CPT® 2023 Guideline Changes

Get ready for consistency in selecting your Evaluation and Management (E/M) Services codes in 2023. Recently, the American Medical Association (AMA) updated the majority of the Current Procedural Terminology (CPT®) E/M codes to be based on a medically appropriate history and/or exam and medical decision making. Does this sound familiar to you?  Hopefully, the answer is yes.  Basically, our Inpatient, Consultation, Home, Nursing Facility and Observation Care codes will be leveled just like our Office E/M codes.  The effective date for these changes is January 1, 2023.

Does this mean that you as a provider do not have to document the History or Exam?  No. Just like the Office Visits, you will continue to document based on your medical training and to establish medical necessity.  As a coder, I will no longer level your service by counting the history and exam elements; however, the Chief Complaint is still required and at minimum, an HPI and/or Interval history should be documented.

Another major change is the deletion of several Observation Care codes.  Personally, I always thought there were too many Observation codes. I’m glad that most of these codes have been removed.  Additionally, the lower level codes have been removed from the Consultation Services just as we saw with the removal of CPT® code 99201 in 2021.

Within these guideline changes, the AMA provided clarifications of the Office and Emergency Department guidelines.  There are also revisions, deletions and/or additions to the Home, Nursing Facility, Domiciliary, and Rest Home codes.  Finally, you will also see deletions, revisions, and the establishment of Prolonged Service codes.

PPMC Academy will host free live events on the 2023 Guideline Changes after the Centers for Medicare and Medicaid Services (CMS) release their guidelines. The CMS Final rules are normally published in early November.  For now we have to wait and see if CMS will adopt all of the CPT® changes.  Or will they create HCPCS codes for some of these services?  Check back in November and visit our Events page for the dates of these webinars. We will hold several sessions in November and December 2022.  Until then, here is the link to the AMA 2023 Guideline Changes:  CPT® Evaluation and Management Code and Guideline Changes

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