E/M

Changes to in-patient evaluation and management (E & M) service codes for 2023 are coming. The changes will be effective January 1^st, 2023. These changes follow the outpatient service coding updates implemented on January 1^st, 2021. A recent AAPC review noted the following lessons from the 2021 implementation:

1. The change was harder than expected
2. Explaining the updates and changes was not as smooth as envisioned
3. There are still gray areas to be addressed
4. Applying the guidelines when reviewing notes is not as easy as counting elements
5. The changes were still an improvement and a good thing

The updates align the method of assigning levels of service (LOS) for in-patient services with those introduced on January 1^st, 2021, in the outpatient setting. The history and physical exam components will be documented at the providers discretion, and will not be factors in assigning the final level of service. The documentation must however support the medical necessity of the service.

We are mindful of the need to prepare physicians and non-physician practitioners for this change in the coding of their professional services. A clear understanding of these changes is imperative to avoid the possible compliance pitfalls that may lie ahead. While change is disruptive, this transition promises to provide greater ease for physicians with their billing practices.

The table below gives a brief snapshot of the pending changes for the respective in-patient service codes. The time thresholds for each code are displayed with the codes below. It is important to note that emergency department (ED) codes and guidelines have been revised. No time thresholds apply to ED codes.

Deleted Codes

Deleted codes include:

• the previous hospital observation codes (99217 to 99220).
• level one codes for consultations services (99241 and 99251).
• nursing facility code 99318, and
• prolonged services codes 99354 to 99357.

https://deandorton.com/wp-content/uploads/2022/11/Revised-EM-Service-Codes.png

New for 2023

The initial (99221-99223) and subsequent (99231-99233) in-patient service codes will also now be used for observation services. In addition, new prolonged services codes have been added for the in-patient and outpatient settings. Code 99417 was added for outpatient, home or residence service encounters. Code 993X0 was added for inpatient, observation or nursing facility services encounters. The appropriate guidelines for all these services have been updated accordingly.

Dean Dorton has experts available to assist your practices in implementing an educational plan, and partnering with you to navigate these regulatory changes. Please do not hesitate to reach out to our experienced team. We are committed to serving any of your healthcare needs.

Sources:

1. Lessons learned from the E/M code changes 
2. Compliance Today; September 2021: A review of the impact of the 2021 E/M coding changes in the office and outpatient setting
3. AMA – 2023 Code changes and descriptors

Brandy Montgomery | Healthcare Consulting Manager
bmontgomery@ddafhealthcare.com
502.566.1037