2023 Inpatient E/M Changes

2023 Inpatient E/M changes will simplify selecting a code level. In 2023, the AMA made changes to the inpatient setting that makes office and facility setting requirements uniform.

Leveling options

  • (MDM) Medical Decision Making, or
  • Time

One exception, the (ED) Emergency Department. Time is not a factor for leveling a service in the emergency department. Keep in mind, both medical decision making and time requirements change according to code set.

For example:  MDM leveling starts at the straightforward level in the ED. Whereas the inpatient hospital levels start at Moderate. Pay attention to your patient’s status and healthcare setting.

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 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 AMA 2023 E/M Code Descriptors and Guidelines.  Also available, a brief 18″ video discussing these changes. You can access the presentation handout and video in (internal links) Teams SharePoint or Sway.

CMS has finalized their CY23 ruling, you can find that here. They will be creating (3) new Prolonged Service codes to use instead of the AMA’s new CPT codes. Update:  CMS “corrected” their Prolonged Service time thresholds as of March 14, 2023, and made changes retroactive for January 1. 

AMA CPT Errata just released November 16, 2022 adding +99418, and changing the times for Admit and Discharge services. We have created an (internal) MDM (Cheat Sheet) and Time (Cheat Sheet) for your convenience.

Update:  Novitas has released their 2023 Interactive E/M Score Sheet. The AAPC released a very detailed worksheet this week (January 2023).

Update: CMS just released R11842CP with an implementation date of May 9, 2023.

Update:  NAMAS published a great MDM tool here.

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