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Exciting Updates on Continued Evaluation and Management Changes for 2023
The process by which office and other outpatient evaluation and management (E&M) levels (CPT® 99202 – 99215) are selected was changed by the American Medical Association (AMA) CPT® Editorial Panel effective January 1, 2021.[1] This welcome change resulted in the removal of barriers that made it difficult for some specialists to reach higher level office and other outpatient E&M levels. Effective January 1, 2023,[2] under the guidance of the AMA CPT Editorial Panel, these same changes will also be applied to the method used to select the level of these E&M service types:
- Hospital Inpatient and Observation Care
- Consultation
- Emergency Department
- Nursing Facility
- Home or Residence
With this change, one will select the levels of office or other outpatient, hospital inpatient and observation care, consultation, emergency department, nursing facility, and home or residence E&M services based on medical decision making only or total time only.
Medical Decision Making
Effective January 1, 2023,2 when using medical decision making to determine the E&M level for any of these E&M types, the four medical decision making levels are:
- Straightforward Medical Decision Making
- Low Medical Decision Making
- Moderate Medical Decision Making
- High Medical Decision Making
When choosing the E&M level based on medical decision making, three elements of medical decision making are considered:
- Number and Complexity of Problems Addressed
- Amount and/or Complexity of Data to be Reviewed and Analyzed
- Risk of Complications and/or Morbidity or Mortality of Patient Management
Effective January 1, 2023,2 each of these E&M types will have its own thresholds of those three medical decision making elements. When reviewing an encounter, if what was medically necessary, performed, and documented meets the thresholds of 2 of a level’s 3 elements, that E&M level may be selected. AMA CPT shares the details of each of those thresholds here: https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf .
Total Time
Effective January 1, 2023,2 when using time to determine the E&M level for any of these E&M types, one will consider the total time spent by the provider performing the evaluation and management on the calendar date of the encounter. Each of the CPT code descriptors for the E&M types listed in this article includes a time value in minutes.
Current Procedural Terminology (CPT®) is copyright 1966, 1970, 1973, 1977, 1981, 1983-2021 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
Dr. Lehrman operates Lehrman Consulting, LLC and is a Certified Professional Coder and Certified Professional Medical Auditor. Follow him on Twitter @DrLehrman.
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1. American Medical Association CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99417) Code and Guideline Changes. Available at: https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf . Accessed September 21, 2022.
2. American Medical Association. CPT Evaluation and Management (E/M) Code and Guideline Changes. Available at: https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf . Accessed September 21, 2022.
