With the New Year fast approaching, there is a new set of changes to guidelines, codes, and code descriptors. So, to make sure your knowledge is up to date, you will need to make sure you understand the key changes. So, here are some of the most important CPT coding and guideline changes that will take effect from January 1st, 2023.
A small group of codes are being deleted. Those are:
· Hospital Observation Services E/M codes 99217-99220
· Consultations E/M codes 99241 and 99251
· Nursing Facility Services E/M code 99318
· Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334-99337, 99339, 99340
· Home or Residence Services E/M code 99343
· Prolonged Services E/M codes 99354-99357
There are some new codes being brought in as a part of the 2023 guideline changes. One of these is the ‘creation of a new code (993X0) to be analogous to the office visit prolonged services code (99417)’. The new code relates to prolonged services and has been created in relation to the deletion of Prolonged Services E/M codes 99354 to 99357.
There are five key areas in which codes have been edited that you need to be aware of. If you work in fields that deal with inpatient and observation care services, consultations, emergency department services, nursing facility services, or home and residence services then these new code changes will be relevant to you. Most deleted codes have been removed in order to merge them with pre-existing codes or replace them with more fitting ones. Here are the details of those edits.
Inpatient and observation care services
The deleted codes 99217 to 99220 and 99224 to 99226 have been merged into the existing CPT codes 99221 to 99223, 99221 to 99233, and 99238 to 99239. The code descriptors have been revised to allow for the structure of total time on the date of the encounter or to account for the level of medical decision-making when selecting code levels. Codes that have been kept include observation and inpatient care services such as admission and discharge services using CPT codes 99234 to 99236.
There have been some changes to the code descriptors in relation to consultations. Some codes or guidelines have been removed since the AMA decided they were too confusing. This includes the ‘transfer of care’ definition.
Emergency department services
In the 2023 changes, there has been alteration made to the code descriptors around the code structure approved in the office visit revisions. There have also been modifications made to MDM levels so that they fit in with office visits and maintain unique MDM levels for each visit. It is also now allowed for critical care to be reported as well as ED service for clinical change.
Nursing facility services
There have been changes to nursing facility guidelines including some changes to definitions. The deleted code 99318 which relates to the annual nursing facility assessment, will now be reported through the subsequent nursing facility care services using CPT codes 99307 to 99310 or, alternatively, Medicare G codes.
Home and residence services
The codes deleted for the New Year in relation to rest homes, 99334 to 99340, will be merged with the home visit CPT codes already in place, 99341 to 99350.
Check out related articles surrounding E/M Codes: Translating Quality Into Payment and Why Prior Authorizations are Important.
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AMA CPT® Evaluation and Management (E/M) Code and Guideline Changes