Evaluation and Management 2023 Updates


Evaluation and Management 2023 Updates

Date Posted: Saturday, February 04, 2023


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 practices

Changes in E/M code sets 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) codes 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:

What Codes Are Revised?

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

+Facilities may not report 99415 or 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):

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 CDM content, coding, charge capture, and accurate claims data (based on payer requirements).

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