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Revisions to hospital E/M codes to take effect in 2023

July 1, 2022

Hospital evaluation and management (E/M) codes are among the Current Procedural Terminology (CPT) codes that will be revised for 2023.

Following are the key revisions to the hospital E/M codes that will become effective with the CPT 2023 code set:

  • Observation E/M codes 99217, 99218-99220 and 99224-99226 will be deleted.
  • Codes 99221-99223, 99231-99233 and 99238-99239 will be revised to describe E/M services to patients in either hospital inpatient or observation status. Though E/M codes for hospital inpatient and observation care will be combined, admission orders must distinctly designate the patient’s admission status, as this may be important for payer coverage and payment rates. Similarly, when a patient transitions from observation to inpatient status, an order for inpatient admission must be documented clearly in the patient record.
  • Codes 99234-99236 will be revised to mirror the code descriptor language applicable to all inpatient or observation E/M services.
  • Consultation code 99251 will be deleted, and codes 99252-99255 will be revised.
  • Prolonged service codes 99356-99357 will be deleted and replaced with new code 993X0.
  • Codes previously selected based on three key components or typical unit/floor time will be selected based on either of the following:
  • level of medical decision-making or
  • total time directed to care of the patient by a physician and/or other qualified health care professional on the date of service (includes time on and off the unit/floor) regardless of the amount of time spent in counseling and/or coordination of care.

While all levels of initial and subsequent hospital or observation care still will include a medically appropriate history and/or examination, these no longer will be components of code selection.

The CPT Editorial Panel is revising the Hospital E/M codes to align with the principles included in the 2021 revisions to Office or Other Outpatient E/M 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:

  • decrease administrative burden of documentation and coding and align CPT and Centers for Medicare & Medicaid Services guidelines whenever possible;
  • decrease the need for audits;
  • decrease documentation in the medical record that is not needed for patient care; and
  • ensure that payment for E/M is resource-based and that there is no direct goal for payment redistribution between specialties.
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