The Coding Corner

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