The American Medical Association (AMA) released the Evaluation and Management CPT code changes that will go in effect January 1, 2023. The changes primarily affect hospital inpatient, observation care, emergency department, nursing facility, home, rest home, domiciliary and consultation visit types.

1. An overview of the CPT E/M changes

  • The level of E/M services will be based on the following:
    • The level of the MDM as defined for each service OR
    • The total time for the E/M service performed on the date of the encounter
      • Time spent by the practitioner includes face-to-face and non-face-to-face time
  • The History, Review of Systems, Personal/Family/Social information, and Exam elements will no longer be used to select the level of code
  • There are revisions and combining of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 with revised guidelines (one code combines both services)
    • The Hospital Observation Service E/M codes have been deleted
    • The Inpatient Hospital Services E/M code descriptions have been revised to include Observation Care Services
  • Changes to the Prolonged Services Codes
  • Centers for Medicare and Medicaid Services (CMS) proposed Prolonged Services Codes

2. CMS proposed 2023 Medicare Physician Fee Schedule Rule

  • CMS has proposed to adopt most of the CPT revisions (although some discrepancies remain)
  • The proposed rule includes to the work and practice expense (PE) values describing E/M services. External Extended ECG Monitoring, and Cardiac Ablation procedures.
  • However, CMS does not agree with the AMA regarding the use of Prolonged Service Codes
    • i. With the AMM: CPT codes 99358, 99359, 99415, and 99416 have new guidelines and 99417 has been revised.
    • ii. Instead, CMS is proposing its own prolonged service codes:
      • 1. GXXX1 for use with initial IP/Observation visits, Subsequent IP/Observation visits or IP/Observation same-day admit/discharge visit
      • 2. GXXX2 for use with initial and subsequent NF visits
      • 3. GXXX3 for use with home visits for new and established patients
  • CMS has also proposed not to adopt the general CPT rule in which a billable unit of time is considered to have been met once the midpoint is passed for the total time of that CPT code.
    • i. For example – CMS would not consider a service with a time description of 30 minutes to have been met if only 15 minutes of time was actually spent furnishing services.

RT Welter will be offering in depth educational webinars around the 2023 E/M code changes. Ensure your practice is ready for these changes and sign up to attend of these sessions. More information to come soon!