We are all excited about the upcoming 2023 E/M changes, aren't we? Well, I can say, as a coder and auditor, I am! I've been in this E/M world for about 35 years. Things were easy prior to 1995, right? Providers just documented the visit, no elements to make sure they included. But 1995 started to put providers in a "cage" of sorts. They now have to make sure that they include appropriate history, exam, and medical decision-making. Then, let's worry about new or established patients. Miss one element and go back on your level – sounds to me like a game of Chutes and Ladders! Can you imagine how frustrating this is for our providers? All they want to do is take care of their patients, not count how many ROS were included. 1997 brought more changes that worked great for specialty physicians, but primary care providers were put into an even smaller "cage." So we played the "Coding Chutes and Ladders" with two sets of rules – whichever worked best in each given situation. Talk about confusing to our providers who, most of the time, received no training on coding during their residency!
Now fast forward to 2021, we have changes, but only to 99202-99215. This is great for the office-based providers, but what about those providers seeing patients in both the inpatient and office setting? We are still at two sets of rules, but I believe the office-based physicians have done a good job of regressing to assessment and plan and not worrying about clicking boxes to meet criteria in the office setting.
One more fast forward, this time to January 1, 2023, where we put all providers on the same playing field with MDM or time (except for ED and critical care). We need to begin auditing and offering follow-up education now! The providers who offer inpatient services will need to think in a new mindset. No more clicking history and exam elements to determine the level of care. We need to ensure the documentation for the assessment and plan are rich with details to support medical necessity.