EM Coding Alert

2022 may bring many changes to the world, but only a few are hitting evaluation and management (E/M) services.

However, enjoy the lull while it lasts, because 2023 may be a doozy, according to expert analysis of information available so far.

Pocket These 2022 Updates

The descriptor for code 99211 will gain some changes: 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.) (Emphasis added.)

You will also seem some changes to code 99491 (Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements:

• multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
• chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
• comprehensive care plan established, implemented, revised, or monitored; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.) (Emphasis added).

Also, codes 99490 and 99487 will receive a small revision. The word “that” will be added to the code descriptors. For example, 99490 will now be (Chronic care management services with the following required elements:

• multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
• chronic conditions that place the patient at significant risk…). (Emphasis added.)

Further Down the Pike: More Big E/M Changes

The 2023 evaluation and management (E/M) service code changes may be extensive, said Lynn M. Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, during her presentation “Orthopedic Surgery Coding: Present and Future,” at HEALTHCON Regional 2021 in Charleston, South Carolina.

Look Ahead: Updates to Musculoskeletal Guidelines

Evaluation and management (E/M) service code revisions will go big in 2023 — when an anticipated explosion of change occurs in the E/M section of the CPT® manual. “The AMA has said that this is in the proposed schedule … to take effect January 2023,” Anderanin said of the E/M changes.

According to Anderanin’s reading of the AMA proposal, the expected changes include:

• Deletion of observation codes 99217 (Observation care discharge day management) through 99226 (Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity.)
• Revision of 99221 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity.) through 99239 (Hospital discharge day management; more than 30 minutes to include observation and revisions to the guidelines)
• Deletion of consultation codes 99241 (Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making.) and 99251 (Inpatient consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making.), “with revisions to the [consultation] guidelines,” said Anderanin. “Surprisingly, they’re not planning to delete consultation codes entirely; but they do plan on eliminating the level 1s [99241, 99251].”
• Revisions of the guidelines for emergency department (ED), nursing facilities, and prolonged services.