The American Medical Association (AMA) announced revisions/changes that will affect Evaluation and Management (E/M) guidelines for hospital inpatient, observation, consultations, emergency department visits, nursing facility services, and prolonged care effective January 1, 2023. Finally, all evaluation and management services guidelines will align and will have the same set of requirements to level a service. We will no longer need to manage two sets of documentation guidelines.
Summary of the E/M changes for 2023
Consultations – Deleting inpatient consult code 99251 and outpatient consult code 99241—which aligns with removing 99201 new patient level one visit in 2021
Inpatient/Observation - The inpatient E/M coding guidelines include deleting observation codes 99217-99220 and 99224-99226 observation codes and adding new language to inpatient codes 99221-99223 and 99231-99239.
Prolonged Services – New prolonged services E/M code 993X0, deleting codes 99354 -99357 and revising guidelines for codes 99358, 99359, 99415, 99416, and 99417
Emergency Department – Revising codes 99281-99285 and coding guidelines
Nursing Facility Services and Home or Residence Services – Deleting nursing facility service code 99318 and revising Nursing Facility Services codes 99304-99310, 99315, 99316, and deleting Home or Residence Services codes 99343 and revising codes for Home or Residence Services 99341, 99342, 99344, 99345, 99347-99350
Domiciliary, Rest Home, or Custodial Care Services – Deleting Domiciliary Rest Home, or Custodial Care Services codes 99324-99328, 99334-99337, 99339, 99340
Highlights of Hospital Inpatient/Observation E/M Changes
- Hospital Inpatient and Observation Care Services E/M codes are being combined (99221-99223, 99231-99233, 99238-99239) and are revising coding guidelines. Inpatient Hospital Services E/M codes are being revised to include Observation Care Services.
- Hospital Observation Services E/M codes are being deleted (99217-99220, 99224-99226).
- Patients who are admitted and discharged from a hospital inpatient or observation on the same day will continue to use CPT codes 99234, 99235, and 99236.
Highlights of Consultation (Inpatient and Outpatient) E/M Changes
- The inpatient and outpatient consultation codes 99251 (inpatient) and 99241 (outpatient) will be removed in 2023.
- The new consultation coding guidelines have been streamlined and now include a definition of transfer of care.
How Can LW Consulting, Inc. Help?
LW Consulting, Inc. (LWCI) offers a comprehensive range of services that can help your institution with preparing for the 2023 E/M Coding Changes, including:
- Performing coding audits on current documentation and using the results to tailor specific education to your providers and coding staff.
- Performing one on one or large group education sessions for providers and coding staff.
