Ample changes were made to how organizations will report observation services and more starting in 2023.
The American Medical Association (AMA) released new evaluation and management (E/M) coding guidelines that will be included in the 2023 CPT manual and take effect January 1, 2023.
Beginning January 1, the CPT coding format for office and other outpatient visits will apply to hospital inpatient and observation visits, consults, and services in the emergency department, nursing facility, home, and residence, according to Part B News.
As a result, history and physical examination will no longer contribute to the level for these visits. Instead, for most visits practices will select codes based on medical decision-making (MDM) or time. The only exception will be emergency department visits, which will be MDM-only because the codes do not have a time component.
Among the most radical changes, Part B News says the AMA plans to delete all observation care codes and merge observation services with initial and subsequent hospital care codes.
The guidelines also include a revised definition of "New and Established Patients" that includes this addition: "In the instance where a physician or other qualified health care professional is on call for or covering for another physician or qualified health care professional, the patient’s encounter will be classified as it would have been by the physician or qualified health care professional who is not available."
According to Part B News, you’ll also find a new definition of "Initial and Subsequent Services" for patients who have been admitted to hospital inpatient, observation, or nursing facilities. In effect, the initial care codes apply when the patient has received no face-to-face services "from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, during the inpatient, observation, or nursing facility admission and stay," the guidelines state.
The update includes revisions to the MDM chart. Under low complexity of problems addressed, "1 acute, uncomplicated illness or injury requiring hospital inpatient or observation level of care," will be added to the list. In addition, there are two revisions to the examples for high risk of morbidity. Parenteral controlled substances will be added to the list of examples and "Decision regarding hospitalization" will be revised to "Decision regarding hospitalization or escalation of hospital-level care."
For even more on these updates, read Part B News’ coverage.
Amanda Norris is the Director of Content for HealthLeaders.