This year’s major revision of the E/M facility service coding structure is the star of the show. The 2023 CPT code set has seen 102 new codes, 68 deleted codes, and 87 codes with revised long descriptions, as well as 36 new parent codes. This new, unified set of E/M guidelines is sure to make them much easier to recall and far less likely to cause discrepancies during an audit.
Major E/M Changes include the following:
Deletion of the Lowest Level of Consultation Codes (99241 and 99251)
Despite the fact that Medicare has not paid for consultation services for many years, the consultation codes remain important as long as other payers will reimburse them. This will not, however, alter the billing procedures for Medicare beneficiaries.
Revision of the Lowest Level of Emergency Department E/M Service (99281)
Has your organization discussed what nursing services will be reported using this, and how the supporting documentation will appear, now that it is being repurposed to report ED nursing staff services that are not separately reportable with another CPT code?
Deletion of the Observation Care Services Codes
The Hospital Inpatient and Observation Care Services have been formed by combining the existing services.
Observation Care Services, Reportable with Codes 99221-99223 and 99231-99233
Admission and discharge on the same date will be reported the same way for both Observation and Inpatient.
Deletion of the Domiciliary and Rest Home Service Category and Associated Codes
The Home & Residence (99341-99345) service code category will now include any location where the patient may temporarily reside (e.g., hotel, cruise ship) for reporting E/M services. These services will be merged into this category.
Changes to the E/M MDM Table
In 2021, a new table was created to accommodate Medical Decision Making (MDM) elements, which feature several problem types and risk definitions specific to the facility setting. While the MDM documentation elements are not new, the scoring system is, so providers should have an expert available to help them understand how the changes will affect their documentation habits, EHR Templates, and reporting processes.
Hernia Repairs
If your organization works in the area of hernia repair, you should be aware of the upcoming significant changes to how hernia repair is coded. Instead of separately reportable services, there will be two main categories of hernia repair procedure codes: anterior abdominal (all-inclusive) and parastomal hernias, as well as repair through any method (open, laparoscopic, or robotic). Be sure to check out the guidelines for more information.
Disclaimer: This article reflects the opinion of the author. It is not meant to serve as official guidance for providers/payers. If you have any questions about the content of this article, please reach out to the author.