time |
| 99307 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. | 10 minutes, minimum |
| 99308 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level medical decision making. | 15 minutes, minimum |
| 99309 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate medical decision making. | 30 minutes, minimum |
| 99310 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level medical decision making. | 45 minutes, minimum |
| Nursing Facility Discharge Services | ||
| Code | Description | Time |
| 99315 | Nursing facility discharge management; 30 minutes or less total time on the date of the encounter. | 30 minutes, or less |
| 99316 | Nursing facility discharge management; more than 30 minutes total time on the date of the encounter. | 31 minutes, minimum |
The new guidelines are located here: https://www.ama-assn.org/practice-management/cpt/cpt-evaluation-and-management
HBE’s team of experts is available to assist you with risk assessments, routine auditing and monitoring, policy and procedure development as well as