With 25 codes going away and revisions to the introductory guidelines related to five different categories of codes, along with prolonged services revisions, the American Medical Association’s E/M changes, effective January 1, 2023, are significant!
The sheer volume of changes may create uncertainty in revenue, affecting Revenue Cycle Management (RCM). When significant changes are tied directly to revenue, a focus on training and evaluation is necessary for organizations to remain on course to reach their 2023 RCM goals.
As part of the revision’s objective, to reduce administrative burden and decrease unnecessary documentation, the history and physical exam (H&P) is no longer a component for E&M level selection. The guidelines state a medically appropriate H&P as determined by the physician/advanced practice provider (APP) should be documented, and the level of service based on medical decision-making or total time as the sole criterion for the level of service selection. Fast approaching, the E&M revisions are effective January 1, 2023.
Below are E&M categories that will undergo revision in 2023:
Hospital Inpatient and Hospital Observation Services | The below changes will be effective:
─Official text to the E&M categories for Hospital Inpatient and Observation Care Services reads as follows: “… which requires a medically appropriate history and/or examination and straightforward or low, moderate, or high level of medical decision making within the three levels of service for initial or subsequent care.”
─In addition, floor/unit time has been revised to read “total time on the date of the encounter.”
There are three components to the levels of Medical Decision Making (MDM) which include the following:
Emergency department E/M guidelines are shifting to focusing on Medical Decision Making (MDM). A provider ranking system that determines the complexity of establishing a patient’s diagnosis and treatment, MDM rankings can range from very straightforward to high complexity. Patient history and a physical exam are principal factors in determining a patient’s diagnosis and treatment.
According to the 2023 CPT updates, patient history and physical exam components will no longer factor into the final code. Instead, code selection is based solely on MDM. The AMA notes that while a patient history and physical exam should still occur, they will not be a determining factor in the assigned level of E/M service. This update aims to create a more simplified, flexible process for documenting E/M services. However, it may also create unforeseen operational challenges. This shift in guidelines will require education and training to avert costly errors.
In consideration of these changes, it is crucial for providers to have an understanding of how this will impact their current operations and to ensure teams are sufficiently aware, trained, and prepared to prevent any improper coding. For your coding teams, providing real-world educational scenarios and training opportunities that illustrate how the updates affect their daily activities is vital to minimizing any errors that can result in lost revenue.
Access the American Medical Association (AMA)
CPT Evaluation and Management (E/M) Code and
Guideline Changes for 2023 for more information: AMA
Axea Solutions Coder Services provides an array of education and training, including Coaching and Development for Coding Teams, New-Hires, and individual coder targeted training. If you need coding support or coder training to take a deeper dive into the revisions and guideline changes, contact an Axea advisor for support.
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