E/M Changes Coming Our Way in 2023!

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Jul 12th, 2022

Changes are one thing we can count on being consistent; even though this is one we have been anticipating, it is time to prepare, and we will have some work to do. The AMA released the new 2023 E/M Guidelines early to help us prepare for the change effective January 1, 2023.  

Beginning in January 2023, the E/M section will once again be revised. The AMA is listening to physicians’ concerns and making changes to help alleviate the administrative burden even further; the 2021 changes simplified code selection based on either time or medical decision-making. The early release will assist in setting the proposed Medicare physician fee schedule, which is usually out in early July, and will give us time to get familiar with them and prepare for the changes before the release date. We will see several deleted codes and new definitions and changes in some code descriptions, be sure to review all 2023 changes announced by the AMA; see the complete summary here. 

Changes in Emergency Department visits:

The CPT Editorial Panel revised the Emergency (ED) visit’s specifically (99281-99285) to align with CMS and the principles used with “Office or other Outpatient Visits.”

Important revisions coming in the 2023 rules and descriptions:

Removing the key components such as history, examination, and medical-decision-making (MDM) will be selected based on MDM only for services provided after January 1, 2023.

New and established patients have no distinction; any CPT code in the ED section may be used.

The observation discharge code (99217) will no longer be used.  We will now report with the hospital or observation discharge codes (99238-99239), or if there is an admission and discharge on the same day, the correct code selection will be (99234-99236).

Additional language was added to the initial and subsequent Inpatient codes (99221-99233 and 99231-99233).

Prolonged services will have a new CPT code and guidelines 993X0.

Observation codes will no longer be used (99217-99226); the observation codes will be merged with the initial and subsequent hospital codes 99221-99223, 99231-99233, and 99238-99239).

For example, the description for code 99221 will state: “Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low-level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.”

Deletion of codes

While some codes will be revised, others will be deleted; please refer to the final changes when the AMA releases them; this article is information only.