Building on its efforts to reduce administrative tasks in medicine, the American Medical Association (AMA) has released the 2023 Current Procedural Terminology (CPT) code set. Modifications to the E/M codes are among 393 editorial changes in the 2023 CPT code set, including 225 new codes, 75 deletions and 93 revisions. The new modification to the E/M codes extend to inpatient and observation care services, consultations, emergency department services, nursing facility services, home and residence services, and prolonged services.
Inpatient and observation care services
- Deletion of observation CPT codes (99217-99220 and 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 structure of total time on the date of the encounter or level of medical decision-making when selecting code level.
- Retention of revised Observation or Inpatient Care Services (Including Admission and Discharge Services) (99234-99236).
- Revision of guidelines.
Consultations
- Retention of the consultation codes, with minor, editorial revision to the code descriptors.
- 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 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.
- Modified MDM levels to align with office visits and maintain unique MDM levels for each visit.
- Existing CPT code numbers maintained (analogous to office visit revisions).
- Articulated current practice that was not explicit in the CPT code set. May be used by physicians and QHPs other than just the ED staff.
- Critical care may be reported in addition to ED service for clinical change.
Nursing facility services
- Editorial revisions to the code descriptors to reflect the new standard E/M code structure.
- Revision to nursing facility guidelines with new “problem addressed” definition of “multiple morbidities requiring intensive management,” to be considered at the high level 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) or Medicare G codes.
- Not all “initial care” codes are the mandated comprehensive “admission assessment” and may be used by consultants.
- Use subsequent visit when the principal physician’s team member performs care before the required comprehensive assessment.
Home and residence services
- Editorial revisions to the code descriptors to reflect the new standard E/M code structure.
- The domiciliary or rest home CPT codes (99334-99340) were deleted and merged with the existing home visit CPT codes (99341-99350).
- Elimination of duplicate MDM Level New Patient code (99343).
Prolonged services
- Deletion of direct patient contact prolonged service codes (99354-99357). These services will now be reported through either the code created in 2021, office prolonged service code (99417) or the new inpatient or observation or nursing facility service code (993X0). 99417 is also used for Home or Residence prolonged services.
- 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.
- Retention of 99358, 99359 for use on dates other than the date of any reported ‘total time on the date of the encounter” service.
Source: American Medical Association (AMA)
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