Orthopedic Coding Alert

If you thought 2021 was a doozy for evaluation and management (E/M) coding changes, wait until 2023.

That’s the impression given what’s coming down the pike. During her presentation “Orthopedic Surgery Coding: Present and Future,” HEALTHCON Regional 2021 in Charleston, South Carolina, Lynn M. Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, didn’t just focus on 2021 in her presentation. She also gave a heads-up about what’s going down at the AMA for 2022 and beyond.

Here’s what she had to say about the near future in the orthopedic coding world.

The Future: Updates to Musculoskeletal Guidelines

For 2022, CPT^® has “accepted revision of the introductory guidelines for Manipulation in the Musculoskeletal System section to more clearly define restorative treatment services,” she reported. This is scheduled to be a guideline change that should help with fracture care treatments, said Anderanin, senior director of coding education at Healthcare Information Services in Park Ridge, Illinois.

We will report more on these updated guidelines as information becomes available.

The Future: More Big E/M Changes

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)
• 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.

Stay tuned: Nothing is set in stone for E/M changes in 2023 — but you can bet that big news is coming. Look for more information on potential 2023 E/M changes in future issues of Orthopedic Coding Alert