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CPT 2023: New E/M Code 99418 Among Big Jan. 1 Changes

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CPT 2023: New E/M Code 99418 Among Big Jan. 1 Changes

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2023 CPT

The end of the year is approaching, and for coders, that always means getting to know a whole new set of procedure codes that take effect January 1. The 2023 CPT code set debuted last week, and includes 393 changes, with most of them (225) consisting of new codes. You’ll also find 75 deletions and 93 revisions that you must know before January 1. Your best bet is to master them now, because if you don’t, you’ll be greeted by a stack of denied claims in 2023 when insurers require you to submit the updated codes.

Check out a few highlights of the 2023 CPT changes so you can prepare for the additions, deletions and revisions.

E/M Changes Take the Spotlight

The most significant changes for 2023 involve the updated evaluation and management (E/M) codes. Whereas you faced major E/M updates in 2021, those involved office-based procedures. In 2023, however, the updates will shine a light on procedures performed outside your office, from the observation care unit to the emergency department (ED) and beyond.

Observation care: Providers who admit patients to the observation unit have become accustomed to reporting their services with codes 99218-99226, but effective Jan. 1, those codes will be deleted. Instead, if you see a patient in observation care, you’ll report an inpatient code (99221-99239). To memorialize this change, CPT will rename its current “Hospital Inpatient Services” section to “Hospital Inpatient and Observation Care Services.”

Inpatient care: In 2021, you stopped coding outpatient encounters using history, exam, and medical decision-making (MDM) as your coding criteria, relying solely on time or MDM to choose the right code. Starting in January, you’ll use that same logic when reporting inpatient encounters. Therefore, providers will need to be extremely detailed when documenting the time they spend with inpatients.

ED coding: Because the concept of coding based on time is not recognized in the emergency department, new ED coding changes mean you’ll have to rely solely on MDM to select the most appropriate ED E/M code (99281-99285) starting in 2023. To make this easier, CPT is debuting a new MDM grid that can help every coder more accurately select the right MDM level.

Prolonged services: Many coders are accustomed to reporting prolonged services with 99354-99357, but CPT will delete those codes effective Jan. 1. Instead, you’ll report one of the following two codes:

For prolonged services in the outpatient setting, you’ll report 99417 (Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services).

For prolonged services in the observation or inpatient setting, you’ll report 99418 (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).

Check 15 New Hernia Codes

Also new to CPT 2023 are 15 new codes that describe anterior abdominal hernia repairs (49591-49623). The new descriptors allow coders to easily select the right code no matter what surgical approach was used because they refer to surgeries performed using any method. For instance, you’ll note the notation of “any approach” in the descriptor for new code 49591 (Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible).

When providers perform hybrid abdominal hernia repairs (part open procedure and part laparoscopic or robotic), you’ll now have a way to report those services. To make way for these new codes, CPT will be deleting several existing hernia repair codes, including 49585 and 49570.

Cognitive Behavior Therapy Monitoring

When CPT introduced five new remote therapeutic monitoring codes in 2022, coders were quick to point out that the codes were limited in scope, and that more codes were needed to round out the code set. The latest CPT update seems to respond to that, expanding the code set.

You’ll find new code 98978 (Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor cognitive behavioral therapy, each 30 days) for cognitive behavior therapy monitoring that occurs outside of a medical practice.

Beyond the codes, the 2023 CPT update will include a new appendix that includes an entire taxonomy so coders can find guidance on how to classify artificial intelligence (AI) applications used in medicine.

Want to know more about the new codes hitting Jan. 1, 2023? Check out the online training Master New 2023 E/M Coding Changes Before Jan. 1 Deadline. During this 60-minute session, coding expert Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, will walk you through the E/M updates so you’ll be prepared when 2023 hits.


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