Jennifer Pohrte, CPC Oct 27, 2022 6:38:27 PM 4 min read

E/M 2023 CPT Changes

Several new CPT changes go into effect January 1, 2023. Are you ready?

All E/M services will now use a single set of guidelines to support the level of care based on Medical Decision-Making (MDM) or Total Time. These changes apply to the E/M encounters for Inpatient/Observation, Consultations, Emergency Department, Nursing Facility, Home Residence, and Prolonged Services. Below are some keys points for each of those categories.

The Observation CPT’s 99217-99220 and 99224-99226 have been inactivated. The code descriptors are revised to now include Hospital Inpatient OR Observation Care with the CPT Codes 99221-99223, 99231-99233, and 99238-99239.

The Consultation Codes have minor editorial revisions to the code descriptors and the deletion of confusing guidelines that pertain to “transfer to care.” The lowest level of Consultation for Office (99241) and Inpatient (99251) have been inactivated to align with the four levels of MDM.

The Emergency Department Codes have maintained the principle that time cannot be used as a key criterion for code level selection. There were some editorial revisions to the code descriptors to reflect the code structure in the office visit revisions. Several modifications to the MDM levels were completed to align with the office visits and to maintain unique MDM levels for each visit. 99281 now does not require a physician or other qualified healthcare provider, 99282 is now Straightforward, 99283 is now Low, 99284 is Moderate, and 99285 is High MDM.

There was a revision to the Nursing Facility Code guidelines with a new “problem addressed” definition of “multiple morbidities requiring intensive management” as high complexity for initial nursing facility care. There was also the retirement of 99318 for the annual Nursing Facility Assessment. That service will now be reported through the Subsequent Facility Care Service Codes 99307-99310 or the appropriate Medicare G-codes.

The Home and Residence Codes have been combined. CPTs 99334-99340 have been inactivated and their services merged into the existing Home CPT Codes 99341-99350. Another elimination was the duplicate MDM level for New Patient, CPT 99343.

CPTs 99354-99347 for Prolonged Services were inactivated and a new code, 993X0, was created. Now you should use CPT 99417 for Prolonged E/M Services for services on the same day with an outpatient, home or residence service, or cognitive assessment and care plan, and CPT 993X0 for Prolonged Services for an inpatient or observation or nursing facility service. CPTs 99358-99359 can still be used for services on dates other than the date of service. CMS also created three new HCPCS II G-codes for the Prolonged Services of the different E/M categories. Inpatient or Observation services will use GXXX1 for a Prolonged Visit, Nursing Facility services will use GXXX2, and a Prolonged Visit for Home or Residence may use GXXX3.

This was just an overview of the CPT 2023 code updates. Please review specific code descriptors and guidelines of the new codes to ensure you are assigning the most appropriate CPT Codes. If you have specific questions or need support, our team is here to help. Contact us to set up a meeting.