Revisions to the Current Procedural Terminology (CPT) codes for Office or Other Outpatient evaluation and management (E/M) (99202-99215) took effect in 2021. The remainder of the E/M sections in the CPT code set will be revised for 2023.
Toward that end, the CPT Editorial Panel revised the five emergency department (ED) E/M codes (99281-99285) to align with the principles included in the Office or Other Outpatient services.
The E/M revisions are intended to simplify coding and documentation requirements for health care providers and improve patient health under the following principles:
- to decrease administrative burden of documentation and coding and align CPT and Centers for Medicare & Medicaid Services (CMS) guidelines whenever possible;
- to decrease the need for audits;
- to decrease documentation in the medical record that is not needed for patient care; and
- to ensure that payment for E/M is resource-based and that there is no direct goal for payment redistribution between specialties.
Following are the key revisions to the ED E/M codes that will become effective with the CPT 2023 code set:
- E/M services in the ED that were selected based on key components (history, examination and medical-decision-making [MDM]) will be selected based on MDM alone for services provided in 2023.
- No distinction will be made between new and established patients in the ED; E/M services in the ED category may be reported for any new or established patient who presents for treatment in the ED.
- Time will not be a descriptive component for the ED levels of E/M services because ED services typically are provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time.
- The highest two of three elements of MDM will be used to select the level of an ED E/M code:
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- Problem(s): the number and complexity of presenting problems;
- Data: the amount and/or complexity of data to be reviewed and analyzed; and
- Risk: The risk of complications and/or morbidity or mortality of patient management.
- The concept of the level of MDM will not apply to code 99281 because this level of service will not require the presence of a physician/other qualified health care professional (QHP).
- All levels of ED service will include a medically appropriate history and examination as determined by the treating physician/QHP.
- As medical necessity will be an overarching criterion for selecting the level of ED E/M service, the physician/QHP will have to consider whether the nature of the presenting problem supports the medical necessity of services rendered.
New ICD-10-CM codes for COVID immunization status
On April 1, the National Center for Health Statistics released several new International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) codes:
- New subcategory: Z28.31 Underimmunization for COVID-19 status (These codes should not be used for individuals who are not eligible for the COVID-19 vaccines, as determined by the health care provider).
- New code: Z28.310 Unvaccinated for COVID-19
- New code: Z28.311 Partially vaccinated for COVID-19
- New code: Z28.39 Other underimmunization status
- ➢Delinquent immunization status
- ➢Lapsed immunization schedule status
