Healthcare providers who understand how to code can significantly increase reimbursement and lower revenue concerns associated with stressful audits. AMA (American Medical Association) has presented a fresh set of revisions in E/M codes, conveying a substantial restructuring. The E/M coding modifications would be adequate from January 1, 2023, and will create coding streamlined for healthcare practices.
Evaluation and Management Codes (E/M) are utilized in general medical practices like hospital visits, office visits, preventive medicine services, or home care services by competent healthcare professionals (QHPs) or physicians. This blog will discuss all you must know about E/M coding changes in 2023.
What is E & M coding?
Evaluation and management codes comprehended as E/M are Current Procedure Terminology (CPT) codes from 99202 to 99499. These AMA codes are used for family physicians, general visits among emergency room physicians, and specialty care practitioners. These codes are based on the benefits given to the patients. E/M codes are used in every step of the patient expedition, from when they enter your practice to physical inspection and all procedures or medical evolution you conduct.
E/M codes Use
Comprehending E/M codes and understanding their care background and corresponding service type is vital to maintain practice efficiency, productivity, and financial health. E/M codes are not used for diagnostics, surgeries, testing, or radiology. These codes apply to the healthcare providers that evaluate or manage the patients. Multiple services fall beneath these codes, for instance, a patient seeing a provider for a general checkup. Here are the kinds of services that fall underneath E/M codes.
- Hospital visits
- General office visits
- Home care services
- Preventative medicine services
Components of E/M codes
There are three elements of E/M codes according to MCT (Medicine & Medicaid services) when determining the suitable level of E/M services delivered:
- Patient history
- Examination process
- Medical decision making
Other factors clinch the selection of E/M codes, like the time spent giving a distinct service to the healthcare provider.
Regulatory & coding changes of 2023
E/M code updates impact the guidelines on how these codes can be used. The current update released by AMA affects various types of healthcare providers. Here is the list of procedures and regulations that were deleted, modified, and retained.
Inpatient and observation care services
- E/M codes 99217-99220 got deleted
- E/M codes 99221-99223 & 99231-99239 got counted as observation and hospital inpatient care services
Consultations
- E/M codes 99241 and 99251 got deleted
- E/M codes 99242-99245 (Office or additional outpatient consultancies) & 99252-99255 (inpatient or observation consultation) got corrected
Emergency department services
- E/M codes 99281-99285 (Emergency department visit) got corrected
Nursing facility services
- E/M code 99318 got removed
- E/M codes 99304-99310 and 99315 -99316 got revised
Custodial care, Rest home, or Domiciliary services
- E/M codes 99324-99238, 99339-33340, and 99334- 99337 got deleted
Home and residency services
- E/M code 99343 got deleted.
- E/M codes 99341- 99342, 99344-99345, 99347- 99350, and guidelines are revised
Prolonged services
- E/M codes 99354-99357 got deleted
- E/M codes 99358 – 99359, and 99415 – 99416 (long face-to-face services in office or outpatient) got modified in the guidelines
- E/M code 99417 (prolonged service with the direct patient) got revised in the service
- E/M code 993X0 got counted in prolonged service codes
E/M coding changes were introduced to facilitate healthcare providers’ lives and free their administrative burden.
Plutus Health has a team of certified coders who got corrected with the coding updates. We use the proper codes to get you paid what you merit. Connect with Plutus Health’s coding professionals to learn more about the coding updates and steps you should pursue to aid them.
Register for the Webinar today to learn more about the changes to E/M coding in 2023.
Essential Takeaways:
- E/M code modifications are likely to develop further in 2023.
- E/M code changes energy disturbs your current workflow, but the benefits it brings to healthcare providers are far more significant.
- E/M code updates got designed to facilitate uncovering the correct code.
- Update your EHR system to organize and evaluate new coding changes
