2023 Evaluation and Management Guideline Changes for Hospitalists

Below are some important changes with regards to billing for hospitalists in hospital medicine for 2023.

Currently, there are three sets of guidelines, the 1995, the 1997 and the new 2021 guidelines. Effective 1/1/2023 there will only be one set of evaluation and management guidelines.

The 2023 guidelines are basically an expansion of the 2021 guidelines. The level of service will be based on either

  1. Medical decision making (MDM) or
  2. Time.

▪ It is no longer applicable to use the following statement
“more than 50% of time was spent face-to-face in counseling or coordinating care”


▪ AMA recommends itemizing the time spent as below
“I spent 60 minutes reviewing the ED notes, seeing the patient, discussions with the nephrologist, and documenting in the medical record.”

There will be 4 levels of MDM.

  1. Straight forward.
  2. Low
  3. Moderate
  4. High

To learn more about the Elements of Medical Decision Making mentioned above, go to page 8-13 of the “CPT® Evaluation and Management (E/M) Code and Guideline Changes” from AMA.

The AMA and Medicare have deleted hospital observation E&M procedure codes and Observation codes will crosswalk or fold into the revised inpatient initial and/or subsequent codes.

If a patient transitions from observation to inpatient status, it does not constitute a new stay.

If hospital LOS is less than 8hrs, billing should be for Initial Hospital Services only.

The final CY 2023 PFS [Physician Fee Schedule conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61.

The consultation codes are being revamped. Like in the 2021 changes, they will be removing the first level codes (99241 and 99251).

A “consultation” initiated by a patient and/or family, and not requested by a physician, other
qualified health care professional, or other appropriate source (eg, non-clinical social worker,
educator, lawyer, or insurance company), is not reported using the consultation codes.

Prolonged Service With or Without Direct Patient Contact on the Date of an Evaluation and Management Service: Per AMA

  1. Use 99417 in conjunction with 99245. 99417 Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service).
  2. Use 993X0 in conjunction with 99223, 99233, 99236, 99255. 993X0 Prolonged inpatient or observation evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the inpatient and observation Evaluation and Management service).

CMS also finalized creation of Medicare-specific coding for payment of Other E/M prolonged services for payment of Office/Outpatient prolonged services. These services will be reported with three separate Medicare-specific G codes.

So, there is discrepancy between AMA and CMS regarding what codes to be used for prolonged services. We will probably end up using G0316 per CMS recommendations.

So, at this time, there is no clear picture of wRVU value for CMS recommended G0316 code to be used for prolonged services.

Self Identified Primary Specialty2020-2021 Overall wRVU % Change2022-2023 Overall wRVU % Change
Hospitalist0.4%9.2%

At this time, I also don’t have wRVU values for Alcohol counseling codes. I will add them once it becomes clear to me.

Download 2023 CPT E&M Code and Guideline changes for Hospitalists in an excel sheet form below. This excel sheet clearly shows the deleted codes, replacement codes for the deleted codes, time needed for each code for billing purposes, new wRVU values, etc.

Source: CPT® Evaluation and Management (E/M) Code and Guideline Changes

Disclaimer: 

The information posted is not intended to serve as legal advice.

The information contained herein is not warranted to be free from defects.

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