AMA announces 2023 Inpatient E/M Changes

By Roman Petrowski, Office of Communications
Inpatient Billing Code Changes

Photo courtesy of Storyblocks.

Beginning Jan. 1, 2023, the American Medical Association will simplify selecting a code level, making changes to the inpatient setting that make office and facility setting requirements uniform for all physicians and billing practitioners.

To prepare for the changes, the Medical School Healthcare Billing Compliance (MSHBC) department has created a new webpage to spread the word regarding the changes to various code sets.

Leveling options will include:

  • Medical Decision Making (MDM), or
  • Time

Note: for the Emergency Department, time is not a factor in leveling a service. Keep in mind, both medical decision-making and time requirements change according to the code set.

Below is a brief summary of the changes:

  • Deleted Codes:
    • Observation Care codes
    • Level 1 Consultation Codes
    • Deleted – Prolonged Services for the Outpatient setting (other than office)
    • Deleted – Prolonged Services for the Inpatient/Observation setting
  • New Codes:
    • Prolonged Service for Inpatient/Observation setting
  • Revised Codes:
    • Prolonged Service for Outpatient setting
    • Initial, Subsequent, and Hospital Discharge codes to include Observation
    • Admit/Discharge same day services to include Observation
    • Emergency Department Services will be leveled by Medical Decision Making
  • Gray Area: AMA did not address those patients that are neither Hospital Inpatient or Observation Status. Unfortunately, those patient visits will use the OOP/Office code set

For a more comprehensive look at the 2023 Inpatient E/M changes, please see the AMA 2023 E/M Code Descriptors and Guidelines. The descriptors and guidelines also feature a brief video discussing the changes. You can access the presentation, handout, and video in Teams SharePoint or Sway.

The Centers for Medicare & Medicaid Services (CMS) has finalized their CY23 ruling, which can be found here. They will be creating three new Prolonged Service codes to use instead of the AMA’s new CPT codes.

Additionally, the AMA CPT Errata released in Nov. 2022 added +99418, and changing the times for Admit and Discharge Services.

The MSHBC has created an MDM Cheat Sheet and a Time Cheat Sheet for your convenience.

***Links on the MSHBC SharePoint site require a one-time permission if the employee has never logged into Teams.***

For questions or concerns regarding connection issues, please contact Caroline Wolbrecht, CPC, OHCC, compliance education program manager, at [email protected].