2023 changes to E/M coding: What's new?

With a new year come new changes to coding and documentation for evaluation and management (E/M) services. As a result of advocacy from ACP and other specialty societies, national guidance for coding inpatient evaluation and management (E/M) services has been revised to align with earlier reforms to reduce administrative burdens starting Jan. 1. Through our work in the AMA's CPT and RUC processes, the College informed these changes, and in line with our Patients Before Paperwork Initiative, ACP supported the efforts to simplify coding guidelines.

The revised coding and documentation framework is intended to reduce administrative burden by including CPT code descriptor times, revising interpretative guidelines for levels of medical decision making (MDM), and permitting choice of medical decision making or time to select code level. The use of history and exam to determine code level was also eliminated. However, a face-to-face E/M service is still required to report these E/M codes, and a medically appropriate history and physical examination are expected, where medically appropriate.

What does this mean for you? For 2023, the codes for reporting observation care services (99217-99220) will be deleted and observation care services will be merged into the codes previously used to report only inpatient E/M care services (99221-99236, 99238-99239). This set describes three types of service periods and is further classified into three levels of complexity. It is important to note that if you are the admitting physician (even if the patient is known to you from prior admissions or outpatient care), you may still use an initial code to report the first day of your face-to-face professional services provided for that hospital visit. The codes for each type of service day are shown in Table 1. For more information and coding tips, visit our interactive online training program, Coding for Clinicians, which prepares you to code smarter and more efficiently.

In addition, the times assigned to each code capture the total time on the date of the encounter by the calendar date. This includes all necessary patient care services performed on the hospital care date, including time required to document the visit and services performed while not with the patient. These are shown in Table 2.

To help relieve burden from coding and documentation requirements, ACP has created a series of expansive coding resources to inform members of how to secure appropriate compensation. Our Inpatient Services Codes resource makes it easy to select and document appropriate levels of services.

To learn more about how ACP continues working to advocate for improved payment for primary care and how code values are determined through the CPT and RUC processes, watch our Informational Webinar series hosted by the College's Coding and Payment Policy subcommittee. ACP believes these new changes will lead to a significant reduction in administrative burdens, and we encourage members to let us know how these reforms may have helped relieve burden in your practice.