Get Ready for the CPT E/M Codes Changes in 2023
The New Year means medical practices must be ready for new code and guideline changes regarding CPT Evaluation and Management (E/M).
The American Medical Association (AMA) released the guidelines regarding these medical codes effective January 1, 2023. Practices must be aware of them to prevent payment delays and run their businesses smoothly.
These changes include 225 new codes, 75 deletions, and 93 revisions. According to the AMA, “the CPT code set continues to grow and evolve with the rapid pace of innovation in medical science and health technology.”
Here is a quick review of some of the 2023 E/M code changes to get your practice ready:
New 2023 CPT Codes
In the Radiology section, there is only one new code (76883), which describes an ultrasound of the nerves and accompanying structures in one extremity.
Regarding Pathology and Laboratory, there are 11 new codes:
- To describe targeted genomic sequence analyses: 81449, 81451, and 81456.
- To describe various infectious agent detections using DNA or RNA: 87468, 87469, 87478, 87484.
- For drug metabolism analysis using a genomic sequence: 81418.
- Detection of inherited bone marrow failure syndromes (IBMFS): 81441.
- Detection of the thiopurine S-methyltransferase (TPMT) enzyme: 84433.
- Detection of the hepatitis B surface antigen: 87467.
This section also includes three revised codes (81445, 81450, and 81455) to move the placement of some examples and descriptive wording within the descriptors.
Also, ten new codes have been added to the Medicine section. These include three codes (93569 and 93573-93575) as add-on codes describing injection procedures for angiographies during cardiac catheterizations and two codes (96202 and 96203) for multiple-family group behavior management/modification training for parents, guardians, or caregivers of patients with a mental or physical health diagnosis.
These new codes also include additional codes to describe the respiratory syncytial vaccine (90678), orthoptic training (92066), quantitative pupillometry (95919), and remote therapeutic monitoring for cognitive behavioral therapy (98978).
In Surgery, there are new codes in several subsections:
- Integumentary system: 15778, 15853, and 15854.
- Musculoskeletal system: 22860.
- Respiratory system: 30469.
- Cardiovascular system: 33900-33904 and 36836-36837.
- Digestive system: 43290, 433291, 49591-49596, 49621-49623.
- Male genital system: 55867.
- Nervous system: 69728-69730.
There are 46 new Category III codes representing various new and emerging services.
Revised 2023 CPT Codes
The addition or deletion of CPT codes requires the AMA to revise the descriptors of several other regulations in the E/M section, such as:
- Hospital Inpatient Services: Initial hospital care codes 99221-99223, subsequent hospital care codes 99231-99233, observation or inpatient care services codes 99234-99236, and hospital discharge services codes 99238-99239 are revised to include “inpatient or observation care.”
- Office or Other Outpatient Consultation: codes 99242-99245 and inpatient consultation codes 99252-99255 are revised to include “office or other outpatient consultation.”
Revisions to other codes are for keeping with AMA’s guideline changes for E/M leveling using time or medical decision-making (MDM). Regarding these revisions, the emergency department codes 99281-99285, initial and subsequent nursing facility care codes 99304-99310, and home services codes 99341-99342, 99344-99350 are revised to require a medically appropriate history “and/or” exam and MDM, instead of all three key components.
Regarding Radiology, five codes (76882, 78803, and 78830-78832) have been revised to include clarifying words to the long descriptors. Also, Pathology contains revisions to codes 81445, 81450, and 81455.
The Medicine section includes seven revisions regarding the 92065, 92229, 92284, 93568, and 98975-98977 codes. Surgery includes modifications for codes 15851, 22857, 27280, 35883, 50080, 50081, 69716-69717, and 69726-69727.
Other revisions include home visit codes to include “residence” as a place of service, changes to the total time to meet when using time for code selection, minor clarifying word changes that have been made to the prolonged outpatient E/M service add-on code, and more.
Deleted 2023 CPT Codes
Many observation codes were deleted due to the consolidation of inpatient and observation E/M codes in CY 2023. Other deleted codes include domiciliary or rest home and prolonged service codes.
Other deleted codes include:
- Hospital Observation Services: 99217, 99218-99220, and 99224-99226.
- Consultations: 9924 and 99251.
- Other nursing facility services: 99318.
- Domiciliary, rest home, or home care plan oversight: 99339, 99340, 99334-99337, and 99324-99328.
- Home Services: 99343.
- Prolonged Services: 99354-99357.
For Surgery, the AMA deleted 18 codes that described the repair of various types of hernias. Category III includes 23 code deletions. Services represented by these codes may have either graduated to become Category I codes or were deemed obsolete. Laparoscopy codes 49652-49657 were also deleted.
Read the complete guideline changes here.
Learn how to keep up with these coding changes, increase revenue and optimize cash flow. At AdvantEdge, we understand that coding is one of the most critical functions of the billing process.
Counting on our AdvantEdge Coding Services can allow you access to coding audits, education, and compliance training. Our coding team will work as your own. We will ensure we develop a comprehensive coding workflow analysis and implementation adapted to your practice’s needs.
Contact an AdvantEdge expert, or stay up to date on company and industry trends by visiting our Linkedin page.