Skip to main content

Evaluation and management 2023 updates

Evaluation and Management 2021 Updates 

The E&M 2021 changes primarily focused on the documentation and coding guidelines for office and outpatient visits (commonly referred to as E&M codes 99202-99215). 

The main goals of these changes were to reduce administrative burden, simplify documentation, and recognize the value of cognitive work performed by healthcare professionals.

Key aspects of the E&M 2021 changes included

The Elimination of history and physical examination requirements as key components for code selection.

The E&M guidelines now allow providers to choose the level of service based on either Medical Decision Making (MDM) or Total time spent on the encounter. 

While the documentation of the history and physical examination is still important for patient care, it is not required to determine the appropriate code level but it should be documented in the medical records.

A Revised guidelines for code selection based on medical decision-making (MDM. The MDM now has a greater role in a code selection. 

The E&M guidelines provide clear definitions and examples of the components of MDM, such as.,

  1. Number and complexity of problems addressed,
  2. Data reviewed and analyzed, and
  3. Risk of complications or morbidity.

Guidelines for Time Based Code Selection

Expansion of time as a determining factor for code selection. The Providers can now select the code level based on total time spent on the patient encounter, including both face-to-face and non-face-to-face time.

This change benefits providers who spend a significant amount of time on activities like care coordination, reviewing records, and discussing cases with other healthcare professionals.

E&M Updates for 2023 

Initially the above said guidelines were introduced to use only for office and outpatient visits and now , effective from Jan 1st 2023, these guidelines will be applicable for across all the level of E&M code selection. 

 There are some new guidelines Introduced for the specific services,

  • Hospital Inpatient and Observation (99221 to 99223, 99231 to 99239)
  • Emergency Department Visits (99281 to 99285)
  • Consultations codes (99242-99245, 99252-99255)
  • Nursing Facility Services codes (99304-99310, 99315, 99316)
  • Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350

Glimpses of 2023 Changes and Updates

  • Deletion of Hospital Observation Services E/M codes 99217-99220
  • Revision of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 and guidelines
  • Deletion of Consultations E/M codes 99241 and 99251
  • Revision of Consultations E/M codes 99242-99245, 99252-99255 and guidelines
  • Revision of Emergency Department Services E/M codes 99281-99285 and guidelines
  • Deletion of Nursing Facility Services E/M code 99318
  • Revision of Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines
  • Deletion of Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334-99337, 99339, 99340
  • Deletion of Home or Residence Services E/M code 99343
  • Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines
  • Deletion of Prolonged Services E/M codes 99354-99357
  • Revision of guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416
  • Revision of Prolonged Services E/M code 99417 and guidelines
  • Establishment of Prolonged Services E/M code 993X0 and guidelines

Summary of Hospital inpatient and observation Changes

The Observation Care Discharge Services CPT 99217 has been deleted. 

  • To report observation care discharge services, see 99238, 99239

Initial Observation Care New or Established Patient 99218, 99219, 99220 have been deleted. 

  • To report initial observation care, new or established patient, see 99221, 99222, 99223 

Subsequent Observation Care 99224, 99225, 99226 have been deleted. 

  • To report subsequent observation care, see 99231, 99232, 99233

Revised CPT Code Description

Admission Service (Initial hospital inpatient or observation)

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.

When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.

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 of medical decision making.

When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.

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 of medical decision making.

When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.

Follow up Service (Subsequent hospital inpatient or observation)

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 of medical decision making.

When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.

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 of medical decision making.

When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.

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 of medical decision making.

When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.

Discharge Service - Hospital inpatient or observation

99238 Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter.

99239 more than 30 minutes on the date of the encounter.

For hospital inpatient or observation care including the admission and discharge of the patient on the same date, see 99234, 99235, 99236

*** For 99211 and 99281, the face-to-face services may be performed by clinical staff

Popular posts from this blog

Telehealth Update Medicare - 2022

The listed CPT codes are covered in telehealth and changes are effective from dated on June 16, 2022 Medicare telehealth services require that the services occur over real-time audio and visual interactive telecommunications. For purposes of diagnosis, evaluation, or treatment of mental health disorders. If the patient doesn’t have the technical capacity or the availability of real-time audio and visual interactive telecommunications, or they don’t consent to the use of real-time video technology, we allow audio-only communication for telehealth mental health services to established patients located in their homes. After the PHE ends, Telehealth Mental Health services may include new or established patients so long as an in-person, face-to-face, non-telehealth service takes place within 6 months of the telehealth mental health services. This means that all telehealth mental health patients should have had a first in-person visit no later than 6 months after the PHE. After the PHE and a

Annual Preventive and Wellness Visit Service

Preventive Service Codes The annual preventive exam is a periodic, comprehensive preventive medicine evaluation (or reevaluation) and management of the patient. The CPT Code selection is based on whether the patient is receiving an initial visit -"New Patient" or a periodic - "Established Patient" preventive service, as well as the patient’s age. Initial Visits - 99381, 99382, 99383, 99384, 99385, 99386, 99387 Subsequent Visits - 99391, 99392, 99393, 99394, 99395, 99396, 99397 The Medicare insurance would be covered by "G" codes instead of the above codes. The details below, Welcome to Medicare - G0402 (Within the one year from the patient enrolled in Medicare) Initial Annual Wellness Visit - G0438 (After the 1st year of enrollment) Subsequent Annual Wellness Visit - G0439 Initial Visits Initial comprehensive preventive medicine evaluation and management of an individual including an" age and gender appropriate history, examination, counseling/anticip

ICD 10 CM Official Updates and Changes - 2023 - New Codes

There are 1790 code changes in 2023 and including new, deleted, revised, and parent codes.   These 2023 ICD-10-CM codes are to be used from the effective date of services from October 1, 2022, through September 30, 2023.  Total changes - 1790 codes New Codes  - 1468 Additions Deleted Codes - 251 Deletions Revised Codes -  35 Revisions   Converted to Parent Code - 36 Codes NEW CODE EFFECTIVE FROM OCTOBER 1ST, 2022 TO SEPTEMBER 30, 2023 Code Description B37.31 Acute candidiasis of vulva and vagina B37.32 Chronic candidiasis of vulva and vagina D59.30 Hemolytic-uremic syndrome, unspecified D59.31 Infection-associated hemolytic-uremic syndrome D59.32 Hereditary hemolytic-uremic syndrome D59.39 Other hemolytic-uremic syndrome D68.00 Von Willebrand disease, unspecified D68.01 Von Willebrand disease, type 1 D68.02 Von Willebrand disease, type 2 D68.020 Von Willebrand disease, type 2A D68.021 Von Willebrand disease, type 2B D68.022 Von Willebrand disease, type 2M D68.