In an effort to continue to tamp down physicians’ administrative burden, the American Medical Association has revised the codes and guidelines for most evaluation and management (E/M) services in its 2023 Current Procedural Terminology (CPT) code set.
The new updates – among 393 in total, including 225 new codes, 75 deletions, and 93 revisions – take effect Jan. 1, 2023. As this story went to press, the Centers for Medicare & Medicaid Services had just released its 2023 Medicare Physician Fee Schedule final rule, in which AMA indicated the revised CPT guidelines and codes had been adopted.
The E/M modifications impact inpatient and observation care services, consultations, emergency department services, nursing facility services, home and residence services, and prolonged services. The changes are intended to free up physicians and their care teams from time-wasting administrative tasks, says AMA President Jack Resneck Jr., MD.
“The process for coding and documenting almost all E/M services is now simpler and more flexible,” Dr. Resneck said in a statement. “We want to ensure that physicians and other users get the full benefit of the administrative relief from the E/M code revisions.”
The updates build on past documentation reduction efforts that go as far back as the 2020 Medicare physician fee schedule, when the Centers for Medicare & Medicaid Services finalized revisions to E/M office visit codes (99201-99215) that:
- Eliminated the requirement to document the medical necessity of furnishing visits in the home rather than an office;
- Removed the requirement for clinicians to re-record elements of the history and physical exam when evidence has been provided that the information has been reviewed and updated;
- Simplified code selection criteria to make them more “clinically relevant and intuitive”; and
- Created consistency across payers by adding detail within the CPT E/M guidelines.
AMA has since continued to revise ensuing CPT codes and guidelines, including the 2023 set, to provide continuity across all E/M sections, the organization told Texas Medicine Today.
Among others, major updates for 2023 include:
- Deletion of confusing consultation guidelines;
- Modification of medical decision-making (MDM) levels to maintain unique levels for each visit; and
- Elimination of direct-patient-contact prolonged service codes (99354-99357).
Dr. Resneck said AMA is “helping physicians and health care organizations prepare now for the E/M coding changes and offers authoritative resources to anticipate the operational, infrastructural and administrative workflow adjustments that will result from the pending transition.”
AMA’s website has a comprehensive list of the code changes, plus tools and resources. Physicians seeking additional information on billing, coding, and payment can visit TMA’s resource page.
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Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469