Knowing, understanding, and properly utilizing codes is essential for any medical practice or hospital system. This most recent article from Larsen Billing highlights 2023 coding changes and how those changes affect your billing practices.
Understanding Coding Changes in 2023
Each year, codes change to identify better and encompass areas of patient care and services rendered. Every practice is responsible for keeping up with these changes, so claims are submitted and processed correctly. However, managing coding changes takes time and energy. If your team doesn’t stay on top of these changes, you put yourself at risk for claim denials, incorrect compensation, and, at worst, fraud.
Partnering with a professional and extensive medical billing service like Larsen Billing ensures your codes are accurate and up to date. Our team exists to streamline the claims process, submitting correct codes the first time around. As we explore the significant coding changes of 2023, know that the team at Larsen Billing has the talent and expertise to ensure accurate, complete coding and claims management for your practice, and we can start today. Read on to learn about the significant medical billing and coding changes in 2023 and how to optimize these changes for your practice.
Update to the ED Evaluation and Management Guidelines
Hospitals and medical practices must stay updated with medical coding changes. Selecting correct codes ensures your practice is compensated fairly and appropriately for services rendered to your patients.
Coding changes occur annually. Of these updates, perhaps the most significant change in 2023 is the Emergency Department Evaluation and Management Guidelines update. An important thing to note is the removal of the history and exam documentation requirements. Previously, higher acuity cases required comprehensive documentation that included:
- Four elements in the History of Present Illness (HPI)
- Ten elements in the Review of Systems (ROS)
- At least two past medical history, social history, and/or family history elements (PFSH)
- Eight organ system elements for the exam
The new 2023 guidelines stipulate that providers are required to document a medically appropriate history and exam. The providers themselves determine what they feel is medically appropriate.
Below is a table of 2023 Emergency Department E/M code definitions.
|99281||ED visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional|
|99282||ED visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making|
|99283||ED visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low medical decision making|
|99284||ED visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate medical decision making|
|99285||ED visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high medical decision making|
Here are 2023 deleted E/M codes:
|99241, 99251||Consultation codes|
|99324-99328, 99334-99337, 99339, 99340||Domiciliary, rest home, or custodial care services|
|99318||Nursing facility code|
|99343||Home or resident services|
|99217-99220, 99224-99226||Hospital observation service codes|
|99354-99357||Prolonged service codes|
This change in documentation requirements will allow providers to focus more heavily on patient care rather than counting elements to meet the level of medical decision-making required in the past.
Often, a provider in an ED will see a patient and may initially believe it’s a low-acuity situation. As they evaluate and examine the patient, they may realize it’s a more complex situation than initially thought. Many providers may not consider reviewing charts and adding more ROS elements or elements of HPI, etc. In that case, the ultimate level of service may have been undervalued because they didn’t include enough documentation elements.
With the changes in the new guidelines, providers don’t have to worry about counting elements as they did in the past. They can instead focus on caring for the patient and documenting what they feel is medically appropriate.
Level of Service Based on Medical Decision Making
Coding guidelines utilize the same elements previously used to score medical decision-making. But they have also expanded to include items such as:
- Consideration of admission, even if the patient is ultimately discharged
- Consideration of tests, even if the tests aren’t performed
- Consideration of prescription medications, even if they were not eventually given to the patient
According to updated coding guidelines, providers now get credit for the thought process in caring for patients, not only the actions they took to care for patients. In addition, coding now includes thought processes, considerations, and tests, which value the chart.
We’ve also included the 2023 Prolonged Service Codes and deleted code sets in the table below.
2023 Prolonged Service Codes
|99417||Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time|
|99418||Prolonged inpatient or observation evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time|
Changes in Codes used for Observation
In the past, providers used code sets 99217-99220 and 99224-99226 to value patient observation. Starting Jan 1, 2023, these codes have been deleted.
Descriptions for existing code sets for inpatient care have been expanded to include observation care. Some providers misunderstand these changes, assuming codes for observations have been eliminated. Providers still utilize observation as a tool when caring for their patients. That service is simply under a different code set now.
Observations include care for patients where there’s diagnostic uncertainty. In these situations, providers need to perform more testing and monitoring before deciding to discharge patients or admit them to the hospital.
Observation is a crucial tool for providers, especially those working in the ED, as they determine how to disposition their patients. The mechanism for observation is not going away. It has merely been revised under a different code set.
Below is a table outlining coding changes for observation services in 2023.
2023 Hospital Inpatient and Observation Care Services
|Visit Type||CPT® Code||Time (Minutes)||MDM|
|Initial||99221||40||Straightforward or low|
|Subsequent||99231||25||Straightforward or low|
|Same-day||99234||45||Straightforward or low|
|99239||< 30||(Time-based code)|
The important takeaway from these changes in observation codes is that observation is still included in patient care. The guideline changes in 2023 have categorized it under codes we already had, ultimately simplifying the coding process for the provider.
Never Miss a Coding Change
Keeping up with coding changes –– in addition to responsibilities associated with patient care –– can feel overwhelming, if not impossible. But staying abreast of these updates is essential to properly file claims, reduce denials, and mitigate fraud risk.
The team at Larsen Billing specializes in coding, compliance, and medical claims, so you don’t have to. Instead, we handle your claims so you can dedicate your time and energy to your patients, not keeping up with coding changes.
Our talented, experienced team is here to take on your medical billing responsibilities, so you can do what you best: deliver optimal patient care. Reach out today to learn how Larsen Billing can provide your practice with the coding and billing services you need!