Evaluation and Management (E/M) Services will have updates coming in 2023. The updates will be effective January 1st, 2023. E/M had an overhaul in 2021 with Outpatient services and the following areas will now be following in line.
| E/M service | Proposed changes |
| Inpatient and Observation Care Services | Deletion of the following codes: Observation care discharge: 99217 Initial observation care: 99218-99220 Subsequent observation care: 99224-99226 Revision of the following codes to include observation care services, and revision of subsection headings and guidelines: Initial hospital care: 99221-99223 Subsequent hospital care: 99231-99233 Observation or inpatient care: 99234-99236 Hospital discharge management: 99238-99239 |
| Consultations | Deletion of the following codes: Office or other outpatient consult (lowest level): 99241 Inpatient consultation (lowest level): 99251 Revision of the following codes including headings and guidelines: Office or other outpatient consult: 99242-99245 Inpatient consultation: 99252-99255 |
| Emergency Department Services | Revision of the following codes and guidelines: Emergency department: 99281-99285 |
| Nursing Facility Services | Deletion of the following codes: Other nursing facility services: 99318 Revision of the following codes and subsection guidelines: Initial nursing facility care: 99304-99306 Subsequent nursing facility care: 99307-99310 |
| Home and Residence Services | Deletion of the following codes: Domiciliary, rest home, or custodial care services new patient: 99324-99328 Domiciliary, rest home, or custodial care services established patient: 99334-99337 Domiciliary, rest home, or home care plan oversight: 99339-99340 Home services new patient (moderate to high): 99343 Revision of the following codes including headings and guidelines: Home services new patient: 99341-99345 Home services established patient: 99347-99350 |
| Prolonged Services | Deletion of the following codes: Prolonged service with direct patient contact: 99354-99357 Revision of the following codes including headings and/or guidelines: Prolonged service with or without direct patient contact on the date of an office or other outpatient service: 99417 Cognitive assessment and care plan services: 99483 |
Detailed Overview of Updates:
Inpatient and observation:
The observation services codes will be deleted and language added to the initial and subsequent inpatient services codes to include those observation services.
Consultation:
Very similar to what we saw in 2021 with the deletion of the lower level office and other outpatient services codes, the lower level consultation codes will be deleted with revisions to the headings and guidelines.
Emergency department:
There are language revisions for the code description and revisions in the guidelines will be effective January 1st, 2023.
Nursing facility services:
The annual nursing facility assessment code will be deleted and there will be language revisions of the code description and guidelines for initial and subsequent nursing care codes.
Home and residence services:
This section will overlap with services and locations: domiciliary, rest home, boarding home, assisted living, custodial care, home care plan, and home services. The changes combine all residence locations under one section for home services.
Prolonged services:
Prolonged services codes with direct patient contact (face-to-face) in the outpatient, inpatient and observation setting will be deleted with a revision of the prolonged service with/without direct patient contact on the date of an office or other outpatient service code, 99417.
Please reach out to Shawn Bromley, shawn.m.bromley@lahey.org and/or 978-236-1704 if you would like to set-up an education with your practice/providers to review the new E/M 2023 updates.
2022 OIG Workplan
The OIG regularly updates their website with additional Work Plan Items.
Please click here for the most recently added Work Plan items