Important Code and Guideline Changes to CPT®

Creating a checklist of tasks is recommended, even necessitating a project team and project plan.

Typical to this time of year the American Medical Association (AMA) has released the changes to the CPT code set and the Centers for Medicare & Medicaid Services (CMS) has issued the proposed rule for policy changes under the Physician Fee Schedule (PFS).

For calendar year 2023, the CPT Evaluation and Management (E&M) revisions were announced on June 30 and the CMS Proposed Rule was released on July 7. I trust most of you reading this might be aware of these, but here is a list of the E&M categories that will undergo revision in 2023:

• Inpatient and observation care services
• Consultations – both outpatient and inpatient
• Emergency department services
• Nursing facility services
• Home and residence services 
• Prolonged services

In addition to the category revisions, there are quite a few revisions to the E&M guidelines. The E&M guidelines overview at the beginning of the E&M section has extensive revisions and more clarification needed from the 2021 revisions to selecting the level of service based on medical decision making. Several of the E&M categories with code revisions also have guidelines revisions. There are deleted E&M codes, combined E&M categories, more work on prolonged services including establishment of a new prolonged services E&M code.  Whew!  Lots of changes! 

The revisions to these E&M categories are a continuation of the changes made in 2021 to the office visit categories for new and established patients. The AMA CPT editorial panel had four objectives in mind when they set out to revise the E&M guidelines and categories for the first time in more than 25 years. These include the following:

1. Decrease administrative burden related to documentation and coding
2. Decrease the need for audits
3. Decrease unnecessary documentation in the medical record that is not needed for patient care
4. Ensure payment for E&M services reflect the level of resources consumed

It is also important to point out that the AMA and CMS collaborated on these revisions with the shared goal of reducing administrative burden to give the physicians more time with their patients. 

With so many revisions to E&M services coming in 2023 a focused effort on these changes is essential. I recommend creating a checklist of tasks, treat these changes as a short-term project, potentially necessitating a project team and project plan.

Beginning mid-September, join us each week on Talk Ten Tuesday as we discuss in detail the revisions to each E&M category along with steps to take to ensure your physicians, your coders and your practice are ready for these changes. We’ll also review the physician fee schedule proposed rule and learn what CMS is proposing related to E&M services. 

As coding and documentation integrity professionals it is our responsibility to educate ourselves on coding and payment policies changes. We are responsible for submitting accurate claims supported in the documentation for proper payment of services provided. 

We are an important piece in the revenue cycle, our physicians rely on us to provide them education on these changes; this is one of the ways our profession remains relevant. 

Programming note: Listen to Colleen Deighan report this story live today during Talk Ten Tuesdays with Chuck Buck and Erica Remer, MD.