The Healthcare industry is constantly changing, and its regulations on billing are no different. The American Medical Association (AMA) released updates to the Current Procedural Terminology (CPT) code set for 2023. The main goal of the updates is to simplify the codes and guidelines for evaluation and management (E/M) services.  

In 2021, the updates made to the E/M codes were focused on office visits. The new modifications for 2023 are broadened to consultations, emergency department services, home and residence services, prolonged services, nursing facility services, and inpatient and observation care services.  

“We want to ensure that physicians and other users get the full benefit of the administrative relief from the E/M code revisions. The AMA is helping physicians and health care organizations prepare now for the E/M coding changes and offers authoritative resources to anticipate the operational, infrastructural and administrative workflow adjustments that will result from the pending transition”, said AMA President Jack Resneck Jr., M.D. 

The Evaluation Management section has one addition, 50 revisions, and 26 deletions. The code that will be added (99418) represents prolonged inpatient or observation E/M services. A few of the revisions are as follows: 

  • Clarifying hospital Evaluation Management codes to include “inpatient or observation.” 
  • Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 and guidelines 
  • Consultations E/M codes 99242-99245, 99252-99255 and guidelines 
  • Emergency Department Services E/M codes 99281-99285 and guidelines 
  • Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines 
  • Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines 
  • Guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416 
  • Prolonged Services E/M code 99417 and guidelines 

Additionally, with technological advancements, there will be a taxonomy for artificial intelligence (AI). This taxonomy will establish the machines’ definitions, descriptions, and performance for all AI applications. There will also be additions for new medical services that use virtual reality technology in therapy and procedural dissociation services instead of anesthesia.  

In total, there will be 225 new codes, 75 deletions, and 93 revisions released on January 1, 2023. The AMA has additional resources on how to implement these new codes and changes, as well as summaries of the revisions.  

If you’re following these industry changes and still have issues with your billing, it may be time to call MedCycle Solutions. Read more about MedCycle Solution’s broad list of services