As the new year begins, it's time to get familiar with the 2023 changes to CPT coding, Medicare payment policies, and Medicare's Quality Payment Program (QPP). There are a host of coding changes, including substantial revisions to evaluation and management (E/M) services that occur in hospitals or nursing homes, and changes to how prolonged services can be reported. The most concerning Medicare payment policy is a reduction in the overall payment rate under the physician fee schedule, but it's not as large as it originally was slated to be. Medicare is also rolling out new bundled coding and payment options for chronic pain management and expanding the list of services that can be provided via telehealth. The changes to QPP are small this year, but noteworthy nonetheless. Now, let's get into the details.

E/M CODING

There are changes to E/M coding on several fronts, as CPT follows up on the office and outpatient E/M visit reforms of 2021.¹

Hospital and nursing home visits. The most consequential changes to E/M coding this year come in hospital and nursing home settings, which have moved to the same code level selection criteria as office/outpatient E/M services. Physicians will now select codes for these services based on either their total time spent caring for the patient or their level of medical decision making (MDM). The same MDM table CPT used for office-based E/M codes will now be used for hospital and nursing home E/M services, with a few revisions from CPT:²

• Added “1 stable acute illness” and “1 acute, uncomplicated illness or injury requiring hospital inpatient or observation level of care” to the low-level MDM elements in the problems category,

• Added decisions regarding the “escalation of hospital-level of care” and “parenteral controlled substances” to the high-level MDM elements in the risk category,

• Added “multiple morbidities requiring intensive management” to the risk category, but this applies only to initial nursing facility visits.

Other CPT changes also impact how you will report these services. For 2023, CPT has done the following:

• Consolidated hospital inpatient and observation codes into a single family of codes: 99221-99223 and 99231-99233,

• Redefined the lowest level of emergency department codes (99281) to describe visits that do not require a physician or other qualified health care professional (much like office-visit code 99211),

• Deleted the separate code for nursing home annual exams, which will now be coded as subsequent nursing home visits (99307-99310),

• Consolidated the category “Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services” into a new category called “Home or Residence Services.”