After undergoing substantial modifications in 2021, the remaining E/M code area will be updated in the 2023 CPT code set, along with revisions to AI and virtual care codes.

Newly updated for 2023, the American Medical Association’s (AMA) Current Procedural Terminology (CPT) code set is intended to make medical coding for evaluation and management (E/M) visits easier.

Billing and coding are used for tracking utilization, measuring the quality of treatment provided, and creating medical claims for payer reimbursement. Providers use these codes to document patient visits, including all services performed. CMS has recently changed the documentation and coding criteria for E/M visits to reduce red tape and improve efficiency.

Specifically, the CMS incorporated the AMA CPT Editorial Panel’s proposed changes to the code descriptors and documentation standards for E/M office visit CPT codes 99201 through 99215 in the 2020 Medicare Physician Fee Schedule Final Rule. For evaluation and management (E/M) visits, the agency authorized providers to use either MDM or total time beginning in 2021 (a change from the E/M documentation rules established in 1995 and 1997).

The new guidelines also removed the need for detailed patient history and physical examination as part of the E/M coding procedure.

Further updates to the rest of the E/M code area are included in the 2023 CPT code set, as recently revealed by AMA.

Jack Resneck Jr., MD, president of the AMA, stated in the announcement¹, “The process for coding and documenting almost all E/M services is now simpler and more flexible.” “We want to ensure that physicians and other users receive the full administrative relief from the E/M code revisions. “The AMA is assisting physicians and [healthcare] organizations in preparing for the E/M code revisions by providing authoritative resources to anticipate the operational, infrastructural, and administrative workflow adjustments that will result from the impending transition.

AMA Code Updates Beginning January 1, 2023

The American Medical Association (AMA) updated their CPT coding recommendations for all care venues and services to better reflect the new E/M code requirements.

Periodically, fresh codes are introduced while older ones become obsolete. Among the codes unveiled in January 2022, CPT Code 99457 is part of this series and carries certain modifications that Remote Patient Monitoring (RPM) service providers should take note of.  

CPT codes are crucial in streamlining and automating a significant portion of the billing and claims process, guaranteeing that remote health monitoring companies receive the full reimbursements they are entitled to.

These are the most recent changes, organized by type of care or service:

Facilities for both inpatient treatment and outpatient observation

– Elimination of the observation CPT codes (99217–99220) and their incorporation into other, existing hospital care CPT codes (99221 through 99223, 99221 through 99233, and 99238 through 99239)

– Modifications to the code descriptions to take into account the structure of total time on the date of the encounter or the level of medical decision-making when choosing a code level

– Continuing services for admission and discharge from a hospital, as well as services for observation or inpatient care (CPT codes 99234 through 99236)

Consultations

– The consultation codes will remain, while their descriptions will undergo some editing.

– Some recommendations, such as the one defining “transfer of care,” were removed because the AMA found them to be unclear.

– According to the four tiers of MDM, the lowest tier office consultation code (99241) and inpatient consultation code (99251) have been removed.

Assistance in a medical emergency

– The long-standing rule that time alone cannot be a deciding factor in determining which code level to utilize will continue to be upheld.

– Alterations to the code descriptions in accordance with the revised code structure discussed and approved during the consultation

– Adjusted MDM levels so that they correspond with doctor’s appointments; now each appointment has its own MDM status.

– Codes currently in use by the CPT will be kept in use.

– Changes to current practice that are not explicitly reflected in the CPT code set, but which are still appropriate for use by physicians and other qualified healthcare professionals outside of the ED.

– Allowing critical care to be documented alongside ED service for clinical improvement

Care provided in a nursing home

– Guidelines for nursing homes are being updated to include a new “issue addressed” definition of “many morbidities needing extensive management,” which should be given priority when deciding who needs nursing home care initially.

– Code 99318 (annual nursing facility assessment) has been removed since its data can now be provided through related nursing care services (CPT codes 99307-99310) or Medicare G codes.

– Consultants now have access to “initial care” codes that aren’t part of the required complete “admission assessment.”

– If a member of the supervising doctor’s team provides care before the mandatory comprehensive assessment, the subsequent visit may be used instead.

Aid for the Household and the Home

– CPT codes for visits to nursing homes or other types of domiciliary care facilities (99334–99340) have been eliminated and rolled into those for regular home visits (99341–99350).

– The New Patient Code at the MDM Level will no longer be duplicated (99343)

Extended support

– The direct patient contact prolonged service codes (99354–99357) will be removed and replaced by the office prolonged service code (99417), which will be reported in 2021, or the new inpatient or observation or nursing facility service code (99358). (993X0)

– A new code (993X0) similar to the code for extended services rendered during an office visit (99417)

– Keep 99358 and 99359 for future usage on days not included in any “total time on the day of the encounter” service reports.

The American Medical Association (AMA) recently revealed that the 2023 CPT code set will include a new appendix with a taxonomy for artificial intelligence/augmented reality (AI/AR) applications, in addition to the previously announced revisions to the E/M coding system.

Expert systems, machine learning, and algorithm-based solutions are just some examples of how artificial intelligence (AI) is being used in the healthcare industry, and this new taxonomy will help providers categorize them. All of the answers will be placed into one of three categories: assistive, augmentative, or autonomous.

The utilization of virtual care technologies and remote monitoring services in treatment is reflected in the 2023 CPT code set as well.

“The new AI taxonomy establishes foundational definitions and a shared understanding among stakeholders that clearly describes the technical features and performance of AI applications, as well as the work performed by the machine on behalf of the health care professional,” said Resneck. “This shared understanding will help guide the CPT editorial process for describing the range of AI products and services.”

There will be a total of 393 editorial changes to the CPT code set for the coming year. This includes 225 brand-new codes, 75 deleted codes, and 93 adjustments. On January 1, 2023, the new set of medical billing and coding will be implemented.

Implications for Healthcare Businesses

The 2023 CPT code set updates aim to streamline coding and documentation, enhancing accuracy in reimbursement claims while reducing administrative burdens. Healthcare businesses must prepare for changes in E/M coding and documentation criteria initiated in 2021, with the AMA providing valuable resources. AI/AR applications highlight technology’s growing role in healthcare, prompting businesses to consider integration for competitiveness. 

The 2023 CPT code set underscores the importance of virtual care and remote monitoring services, encouraging expansion in these areas. Coding guideline changes in diverse care settings, like nursing homes and emergency care, require businesses to stay informed for compliance. Healthcare businesses must update coding and billing systems to accommodate new codes, involving staff training and system upgrades. With 393 editorial changes in the CPT code set, strategic planning is essential to anticipate impacts on operations, revenue, and compliance efforts.

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Major CPT codes Differences From 2022 for 2023

This year’s revisions to the CPT manual center on making it easier to code for office visits for evaluation and management (E/M). The American Medical Association has long worked to lessen the burdensome paperwork in the medical field that contributes to physician burnout. Exciting new developments are occurring as a result of technological advancements in healthcare, such as the use of artificial intelligence (AI) and virtual reality.

Summary of the New CPT Codes for 2023

Now, we’ll take a look at the exact alterations that will be made to the 2023 code base.

E/M CPT codes represent evaluation and management.

Variations to E/M codes make up a sizable chunk of the revision. CMS recently modified the documentation and coding criteria for E/M visits to reduce administrative burdens and improve the efficiency of the coding process. Alterations will affect not only hospitals but also nursing homes, hospitals, and in-home care.

Artificial Intelligence and Virtual Technologies ICD-10-CM and CPT

The American Medical Association (AMA) is adapting to the rapidly developing field of innovative health care by including a new appendix with a specialized taxonomy for the use of artificial intelligence (AI). With this taxonomy in mind, AI medical services are clearly defined and organized into three classes: assisted, augmented, and autonomous. As such, the AMA intends to lay a solid groundwork and provide a detailed explanation of AI applications’ technical requirements and performance.

As with many other sectors, healthcare has had to change over the past two years as a result of the worldwide COVID-19 outbreak. New and developing applications of virtual reality technology in mental health care and for people with neurodevelopmental disorders are addressed by codes in the 2023 CPT code set. Some patients are even forgoing anesthesia in favor of using virtual reality technology to lessen their discomfort.

CPT codes for the repair of an abdominal hernia

Summing up, fifteen new CPT codes 2023² for anterior abdominal hernia repair services were added (49591-49623). The new classifications account for the fact that hybrid abdominal hernia repairs, which can be performed both fully open and laparoscopically, require different types of reporting. They also discuss using a robot to execute the operation.

How do Third parties help you in medical billing and coding services?

As the healthcare industry continues to evolve, so do the laboratory medical billing and coding challenges that providers face. In an effort to keep up with the changing landscape, many providers are turning to RCM companies for assistance.

Outsource Podiatry medical billing and coding companies that specialize in helping healthcare providers with their revenue cycle management. We understand the RCM challenges that you face and can help you overcome them.

We have a team of experienced professionals who are familiar with the latest changes in the industry and can help you stay compliant. We offer a variety of services that can be customized to meet your specific needs.

Author Bio

Isaac is a content writer at Medcare MSO. He holds a current medical billing & coding certification and is a member of the American Academy of Professional Coders. He has worked in medical billing and coding for over 6 years, working in a wide variety of medical specialties like evaluation/management, physical therapy, mental health, acupuncture, outpatient and inpatient care, nursing home care, radiology, and wound care. Isaac has worked in a provider’s office and for professional medical billing services.

References:

1. References: Jack Resneck Jr., MD, New 2023 CPT code set includes burden-reducing revisions. American Medical Association. (n.d.). from https://www.ama-assn.org/press-center/press-releases/ama-new-2023-cpt-code-set-includes-burden-reducing-revisions
2. References: Intelligent platform. AMA. (n.d.), from https://platform.ama-assn.org/ama/#/products/cpt-standard