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

Labels:

Popular posts from this blog

Usage of CPT Index - Instructions

The alphabetic index is not a substitute for the main text of the CPT codebook. Even if only one code is present, the coder must refer to the main term to ensure that the code is selected accurately and correctly to identify the services rendered. Main Terms The index is organized by main terms. Each main term can stand alone or can be followed by up to three modifying terms. There are four primary classes of main entries, Procedures or Services - E.g, Scopic, Anastomosis, Splint, Opening Organ or Other Anatomical Site - E.g, Knee, Arm, Ear, Tibia, Colon Conditions - E.g, Abscess, Entropion, Tetralogy of Fallot. Synonyms, Eponyms, and Abbreviations. - ECG, EEG, PET, Brock Operations, Clagett Procdures Modifying Terms The main term may be followed by up to three indented terms that modify the terms they follow. EG. The main term "Endoscopy" is subdivided by the anatomical sites in which the procedure is used. And within these anatomical sites, the specific purpose of the pr
Read more

Additional Information About Modifiers

Sequencing of modifiers  How can that be if the modifiers used were accurate?  There is an order to reporting modifiers and there are three categories that modifier usage fall under:  1. Pricing  Pricing modifiers are always sequenced “before” payment modifiers and/or location modifiers.   The only exception to this rule is when a global surgery package is involved.  For example, you would code modifier 58 first and modifier 82 second in a global surgery.  A few examples of pricing modifiers are: 22, 26, 50, 52, 53, 62, 80, and P1-P6.   2. Payment   Payment modifiers alert the insurance carrier that there is a special situation within the claim  Some examples of payment modifiers would be: 24, 25, 51, 57, 58, 59, 76, and 78.  3. Location  Examples of location modifiers are: E1-E4, FA, F1-F9, LC, LD, LT, RT, RC, TA, and T1-T9.  The general order of sequencing modifiers is ( 1) pricing (2) payment (3) location. Location modifiers, in all coding situations, are coded “last”.  If you code
Read more

Evaluation and Management (E/M) Services - Domiciliary or Rest Home Environment

Domiciliary, Rest Home, or Custodial Care Services CPT codes 99324 - 99337 Domiciliary, Rest Home (e.g. Boarding Home), or Custodial Care Services, are used to report E/M services to individuals residing in a facility which provides room, board, and other personal assistance services, generally on a long-term basis.  These codes are also used to report E/M services in an assisted living facility. The facility’s services do not include a medical component. A home or domiciliary visit includes a patient History, Physical Examination and Medical Decision Making in various levels depending upon a patient’s needs and diagnosis.  The visits may also be performed as counseling and/or coordination of car, when medically necessary outside the office environment and are an integral part of a continuous of the patient's care.  The patients seen may have chronic conditions, may be disabled, either physically or mentally, making access to a traditional office visit very difficult, or may have l
Read more