There are many additions and updates to the CPT E/M guidelines and here is a link to the 2023 CPT E/M Descriptors and Guidelines.
If you are coding and/or auditing evaluation and management services, you really should print the AMA document and keep it handy.
These critical updates/revisions are effective as of January 1, 2023.
If you work for or contract with a computer-assisted coding or an encoder vendor, make sure they are updating and testing their systems now.
Deleted Codes:
• Observation Care Discharge Services (99217)
As of January 1, 2023, assign Hospital Discharge Services 99238 or 99239 for observation care discharge services
• Initial Observation Care (99218-99220)
As of January 1, 2023, assign Initial Hospital Care 99221-99223 for initial observation care
• Subsequent Observation Care (99224-99226)
As of January 1, 2023, assign Subsequent Hospital Care 99231-99233 for initial observation care
• Office or Other Outpatient Consultations (99241)
As of January 1, 2023, assign 99242-99245
• Inpatient or Observation Consultations (99251)
As of January 1, 2023, assign 99252-99255
• Other Nursing Facility Services (99318)
As of January 1, 2023, assign 99307-99310
• Domiciliary, Rest Home, or Custodial Care Services – New Patient (99324-99328)
• Domiciliary, Rest Home, or Custodial Care Services – Established Patient (99334-99337)
As of January 1, 2023, assign 99341, 99342, 99344, or 99345 (new patient)
As of January 1, 2023, assign 99347-99350 (established patient)
• Domiciliary, Rest Home, or Home Care Plan Oversight Services (99339, 99340)
As of January 1, 2023, assign 99347, 99491 or 99424, 99425
• Prolonged Services – Outpatient (99354, 99355)
As of January 1, 2023, assign 99417
• Prolonged Services – Inpatient, Observation, or Nursing Facility (99356, 99357)
As of January 1, 2023, assign 993X0
New Code:
• 993X0
This is a new add-on code for 2023 to report prolonged service time for inpatient or observation with or without direct patient contact. This code is to be reported in addition to 99223, 99233, 99236, 99255, 99306, and 99310.
Revised Codes Descriptions:
The following categories are revised to align with the 2021 code structure for office visits.
Effective as of January 1, 2023, these categories will only require a medically appropriate history and/or examination. The E/M level will be assigned based upon the level of Medical Decision Making or Time except for Emergency Department Services where time is not a factor.
Note the 2023 changes in Time for each E/M level!
• Initial Hospital Inpatient or Observation Care (99221-99223)
99221 – 40 minutes
99222 – 55 minutes
99223 – 75 minutes
Services 90 minutes or longer, use prolonged services codes
• Subsequent Hospital Inpatient or Observation Care (99231-99233)
99231 – 25 minutes
99232 – 35 minutes
99233 – 50 minutes
Services 65 minutes or longer, use prolonged services codes
• Hospital Inpatient or Observation Care Services – Including Admission and Discharge Services (99234-99236)
99234 – 45 minutes
99235 – 75 minutes
99236 – 85 minutes
Services 100 minutes or longer, use prolonged services codes
• Office or Other Outpatient Consultations
99242 – 20 minutes
99243 – 30 minutes
99244 – 40 minutes
99245 – 55 minutes
Services 70 minutes or longer, use prolonged services code 99417
• Inpatient or Observation Consultations
99252 – 35 minutes
99253 – 45 minutes
99254 – 60 minutes
99255 – 80 minutes
Services 95 minutes or longer, use prolonged services codes
• Initial Nursing Facility Care
99304 – 25 minutes
99305 – 35 minutes
99306 – 45 minutes
Services 60 minutes or longer, use prolonged services codes
• Subsequent Nursing Facility Care
99307 – 10 minutes
99308 – 15 minutes
99309 – 30 minutes
99310 – 45 minutes
Services 60 minutes or longer, use prolonged services codes
• Home or Residence Services – New Patient
99341 – 15 minutes
99342 – 30 minutes
99343 – This code is not listed in the updates as deleted or revised. Stay tuned for the Addendum
99344 – 60 minutes
99345 – 75 minutes
Services 90 minutes or longer, use prolonged services code 99417
• Home or Residence Services – Established Patient
99347 – 20 minutes
99348 – 30 minutes
99349 – 40 minutes
99350 – 60 minutes
Services 75 minutes or longer, use prolonged services code 99417
• Emergency Department Services (99281-99285)
Time is NOT a descriptive component for services in the Emergency Department. The overall level of E/M services will be based upon the level of Medical Decision Making.
Effective January 1, 2023, some of the descriptors for the levels of Medical Decision Making will be revised:
99281 – was Straightforward MDM. For 2023, the descriptor is “may not require the presence of a physician or other qualified health care professional”
99282 – was Low complexity MDM. For 2023, the descriptor is Straightforward MDM
99283 – was Moderate MDM. For 2023, the descriptor is Low MDM
99284 – was and will remain Moderate MDM for 2023
99285 – was and will remain High MDM for 2023
Coffee With a Medical Coding Auditor 