2023 Evaluation and Management Coding Changes – Part 3

Welcome to the last part of our three-part series on 2023 E/M Coding Changes! If you haven’t seen Part 1 or Part 2, feel free to check those out for additional details on upcoming changes.

In this post, we’re rounding up all the CPT^® codes covered in our recent webinar so you can have a quick and easy reference.

Hospital Inpatient and Observation

Initial​

• • 99221 – straightforward 40 minutes​
  • 99222 – moderate 55 minutes​
  • 99223 – high 75 minutes​
  • 993X0 – for services over 90 minutes (use prolonged code)

Subsequent​ 

• • 99231 – straightforward 25 minutes​ 
  • 99232 – moderate 35 minutes​ 
  • 99233 – high 55 minutes​
  • 993X0 – for services over 65 minutes (use prolonged code)

Office or Outpatient Consultations

• • 99242 – straightforward 20 minutes​
  • 99243 – low 30 minutes
  • 99244 – moderate 40 minutes
  • 99245 – high 55 minutes​
  • 99417 – services over 70 minutes (use prolonged code)

Emergency Department Services

• 99281 –  presence of physician or qualified provider is not required​
• 99282 –  straightforward​
• 99283 –  low​
• 99284 –  moderate 
• 99285 –  high
 

Nursing Facility Services

Initial​ 

• 99304 – straightforward and low 25 minutes​ 
• 99305 – moderate 35 minutes​ 
• 99306 – high 45 minutes​
 

Subsequent​ 

• 99307 – straightforward 10 minutes​ 
• 99308 – low 15 minutes
• 99309 – moderate 30 minutes​
• 99310 – high 45 minutes

Codes to use when service is performed not on a date with E/M or direct contact (prolonged)

• 99358 – first hour of service​
• 99359 – each additional 30 minutes​
• Less than 30 minutes is not reportable​
• Less than 15 after first hour or last 30 minutes is not reportable​

Reporting with Prolonged Clinical Staff Services with Provision