Effective January 1, 2023, E/M Introductory Guidelines related to Hospital Inpatient and Observation Care Services codes 99221-99223, 99231-99239, Consultations codes 99242- 99245, 99252 99255, Emergency Department Services codes 99281-99285, Nursing Facility Services codes 99304-99310, 99315, 99316, Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350.
Deletion of Hospital Observation Services E/M codes 99217-99220
(99217 has been deleted. To report observation care discharge services, see 99238, 99239)
(99218, 99219, 99220 have been deleted. To report initial observation care, new or established patient, see 99221, 99222, 99223)
(99224, 99225, 99226 have been deleted. To report subsequent observation care, see 99231, 99232, 99233)
For a patient admitted and discharged from hospital inpatient or observation status on the same date, report 99234, 99235, 99236, as appropriate.
Deletion of Consultations E/M codes 99241 and 99251
(99241 has been deleted. To report, use 99242)
(For services 70 minutes or longer, use prolonged services code 99417)
(99251 has been deleted. To report, use 99252)
(For services 95 minutes or longer, use prolonged services code 993X0)
Revision of Emergency Department Services E/M codes 99281-99285 and guidelines.
E/M codes that have levels of services include a medically appropriate history and/or physical examination, when performed. The nature and extent of the history and/or physical examination are determined by the treating physician or other qualified health care professional reporting the service. The care team may collect information, and the patient or caregiver may supply information directly (eg, by electronic health record [EHR] portal or questionnaire) that is reviewed by the reporting physician or other qualified health care professional. The extent of history and physical examination is not an element in selection of the level of these E/M service codes.
Select the appropriate level of E/M services based on the following:
1- The level of the MDM as defined for each service,
2- The total time for E/M services performed on the date of the encounter.
Guidelines for Selecting Level of Service Based on Medical Decision Making
Four types of MDM are recognized: straightforward, low, moderate, and high. The concept of the level of MDM does not apply to 99211, 99281.
MDM includes establishing diagnoses, assessing the status of a condition, and/or selecting a management option. MDM is defined by three elements. The elements are:
The number and complexity of problem(s) that are addressed during the encounter.
The amount and/or complexity of data to be reviewed and analyzed.
The risk of complications and/or morbidity or mortality of patient management .
For more detailed information kindly review AMA CPT® Evaluation and Management (E/M) Code and Guideline Changes effective January 1, 2023
Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections.