2023 Gastroenterology Reimbursement and Coding Update (On-Demand) | November 2022-Coding Preview 2023 EM Changes

Pdf Summary

The document discusses changes to Evaluation and Management (E/M) codes and Medicare for the year 2023. The transition to new E/M code descriptors and billing rules is highlighted, as well as the focus on total time for the day of the encounter and medical decision-making complexity. The document also mentions the use of time and medical necessity for documentation and provides guidelines for coding based on time for both outpatient visits and hospital inpatient or observation care. The concept of "two-timing" is explained, cautioning against double-dipping and billing for visit codes in addition to other non-face-to-face services. There are also updates on consultation codes, with specific time thresholds and revisions for hospital inpatient admit and consult codes. The document includes a table indicating the total time for different E/M codes for both outpatient and consultation visits. There is a brief mention of other E/M codes for emergency departments and skilled nursing facilities, as well as the merging of domiciliary, rest home, and custodial care into home or residence settings. The document covers the changes to prolonged services and the inclusion of parenteral controlled substances. It briefly touches on the medical decision-making matrix for E/M codes, as well as providing insights into common questions and answers related to E/M coding. The document also mentions changes to ICD-10 codes related to social determinants of health. It concludes with discussions on E/M revenue repair through coding for higher-level visits, chronic care management, and care plan oversight. There is additional information on home health certification/recertification and remote physiologic monitoring. The document ends with a reminder about opportunities and threats and provides contact information for further questions.

Asset Subtitle

Glenn D. Littenberg, MD, MACP, FASGE

Keywords

Evaluation and Management codes

Medicare

E/M code descriptors

billing rules

total time

medical decision-making complexity

consultation codes

prolonged services

ICD-10 codes

chronic care management