AMA Update to CPT Codes for 2023

The AMA has released its Current Procedural Terminology (CPT®) code set for 2023. In the chart and explanations that follow, we share with you the most relevant codes to be aware of that will be deleted, revised or added starting January 1, 2023.

CODE UPDATE EXPLAINED

Inpatient and observation care services

  • Deletion of observation CPT codes (99217 through 99220 and 99224 through 99226) and merged them into the existing hospital care CPT codes (99221 through 99223, 99221 through 99233, and 99238 through 99239)

  • Revision of the code descriptors to account for the structure of total time on the date ofthe encounter or level of medical decision-making when selecting code level

  • Retention of revised observation or inpatient care services, including admission and discharge services (CPT codes 99234 through 99236)

 

Consultations

  • Retention of the consultation codes, with some editorial revision to the code descriptors

  • Deletion of certain guidelines deemed confusing by the AMA, including the definition of “transfer of care”

  • Deletion of lowest level office (99241) and inpatient (99251) consultation codes to align with four levels of MDM

 

Emergency Department Services

  • Retention of the existing principle that time cannot be used as a key criterion for code level selection

  • Revisions to the code descriptors to reflect the code structure approved in the office visit revisions

  • Modified MDM levels to align with office visits and maintain unique MDM levels for each visit

  • Retention of existing CPT code numbers

  • Updates to current practice that was not explicit in the CPT code set, which may be used by physicians and other qualified healthcare professionals other than ED staff

  • Allowance of critical care to be reported in addition to ED service for clinical change

 

Nursing Facility Services

  • Revision to nursing facility guidelines with a new “problem addressed” definition of “multiple morbidities requiring intensive management,” to be considered at the high level for initial nursing facility care

  • Deletion of code 99318 (annual nursing facility assessment), which will be reported through the subsequent nursing facility care services (CPT codes 99307 through 99310) or Medicare G codes

  • Updated standard so not all “initial care” codes are the mandated comprehensive “admission assessment” and may be used by consultants

  • Allowance of the use of subsequent visit when the principal physician’s team member performs care before the required comprehensive assessment

 

Home and Residence Services

  • Deletion of the domiciliary or rest home CPT codes (99334 through 99340), which have now been merged with the existing home visit CPT codes (99341 through 99350)

  • Elimination of the duplicate MDM Level New Patient code (99343)

 

Prolonged Services

  • Deletion of direct patient contact prolonged service codes (99354 through 99357), which will be reported through either the code created in 2021, office prolonged service code (99417), or the new inpatient or observation or nursing facility service code (993X0)

  • Creation of a new code (993X0) to be analogous to the office visit prolonged services code (99417)

  • Retention of 99358 and 99359 for use on dates other than the date of any reported

David Swiercz