Swiftaudit now supports all current AMA updates to Medical Decision Making and E/M code calculations. We’ll be posting a series of educational discussion pieces over the next few weeks to dig deeper into these changes, so stay tuned! In the meantime, here is a brief summary of revisions.
2023 summary of revisions to the E/M code descriptors and guidelines
Inpatient and observation care services
- Deletion of observation CPT codes (99217-99220, 99224-99226) and merged into the existing hospital care CPT codes (99221, 99222, 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.
More Information:
Review and download the E/M code descriptors and guidelines for 2023.
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