After implementing the 2020 Medicare Physician Fee Schedule Final Rule provision, which included revisions to the Evaluation and Management (E/M) office visit Current Procedural Terminology (CPT) (99201-99215) code descriptors and documentation standards that directly addressed the continuing problem of administrative burden for physicians in nearly every specialty, from across the country, the CPT Editorial Panel approved, for 2023, additional revisions to the rest of the E/M code section. Here’s a summary of revisions:

Inpatient and observation care services

  • Deletion of observation CPT codes (99217-99220, 99224-99226) and merged into the existing hospital care CPT codes (99221-99223, 99221-99233, 99238-99239).
  • Editorial revisions to the code descriptors to reflect the code structure approved in the office visit revisions.

Consultations

  • Deletion of confusing guidelines, including the definition of “transfer of care.”
  • Deletion of lowest level office (99241) and inpatient (99251) consultation codes to align with four levels of Medical Decision Making (MDM).

Emergency department services

  • Maintained the existing principle that time cannot be used as a key criterion for code level selection.
  • Editorial revisions to the code descriptors to reflect the code structure approved in the office visit revisions.

Nursing facility services

  • Editorial revisions to the code descriptors to reflect the code structure approved in the office visit revisions.
  • Revision to nursing facility guidelines with new definition of “multiple morbidities requiring intensive management,” to be considered at the high-level MDM for initial nursing facility care.
  • Deletion of code 99318 (annual nursing facility assessment). This existing service will be reported through the subsequent nursing facility care services (99307-99310).

Home and residence services

  • Editorial revisions to the code descriptors to reflect the code structure approved in the office visit revisions.
  • The domiciliary or rest home CPT codes (99234-99340) were deleted and merged with the existing home visit CPT codes (99341-99350).

Prolonged services

  • Deletion of direct patient contact prolonged service codes (99354-99357). These services will now be reported through either the new code, created in 2021, office prolonged service code (99417), the new inpatient or observation or nursing facility service code (993X0).
  • Creation of a new code (993X0) to be analogous to the office visit prolonged services code (99417). This new code is to be used with the inpatient or observation or nursing facility services.

Source: American Medical Association (AMA)

 

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