2023 E/M Coding Changes

Summary of the Changes

• • E/M Introductory Guidelines related to the following:
  • ○ Hospital Inpatient and Observation Care Services codes 99221-99223, 99231-99239
  • ○ Consultations codes 99242- 99245, 99252-99255
  • ○ Emergency Department Services codes 99281-99285
  • ○ Nursing Facility Services codes 99304-99310, 99315, 99316
  • ○ Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350
• • 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
• • Deletion of Consultations E/M codes 99241 and 99251
• • Revision of Consultations E/M codes 99242-99245, 99252-99255 and guidelines
• • Revision of Emergency Department Services E/M codes 99281-99285 and guidelines
• • 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 (eg, Boarding Home), or Custodial Care Services E/M  codes 99324-99328, 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

Here Come the Changes

• • An initial service may be reported when the patient has not received any professional 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 stay.

Initial Hospital Inpatient or Observation Care New or Established Patient

• • 99221 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low-level medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
• • 99222 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
• • 99223 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
• • (For services of 90 minutes or longer, use prolonged services code 993X0)

Subsequent Hospital Inpatient or Observation Status

• • 99231 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
• • 99232 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
• • 99233 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
• • (For services of 65 minutes or longer, use prolonged services code 993X0)

Hospital Inpatient or Observation Care Services (Including Admission and Discharge Services)

• • 99234 Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
• • 99235 Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded.
• • 99236 Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 85 minutes must be met or exceeded.
•  • (For services of 100 minutes or longer, use prolonged services code 993X0)

Hospital Inpatient or Observation Discharge Services

• • 99238 Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter
• • 99239 more than 30 minutes on the date of the encounter
• • (For hospital inpatient or observation care including the admission and discharge of the patient on the same date, see 99234, 99235, 99236

Inpatient or Observation Consultations New or Established Patient

• • 99252 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.          
  • ○ When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
• • 99253 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making.      
  • ○ When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
• • 99254 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.           
  • ○ When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
• • 99255 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making.      
  • ○ When using total time on the date of the encounter for code selection, 80 minutes must be met or exceeded
• • (For services 95 minutes or longer, use prolonged services code 993X0)

Emergency Department Services

• • Time is not a descriptive component for the emergency department levels of E/M services because emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time.
• • Emergency Department Classification of New vs Established Patient
  • ○ No distinction is made between new and established patients in the emergency department. E/M services in the emergency department category may be reported for any new or established patient who presents for treatment in the emergency department.
• • 99281 Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional
• • 99282 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
• • 99283 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making
• • 99284 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making
• • 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making

Nursing Facility Services

• • The following codes are used to report evaluation and management services to patients in nursing facilities and skilled nursing facilities. These codes should also be used to report evaluation and management services provided to a patient in a psychiatric residential treatment center and immediate care facility for individuals with intellectual disabilities.
• • 99304 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
• • 99305 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
• • 99306 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
• • (For services 60 minutes or longer, use prolonged services code 993X0)
• • 99307 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
• • 99308 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
• • 99309 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
• • 99310 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
• • (For services 60 minutes or longer, use prolonged services code 993X0)

Home or Residence Services

• • Deletion of Domiciliary, rest Home (eg Boarding Home), or Custodial Care Services E/M codes 99324-99328, 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
• • The following codes are used to report evaluation and management services provided in a home or residence. Home may be defined as a private residence, temporary lodging, or short-term accommodation (eg, hotel, campground, hostel, or cruise ship)
• • These codes are also used when the residence is an assisted living facility, group home (that is not licensed as an intermediate care facility for individuals with intellectual disabilities), custodial care facility, or residential substance abuse treatment facility.
• • 99341 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straight forward medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
• • 99342 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
• • (99343 has been deleted. To report, see 99341, 99342, 99344, 99345)
• • 99344 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
• • 99345 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
• • (For services 90 minutes or longer, see prolonged services code 99417)
• • 99347 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
• • 99348 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
• • 99349 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
• • 99350 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making.
  • ○ When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
• • (For services 75 minutes or longer, see prolonged services code 99417)

Michael G. Warshaw

DPM, CPC

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