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December 19, 2022

E/M Coding Changes 2023: Everything You Need to Know

Balaji Ramani has more than 22 years of experience in Healthcare Revenue Cycle Management. Balaji has expertise in building, training, mentoring, and managing end-to-end healthcare RCM teams. He has experience using the Web for information sourcing, research & analyses to enable ‘patient and payer satisfaction’ in the healthcare space.

ABA Providers Recover Dues From Patients To Efficient Your Account Receivables

Healthcare providers who know how to code can significantly increase reimbursement and reduce revenue problems associated with stressful audits. AMA (American Medical Association) has introduced a new set of revisions in E/M codes, bringing a significant restructuring. The E/M coding changes would be effective from January 1, 2023, and are expected to make coding simple for healthcare providers.

E/M codes (Evaluation and Management Codes) are used in general medical practices like office visits, hospital visits, home care services, or preventive medicine services by qualified healthcare professionals (QHPs) or physicians. This blog will discuss everything you need about E/M coding changes in 2023.

What is E & M coding?

Evaluation and management codes known as E/M or E and M are Current Procedure Terminology (CPT) codes ranging from 99202 to 99499. These AMA codes are commonly used for general visits among emergency room physicians, family physicians, and specialty care practitioners. These codes are based on the services given to the patients. E/M codes are used in every stage of the patient journey, from the time they enter your practice to physical examination and all procedures or medical evolution you perform.

Which services use E/M codes?

Knowing E/M codes and understanding their care setting and corresponding service type is vital to maintain practice productivity, efficiency, and financial health. E/M codes are not used for surgeries, diagnostic testing, or radiology. These codes apply to the providers that evaluate or manage the patients. Many services fall under these codes, for example, a patient visiting a provider for a general checkup. Here are the types of services that fall under E/M codes.

  • Hospital visits
  • General office visits
  • Home care services
  • Preventative medicine services

What are the components of E/M codes?

There are three components of E/M codes according to MCT (Medicine & Medicaid services) when choosing the right level of E/M services offered:

  • Patient history
  • Examination process
  • Medical decision making

Apart from these, other factors determine the selection of E/M codes, like the time spent on giving a particular service to the healthcare provider.

What are the coding and regulatory changes of 2023?

E/M code updates affect the guidelines on how these codes can be used. The recent update released by AMA affects different types of healthcare providers. Here is the initial list of guidelines and codes that were deleted, revised, and retained.

Inpatient and observation care services

  • E/M codes 99217-99220 are deleted
  • E/M codes 99221-99223 & 99231-99239 are added to hospital inpatient and observation care services

Consultations

  • E/M codes 99241 and 99251 are deleted
  • E/M codes 99242-99245 (Office or other outpatient consultancies) & 99252-99255 (inpatient or observation consultation) are updated

Emergency department services

  • E/M codes 99281-99285 (Emergency department visit) are updated

Nursing facility services

  • E/M code 99318 is deleted
  • E/M codes 99304-99310 (initial nursing facility care per day), and 99315 -99316 (nursing facility discharge management) are revised

Domiciliary, Rest home, or Custodial care services

  • E/M codes 99324-99238, 99339-33340, and 99334- 99337 are deleted

Home and residency services

  • E/M code 99343 is deleted
  • E/M codes 99341- 99342 (home and residency visit), 99344-99345 (home and residency above 60 minutes), 99347- 99350 (home and residency visit for established patients), and guidelines are revised

Prolonged services

  • E/M codes 99354-99357 are deleted
  • E/M codes 99358 - 99359 (prolonged outpatient evaluation and management service), and 99415 – 99416 (prolonged face-to-face services in office or outpatient) are revised in the guidelines
  • E/M code 99417 (prolonged service with the direct patient) is revised in the service
  • E/M code 993X0 is added in prolonged service codes

E/M coding changes have been introduced to ease the lives of healthcare providers and free their administrative burden.

Plutus Health has a team of certified coders who are updated with the coding updates. We use the correct codes to get you paid what you deserve. Connect with Plutus Health’s coding experts to know more about the coding updates and steps you should follow to benefit from them.

Key Takeaways:

  • E/M code changes are likely to evolve further in 2023.
  • E/M code changes might disturb your current workflow, but the benefits it brings to healthcare providers are far greater.
  • E/M code updates are designed to simplify finding the correct code.
  • Update your EHR system to manage and evaluate new coding changes
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Balaji Ramani

Balaji Ramani has more than 22 years of experience in Healthcare Revenue Cycle Management. Balaji has expertise in building, training, mentoring, and managing end-to-end healthcare RCM teams. He has experience using the Web for information sourcing, research & analyses to enable ‘patient and payer satisfaction’ in the healthcare space.

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