How the 2023 CPT code set will help cut administrative burdens

Andis Robeznieks , Senior News Writer

The AMA has released the 2023 Current Procedural Terminology (CPT®) code set, which includes new modifications that make coding and documentation easier and more flexible for evaluation and management (E/M) services performed in inpatient and other nonoffice-based settings. 

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Building on its efforts to reduce administrative tasks that can lead to physician burnout, the AMA has also released an AMA STEPS Forward® toolkit, “Simplified Outpatient Documentation and Coding” (PDF).

The toolkit will help reduce your documentation-and-coding workload by:

  • Describing the most recent billing and coding documentation guidelines.
  • Illustrating workflow solutions for more efficient documentation.
  • Providing examples of documentation to help educate physicians and their teams.

“We want to ensure that physicians and other users get the full benefit of the administrative relief from the E/M code revisions,” said AMA President Jack Resneck Jr., MD.

“The AMA is helping physicians and health care organizations prepare now for the E/M coding changes and offers authoritative resources to anticipate the operational, infrastructural and administrative workflow adjustments that will result from the pending transition,” added Dr. Resneck, a professor and vice chair of the University of California, San Francisco, School of Medicine’s dermatology department.

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Changes implemented last year included providing physicians and other qualified health care professionals the flexibility to select a level of service based on the complexity of medical decision-making or total time on the day of service. That includes work completed when the patient wasn’t present.

These changes recognized duplication in data collection and recording, helped clarify billing rules, and removed specialty-specific challenges created by the previous guidelines that had been in use for a quarter of a century.

Those revisions covered E/M outpatient office-visit CPT codes 99201 through 99215 and the corresponding code descriptors and documentation standards. For 2023, several codes and their descriptors have been revised, consolidated or deleted.

The new modification to the E/M codes extend to inpatient and observation care services, consultations, emergency department services, nursing facility services, home and residence services and prolonged services.

The revisions are also meant to track with E/M changes for 2023 planned by the Centers for Medicare and Medicaid Services (CMS). The importance of this was highlighted in a recently released AMA summary (PDF) of the proposed 2023 Medicare physician payment schedule, which noted that the E/M code sets being revised for 2023 comprise about 20% of all allowed charges in the entire CMS proposed rule.

The E/M modifications were among the 393 editorial changes in the 2023 CPT code set describing medical procedures and services available to patients.

Changes include 225 new codes, 75 deletions and 93 revisions. They illustrate how the CPT code set, sometimes called “the language of medicine,” continues to grow and evolve with the rapid pace of innovation in medical science and health technology.

Changes to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel, an independent body convened by the AMA that collects broad input from the health care community and beyond to ensure CPT content reflects the coding and data-driven demands of a modern health care system. 

The list of CPT codes for remote-monitoring services continues to grow with the addition of a new code to report cognitive behavior therapy monitoring (98978) for a range of physical and mental health disorders.

The 2023 CPT code set also includes Appendix S, a taxonomy that provides guidance for classifying augmented intelligence or AI-powered medical service applications.

“The new AI taxonomy establishes foundational definitions and a shared understanding among stakeholders that clearly describes the technical features and performance of AI applications, as well as the work performed by the machine on behalf of the health care professional,” said Dr. Resneck.

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A special section for CPT education has been created for the AMA Ed Hub™, an online learning platform containing CME and education, including a module series covering an overview of CPT coding basics and other topics. The CPT Network is also available for authoritative CPT coding guidance.

The AMA also has developed an extensive online resource library of videos, guides, and educational modules to help with the transition to the revised E/M codes and guidelines. This includes a packet of five AMA STEPS Forward E/M coding clinical vignettes (PDF). Discover more about implementing the CPT E/M revisions.

This year's Outpatient CDI Workshop and CPT and RBRVS 2023 Annual Symposium are being held virtually Nov. 15–18. Stay up to date on significant CPT code and relative value unit (RVU) changes for 2023. Register now.