Key changes to 2023 CPT® E/M codes and guidelines

Editor's note: MGMA members enjoy exclusive access to a Medicare Physician Fee Schedule Tool, analysis of the 2023 Medicare Physician Fee Schedule final rule, a Work RVU Variance Calculator, and even more resources around 2023 medical coding updates in the 2023 Medical Coding and Billing Toolkit.

The American Medical Association (AMA) published many changes impacting CPT® E/M codes and guidelines, taking effect Jan. 1, 2023. There are 25 deleted codes and many revisions to codes and guidelines in five code categories.

Keep these four points in mind when preparing for these upcoming changes:

1. Medical decision making (MDM) tables are revised in which acuity or chronicity rather than quantity of disease/illness is addressed as complexity.
2. Time-based coding is updated on many codes.
3. Update the EHR to reflect deletions and revisions.
4. Pay close attention to amended guidelines noted in the E/M section of the CPT® manual.

Here is an overview of what the AMA has instructed on E/M codes in 2023. Click here (PDF) for the AMA’s full overview of these changes.

Hospital Observation

• Deletion of Hospital Observation Services E/M codes 99217-99220
• Revision of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 and guidelines
• Amendments to codes 99234-99236 contain changes to total time on the date of the encounter and MDM affecting level of service. 

Consultations

• Deletion of Consultations E/M codes 99241 and 99251
• Revision of Consultations E/M codes 99242-99245, 99252-99255 and guidelines
• Language in the E/M guidelines stating “transfer of care” is removed
• E/M consultation codes 99421 (outpatient) and 99251 (inpatient) consultation are deleted
  • Remember: Consultations must be requested by another healthcare professional and coded only once per stay as well as specialty/group.

Emergency Department Services

• Revision of Emergency Department Services E/M codes 99281-99285 and guidelines
• Code 99281 does not require the presence of a physician or a qualified healthcare professional

Nursing Facilities, Domiciliary, Home/Residence Services

• Deletion of Nursing Facility Services E/M code 99318
• Revision of Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines
• Deletion of Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334-99337, 99339, 99340
• Deletion of Home or Residence Services E/M code 99343
• Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines
• Modifiers may be reported to identify the role of the physician or qualified healthcare professional performing the services.

Prolonged Services

• Deletion of Prolonged Services E/M codes 99354-99357
• Revision of guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416
• Revision of Prolonged Services E/M code 99417 and guidelines
• Establishment of Prolonged Services E/M code 993X0 and guidelines
• Codes 99415-99415 are not payable by Medicare. Use appropriate G codes.