2023 Evaluation & Management Updates Free Webinar

October 24th, 2022 - Aimee Wilcox
Categories:   Evaluation & Management (E/M)  

Congratulations on implementing the major Evaluation and Management (E/M) changes that became effective in 2021 for the Office and Other Outpatient E/M Services (99202-99215), a big transition for all provider organizations, and hopefully yours has experienced great success. 

Now, it is time to transition the remaining E/M service categories to the same process. Last month we published an article on the upcoming E/M changes headed our way in 2023 (click here to access the article). While the changes are significant, they continue to follow the previously outlined changes seen in 2021, with scoring of an E/M service being determined by medical decision making (MDM) or total time, with the exception of the Emergency Department, which cannot use time as a scoring factor and must only score based on the level of MDM.

Medically Appropriate History and Examination 

If you have ever coded a hospital record, you already know that often the interval history or history section in general, can be confusing. Often you cannot see a difference between the prior day’s documentation and the current day's documentation. By allowing providers to document a medically appropriate history and examination based on their professional opinion and need, along with no longer having to score those sections as part of the overall E/M leveling process, it will make big difference for coder, auditors and our providers, too. 

Total Provider Time

Speaking of scoring based on time, what has your organization done to ensure time is properly captured in the medical record? Does your organization use a computer assisted coding (CAC) program? If so, then creating a section header using the right terms (e.g., Total Provider Time:) is extremely important to ensure the engine can first identify the section and, secondly, can capture the time. This helps distinguish provider time from clinical staff time as well - another important factor in correctly documenting in the medical record. 

Medical Decision Making

With a reduction in the burden of documenting either the history or examination so they meet the level of medical necessity noted in the MDM section, providers can now concentrate more fully on documenting to support the patient’s true complexity and needs, in the MDM section. Providers can hopefully spend a little of that saved time documenting the status of a chronic or acute condition as stable, worsening, severe, or exacerbated. 

Data should be formatted within the MDM section for clarity to make it easy to see what was ordered and performed during the encounter, what was reviewed from a prior encounter or different provider and if anything was discussed or physically reviewed again. What other medical professionals or family members did the provider speak with about the patient’s condition and care? Having this in a simple format makes it easy to score and easier to prove when faced with an audit. 

And finally, how are your providers identifying the risk associated with the patient’s condition, treatment recommendations and/or failure to follow the recommended treatment? Are the medications being reviewed for these chronic conditions before refilling? Or are they just an afterthought? 

Be Aware of the Overall 2023 Changes

The changes that are being implemented on January 1, 2023 are significant because they are for all remaining E/M categories, and not just one. We invite you to attend a free webinar on these 2023 Evaluation and Management changes to get a feel for what they are and how these categories and guidelines have been streamlined and changed. 

Another important change that we should be aware of is the deletion of many prolonged E/M service codes to be replaced by a new inpatient prolonged service code. In 2021 we were introduced to 99417 , which is the prolonged service code specifically assigned to 99202-99215 ,  but this will also be eligible to be assigned to other outpatient services and a new inpatient code for all inpatient services. What a great way to streamline coding for ease of application! 

For additional information on how get an early understanding of the changes headed your way, join us for our next webinar, "Webinar Title" scheduled for Thursday, Oct. 6, 2022 @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET. Click HERE to register for this FREE webinar.

Disclaimer: The above article is the opinion of the author(s) and should not be interpreted by providers/payers as official guidance. For any questions about the content of this article, please contact the author(s).

About the Author: Aimee Wilcox is a medical coding, billing, and auditing consultant, author, and educator with more than 30 years of clinical and administrative experience in healthcare, coding, billing, and auditing. Medicine, including coding and billing, is a constantly changing field full of challenges and learning and she loves both. She believes there are talented medical professionals who, with proper training and excellent information, can continue to practice the art of healing while feeling secure in their billing and reimbursement for such care.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Compliance Billing: Power Mobility Devices
December 27th, 2022 - Chris Woolstenhulme
In May of 2022, the OIG conducted a nationwide audit of Power Mobility Device (PMD) repairs for Medicare beneficiaries. The findings were not favorable; the audit revealed CMS paid 20% of durable medical suppliers incorrectly during the audit period of October 01, 2018- September 30, 2019. This was a total of $8 million in device repairs out of $40 million paid by CMS. We gathered information in this article to assist providers and suppliers in keeping the payments received, protecting beneficiaries, and assisting you in ensuring compliance.
Leveraging Hierarchical Condition Category (HCC) Coding to Improve Overall Healthcare
December 27th, 2022 - Kem Tolliver
Diagnosis code usage is a major component of optimizing HCCs to improve overall healthcare. Readers will gain insight into how accurate diagnosis code usage and selection impacts reimbursement and overall healthcare.
Accurately Reporting Diabetic Medication Use in 2023
December 20th, 2022 - Aimee Wilcox
Along with the ICD-10-CM coding updates, effective as of October 1st, the guidelines were also updated to provide additional information on reporting diabetic medications in both the general diabetic population and pregnant diabetics. Accurate reporting is vital to ensure not only maximum funding for risk adjusted health plans, but also to ensure medical necessity for the services provided to this patient population.
REMINDER: CMS Discontinuing the use of CMNs and DIFs- Eff Jan 2023 Claims will be DENIED!
December 19th, 2022 - Chris Woolstenhulme
Updated Article - REMINDER! This is important news for durable medical suppliers! Effective January 1, 2023, CMS is discontinuing the use of Certificates of Medical Necessity (CMNs) and DME information forms (DIFs). We knew this was coming as the MLN sent out an article on May 23, 2022, but it is time to make sure your staff knows about these changes.
How Automation Could Impact the Future of Medical Coding
December 15th, 2022 - Find-A-Code
Automation is a fact of life in the modern world. As digital systems expand and mature, the creators of those systems are bringing more automation to more industries. Medical coding isn't the exception.
CPT Codes and Medicare's Relative Value Unit
December 13th, 2022 - Find-A-Code
A recently published study looking to explain income differences between male and female plastic surgeons suggests that billing and coding practices may be part of the equation. The study focused primarily on Medicare's relative value units (RVU) as applied to surgeon pay. But what exactly is an RVU?
Identifying the MEAT to Support Reporting Chronic Conditions in the Computer-Assisted-Coding (CAC) World
December 13th, 2022 - Aimee Wilcox
The benefits of computer-assisted-coding (CAC) are great and understanding how to engage with the engine to ensure maximum coding efficiency is vital to the program's success for your organization. But how do you know when to accept an autosuggested code and when to ignore it, especially when it has to do with historical patient data?



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2023 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association