Transforming E/M Coding: AMA's Release of the 2023 CPT Code Set
The American Medical Association (AMA) has recently released the 2023 Current Procedural Terminology (CPT) code set, introducing updates aimed at reducing the medical coding burden associated with evaluation and management (E/M) visits. These revisions align with the changes made by the Centers for Medicare and Medicaid Services (CMS) to streamline the documentation and coding requirements for E/M visits, addressing administrative complexities. Let’s explore the key highlights of the 2023 CPT code set and how they aim to simplify the coding process.
Streamlining E/M Coding
The 2023 CPT code set provides additional revisions to the E/M coding section, building upon the changes implemented in 2021. CMS’s revision of code descriptors and documentation standards for E/M office visit codes allowed providers to document visits based on medical decision-making (MDM) or total time, eliminating the strict adherence to the 1995/1997 E/M documentation guidelines. The new standards also removed patient history and physical exam elements, streamlining the coding process. The 2023 CPT code set further refines these changes to provide a simpler and more flexible coding experience.
Updates by Care Setting
The 2023 CPT code set introduces revisions specific to various care settings and services, aligning with the new E/M coding standards. Here are the key updates:
Inpatient and Observation Care Services
- Deletion of observation codes (99217-99220 and 99224-99226) and their merger into existing hospital care codes (99221-99223, 99231-99233, 99238-99239).
- Revision of code descriptors to account for total time or level of medical decision-making.
- Retention of revised observation or inpatient care services, including admission and discharge services (99234-99236).
- Retention of consultation codes, with some editorial revisions to code descriptors.
- Deletion of certain confusing guidelines, including the definition of “transfer of care.”
- Deletion of lowest-level office (99241) and inpatient (99251) consultation codes to align with four levels of MDM.
Emergency Department Services
- Retention of the existing principle that time cannot be used as a key criterion for code-level selection.
- Revisions to code descriptors to reflect the code structure approved in the office visit revisions.
- Modified MDM levels to align with office visits and maintain unique MDM levels for each visit.
- Retention of existing CPT code numbers.
Nursing Facility Services
- Revision to nursing facility guidelines with a new “problem addressed” definition of “multiple morbidities requiring intensive management,” considered at the high level for initial nursing facility care.
- Deletion of code 99318 (annual nursing facility assessment), which will now be reported through subsequent nursing facility care services (99307-99310) or Medicare G codes.
- Updated standard so not all “initial care” codes are the mandated comprehensive “admission assessment” and may be used by consultants.
- Allowance of the use of subsequent visit codes when the principal physician’s team member performs care before the required comprehensive assessment.
Home and Residence Services
- Deletion of domiciliary or rest home codes (99334-99340), which have been merged with existing home visit codes (99341-99350).
- Elimination of duplicate MDM Level New Patient code (99343).
- Deletion of direct patient contact prolonged service codes (99354-99357), to be reported through the office prolonged service code (99417) or the new inpatient, observation, or nursing facility service code (993X0).
- Creation of a new code (993X0) analogous to the office visit prolonged services code (99417).
- Retention of codes 99358 and 99359 for use on dates other than the date of any reported “total time on the date of the encounter” service.
AI Taxonomy and Virtual Care Technology
The 2023 CPT code set introduces an appendix featuring a taxonomy for artificial intelligence/augmented intelligence (AI) applications. This taxonomy provides guidance for classifying AI-powered medical services applications, such as expert systems, machine learning, or algorithm-based solutions. The taxonomy classifies these solutions as assistive, augmentative, or autonomous, ensuring a shared understanding among stakeholders.
Additionally, the 2023 code set reflects emerging virtual care technology and remote monitoring services in therapy. These additions recognize the evolving landscape of healthcare delivery, enabling providers to accurately code and bill for virtual care services and remote patient monitoring.
Why does your healthcare organization need to focus on these updates?
The 2023 CPT code set introduces significant updates to simplify the coding process, particularly for E/M visits. The revisions align with CMS changes and offer greater flexibility and efficiency in documenting patient encounters. By incorporating an AI taxonomy and accounting for emerging technologies, the AMA demonstrates its commitment to staying at the forefront of healthcare advancements.
To ensure accurate coding and reimbursement, healthcare providers and organizations should familiarize themselves with the 2023 CPT code set. The AMA provides authoritative resources to support a seamless transition and anticipates the operational adjustments resulting from these coding changes.
With 393 editorial changes, including new codes, deletions, and revisions, the 2023 CPT code set becomes effective on January 1, 2023. Providers can integrate the updated code set into their existing IT systems using the downloadable CPT 2023 Data File.
Ultimately, these streamlined coding updates contribute to more efficient and precise documentation and billing practices, benefiting healthcare providers, payers, and patients alike.
Solutions to keep up with 2023 coding changes:
Most healthcare organizations struggle to keep up with these coding changes and often make mistakes during billing and receive more than 60% of coding-related claim denials. Some of the innovative solutions that can help your healthcare organization to streamline coding are:
Even though you have an in-house coding team they do not have the time to constantly keep an eye on CMS and other federal agencies coding changes. This is mainly because of your high patient volume and meeting the target of submitting those claims within the timely filing limits of the payors.
Hiring a third-party revenue cycle management company that has coding trainers, auditors, and AAPC-certified coders can increase the quality output of claims and reduce denials. Healthcare providers and leaders reduce costs and increase collections simultaneously.
Use AI and Automation (RPA)
Coding AI and Automation (RPA) can eliminate coding errors and denials, it is crucial for optimizing revenue and ensuring accurate reimbursement. Additionally, reducing costs and increasing productivity are key objectives for healthcare organizations. Advanced robotic process automation (RPA) coding technology, powered by AI and automation, offers an efficient and accurate solution to address these challenges.
Enhanced Accuracy and Efficiency
AI-driven RPA coding technology utilizes advanced algorithms to identify, document, and code medical services and procedures accurately. With configurable ICD parsers, it can identify various medical conditions, including abbreviations and combinations. By incorporating the latest updates from CMS, these bots ensure compliance with coding standards and minimize errors, reducing the risk of coding-related denials.
Comprehensive Support for Coding Requirements
AI-powered coding solutions support both ACA Commercial and Medicare Advantage lines, including CMS-HCC for Part C and RxHCC for Part D. These tools maintain up-to-date databases of ICD-9 and ICD-10 codes, ensuring accurate coding and reducing the chances of errors. By providing comprehensive coding support, AI and automation contribute to improved documentation accuracy and coding efficiency.
Increased Productivity and Faster Turnaround Time
The intuitive nature of Automated coding bots enables quick adoption by coding professionals. By pre-populating charts and providing an informed head start, these bots enhance productivity and efficiency. As a result, healthcare organizations can experience productivity gains of up to 90%. Moreover, AI-powered optical character recognition (OCR) technology converts medical records into XML schemas, enabling faster processing and producing results with low turnaround time (TAT).
Streamlined Workflow and Cost Reduction
RPA-assisted coding bots streamline the coding process by automatically populating charts with relevant information extracted from medical records and charts. This reduces manual data entry, saving time and eliminating transcription errors. As a result, healthcare organizations can significantly reduce costs compared to hiring multiple AAPC-certified coders while maintaining coding accuracy and compliance.
It is Time to Evolve your Healthcare Organization’s Coding Approach
The evolving E&M coding landscape requires healthcare organizations to adapt quickly and accurately. By harnessing the power of AI and automation or hiring expert medical coding resources, healthcare organizations can navigate these changes seamlessly.
The combination of AI’s analytical capabilities and automation’s efficiency with certified, skilled third-party coding staff empowers healthcare organizations to maintain compliance, streamline documentation processes, stay updated with coding guidelines, and leverage data analytics for continuous improvement. Embracing AI and automation or hiring expert coding staff in E&M coding ensures organizations can deliver quality care while optimizing revenue capture and operational performance.