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AMA Issues 2023 CPT Code Set in an Effort to Reduce E/M Coding Burden

The AMA– American Medical Association recently published the CPT – Current Procedural Terminology – codes list for 2023, which also includes modifications aimed at lowering the coding load for E/M – Evaluation and Management – visits.

The CPT code system is employed by providers for recording patient visits, along with all services provided, as well as the codes are applied to track utilization, analyse treatment quality and generate health claims for insurer payment. CMS has changed the documentation & coding criteria for E/M visits in order to streamline the procedure and reduce administrative constraints.

In the 2020 Medicare Physician Fee Schedule Final Regulation, CMS changed its code descriptions and reporting criteria under E/M clinic visit CPT codes – 99201-99215, which were approved by an AMA CPT Advisory Board. Beginning in 2021, physicians might record E/M visits according to MDM – Medical Decision-Making or time duration (as opposed to the 1995/1997 E/M documentation standards).

According to AMA, the new 2023 CPT code set includes significant adjustments to the remaining part of the E/M code part.

The method for coding and recording practically all E/M activities is now easier and much more versatile,” AMA President Jack Resneck Jr, MD said, “We really like to make sure that all administrative respite provided by the E/M code modifications benefits healthcare professionals as well as other users.” The AMA is assisting healthcare professionals and [health] organisations in preparing for the upcoming E/M code changes by providing authoritative tools to predict operational, technical, or administrative workflow alterations that will emerge from the upcoming transition.

To comply with updated E/M standards and codes, the AMA amended CPT coding criteria across healthcare settings & services. The modifications by health system and function are as follows:

Table of Contents

Observation & inpatient services

CPT codes for observations (99217-99220 and 99224-99226) are eliminated and replaced with medical services CPT codes (99221-99223, 99231-99233, 99238 and 99239).
While choosing code level, revise the code descriptor that accounts for the layout of overall duration on the date of both the encounter and the extent of decision making.

Continued delivery of updated observation & in-patient healthcare, including as admissions & discharges (CPT codes – 99234 through 99236).

Services for Consultations

The consultation codes will be kept, with minor editorial modifications to the code descriptions.
The AMA has recommended that key standards, such as the notion of “transfer of care,” be removed.
The absolute lowest clinic { 99241 } & in-patient { 99251 } appointment codes are eliminated to coincide with the 4 different levels in MDM.

Services provided by emergency departments

The present notion that time cannot be employed as a primary criterion for code-level selection is retained.
Modifications to code descriptions that adhere to the revised office visit code structure.
MDM levels are adjusted to match with office visits as well as to retain distinct MDM levels for every visit.
Retention of current CPT code numbers.
Allowing critical care to always be reported with ED care for clinical benefit.

Service offered by nursing care facilities

Nursing care facilities’ criteria are now being revised criterion of “Multiple morbidities requiring intensive management” in determination of MDM for the first nursing care facility.
The yearly nursing care facility evaluation code 99318 would be dropped, and future nursing care facility care services – CPT codes: 99307 through 99310 or G-codes in Medicare, can be used to record it.
Newly revised standards allow consultants to utilize initial care codes that are not required to be part of the mandatory admission assessment.

Services for Homes & Residences

Removal of the home-based / rest facility – CPT codes: (99334 – 99340) that have been integrated with the current home visit – CPT codes: (99341 – 99350).
Cancellation of the redundant MDM Level New Patient code – 99343.

According to the AMA, new 2023 CPT code system also contains a new appendix with a classification for artificial intelligence or AI- Augmented Intelligence applications. These modifications to E/M coding are incorporated into the code system. The updated classification provides organizations with assistance for categorising applications that use Artificial Intelligence to fuel medical services, like expert systems, deep machine learning, or algorithm-based approaches. There will be three categories for the options: assistive, augmentative, and autonomous.

Additionally, modifications to the 2023 CPT code system highlight the usage of remote monitoring services and new digital healthcare technology in therapies.

According to Resneck, “The new AI – Artificial Intelligence taxonomy establishes fundamental concepts as well as a mutual understanding between stakeholders, which clearly specifies all technical aspects and functionality of AI applications, in addition to the task done by the device on behalf of the physician.” The editing process for explaining the array of AI services and products will be guided by this unified understanding, as per CPT.

Final Thoughts

A set of 393 editorial modifications, along with 225 new updated codes, 75 removals, & 93 modifications, will be added to the CPT code system for next year- 2023. Starting on January 1, 2023, this code set is going to be used. The CPT 2023 Data File, which is downloadable, allows providers to incorporate the revised code set in their current computer systems.

After considerable modifications in 2021, the remaining E/M code part will be updated within the 2023 – CPT code set, along with revisions to the AI & digital healthcare codes. Do you wish you had more information right now? We will keep updating the content on our Practolytics page. Check out this link to know more about our medical coding services.