2023 E/M changes, part 2: Emergency department services E/M revisions

The American Medical Association (AMA) announced major revisions to Evaluation and Management (E/M) Services for Jan. 1, 2023. The E/M categories that will undergo revision in 2023: 

• Inpatient and observation care services 
• Emergency department services 
• Consultations – both outpatient and inpatient 
• Nursing facility services 
• Home and residence services 
• Prolonged services 

My goal each week over the next few weeks is to focus in on one E/M category and take a deeper dive into the revisions and guideline changes. Today’s blog is on the revisions to E/M services for emergency department services. 

Retained in the emergency department guidelines that appear at the category level is the following: 

• Code range is used to report E/M services provided in the emergency department. 
• An emergency department is defined as an organized, hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. 
• The facility must be available 24 hours a day. 
• No distinction is made between new and established patients in the emergency department. 
• Time is not a component of emergency department services because emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time. 

Beginning Jan. 1, 2023, the following revisions to this E/M category are: 

• E/M codes 99281-99285 are retained 
  
  
• E/M code 99281 is revised to read:
  • 99281 Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional. 
• E/M codes 99282-99285 are revised to read:
  • 99282 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.
  • 99283 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making.
  • 99284 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
  • 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. 
• Added to the category guidelines: Critical care and emergency department services may both be reported on the same day when after completion of the emergency department service, the condition of the patient changes and critical care services are provided. 

In summary, 99281, a level 1 emergency department patients may not require the face-to-face presence of a physician or advanced practice provider (APP). It does require supervision by a physician or APP with the expected use of this code for suture removal or simple or routine wound care as two examples provided by the AMA for potential use of 99281.  

With this new descriptor for 99281, the medical decision making for 99282 is revised from low to straightforward and 99283 is revised from moderate to low medical decision making. A level 4 emergency department patient, 99284, remains moderate medical decision making and 99285 remains high medical decision making. These are big revisions to share with your emergency department physicians and APPs.   

Finally, the biggest revision to the emergency department category, as with all the categories undergoing revision for 2023, is that the three key components—history exam and medical decision making—are no longer required for reporting these services. A medically appropriate history or physical as determined by the physician or APP should be documented; the level of service is determined solely by the level of medical decision making.   

More to come next week when I share the revisions to consultation services and details on the elements of medical decision making. 

Colleen Ejak (Deighan), RHIA, CCS, CCDS-O, is a consultant with 3M Health Information Systems.  

References 

American Medical Association 2023 E/M code and guideline changes, available at: 2023 CPT E/M descriptors and guidelines (ama-assn.org) 

AMA CPT® Professional 2022 Codebook © 2021 American Medical Association