E/M Coders, Here We Go Again! (part 2)

Posted by: Lisa Greene, CCS, CCS-P at Jan 10, 2023

If you’re a coder who routinely performs Evaluation and Management coding and have been working in the field for a while, you probably remember when the Office Visits codes were revised in 2021. Also, by now you may have heard the news – the codes are changing again for 2023. And by codes, we mean that essentially every other E/M code that requires use of documentation guidelines for determination of the appropriate level of service changed effective 1/1/2023!

The good news is, overall the process will be getting easier and more uniform. The 1995/1997 E/M Documentation Guidelines will no longer be effective – no more “bullets” to document or count. The guidance revisions that were implemented in 2021 are now being phased in for the balance of the E/M codes; code levels will be determined by assessment of either Medical Decision Making or the provider’s documentation of time spent for the encounter. So if you learned how to do this in 2021, you should not have much trouble making the adjustments for 2023. However, be aware that there are changes for 2023 – new guidance, more definitions, addition of some new terms PLUS a new table to use that will replace the one published in 2021 – so it will be essential for coders to familiarize themselves with the new material before starting to code for 2023.

Here are the codes that will be impacted:

• Office or Other Outpatient Services
• Hospital Inpatient and Observation Care Services (These services are now merged!)
• Consultations
• Emergency Department Services
• Nursing Facility Services
• Home or Residence Services (These are merged too!)
• Prolonged Service With or Without Direct Patient Contact on the Date of an Evaluation and Management Service

Buckle your seat belts, grab your CPT® books, and jump in to a great New Year!

Lisa Greene, CCS, CCS-P
Associate Manager, Consulting Services