Evaluation and Management 2023 Updates

What You Need to Know

Changes to 2023 Evaluation and Management (E/M) coding will impact CDM files, coding, documentation, charge capture processes, and various information systems.

This article outlines new revisions to E/M codes for 2023 and addresses several questions we believe professionals will encounter when they learn of the changes.

Brief History of E/M Changes

Over the past few years, AMA and CMS have collaborated on E/M code family refinement. The goals of updates include:

  • Reducing administrative burden
  • Improving payment accuracy
  • Updating the code set to reflect current medical practice

Changes in E/M code set date back to the 2020 MPFS Rule and have continued annually. CPT® Symposium attendees heard a preview of these updates in 2018 and 2019 from a special physician committee dedicated to code set redesign. A year later, CPT Symposium attendees received a detailed summary of the updates at 2019’s Symposium. With the exception of the Prolonged Service(s) code for office visits (99417), final updates from AMA’s presenters were consistent with the CMS MPFS Final Rule’s details.

What’s New for 2023?

As a part of the continuing CPT Editorial Panel E/M improvement process, additional new E/M code changes will occur in 2023. These changes include a new code, revised and deleted E/M codes, and significant guideline revisions.
The preview information below is from AMA CPT website publications (preliminary until officially released).

What Codes are Deleted?

The table below illustrates the codes to be deleted by AMA effective 12/31/2022:

99217–99220Observation care discharge day management & Initial observation care, per day
99234Observation or inpatient hospital care, for the evaluation and management of a patient, including admission and discharge on the same date
99241Office consultation for a new or established patient, minor
99251Inpatient consultation for a new or established patient, minor
99318Evaluation and management of a patient involving an annual nursing facility assessment
99324–99238Domiciliary or rest home visit for the evaluation and management of a new patient
99334–99337Domiciliary or rest home visit for the evaluation and management of an established patient
99339–99340Individual physician supervision of a patient in home, domiciliary or rest home (eg, assisted living facility)
99354–99357Prolonged Services

What Codes are Revised?

The table below illustrates the CPT code ranges with planned descriptor changes effective 01/01/2023:

99221–99223Initial Hospital Inpatient and Observation Care Services
99231–99239Subsequent Hospital Inpatient and Observation Care Services, and Hospital discharge day management
99242–99245Office consultations
99252–99255Inpatient consultations
99281–99285Emergency department visit
99304–99310Nursing Facility Services
99315–99316Nursing Facility Discharge Services
99341Home or residence visit for the evaluation and management of a new patient
99342Home or residence visit for the evaluation and management of a new patient
99344Home or residence visit for the evaluation and management of a new patient
99345Home or residence visit for the evaluation and management of a new patient
99347–99350
Home or residence visit for the evaluation and management of an established patient
99358
Prolonged evaluation and management service before and/or after direct patient care
99359
Prolonged evaluation and management service before and/or after direct patient care, each additional 30 minutes
99415+
Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting
99416+
Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, each additional 30 minutes
99417
Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service)

+Facilities may not report 99415, 99416

What Are the New Codes?

There is one planned new CPT code for the 2023 E/M code series. CMS has not issued 2023 coding guidance, so we will wait to confirm whether the new code from CPT will be accepted, or whether alternative coding will be utilized.

Temporary code (a placeholder code format is currently displayed until formal code release):

#★✚●993X0Prolonged inpatient or observation evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the inpatient and observation Evaluation and Management service.

Begin Planning Now

Early review and planning is essential. The official release of the 2023 E/M CPT-4 updates will include code updates, guideline changes, and terminology refinements.

We hope our customers take the necessary time to plan ahead for changes related to Charge Master files, charging mechanisms, documentation templates, order sets, coding, and billing. Additionally, teams should prepare for staff and provider training as done with past years’ E/M updates.

Hospital Revenue Integrity and CDM Teams will want to put processes in place to ensure correct CDDM content, coding, charge capture, and accurate claims data (based on payer requirements).