Now that we are almost two months into the 2023 E/M changes I thought I would share a few things that I have received a lot of questions related to and some things payers are looking at.
https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf
Same Day Admit/Discharge Services
99234-99236 – These codes are reserved for use when a patient is admitted and discharged on the same DOS. Did you realize that providers must perform and document two separate encounters on the DOS to be eligible to utilize these codes?
Codes 99234, 99235, 99236 require two or more encounters on the same date of which one of these encounters is an initial admission encounter and another encounter being a discharge encounter. For a patient admitted and discharged at the same encounter (i.e., one encounter), see 99221, 99222, 99223. Do not report 99238, 99239 in conjunction with 99221, 99222, 99223 for admission and discharge services performed on the same date.
Emergency Room Services
99281 – is now able to be utilized by clinical staff much like the 99211 for a minimal problem, which is defined as that may not require the presence of the physician or other QHP, but service is provided under the physician or QHP’s supervision.
There is also a new code for reporting of direction of EMS, emergency care, advanced life support.
99281- Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional
99288 - Physician or other qualified health care professional direction of emergency medical systems (EMS) emergency care, advanced life support
Prolonged Services
Do not get confused on which codes to use when reporting prolonged services. Medicare and AMA prolonged service codes differ in time requirements. There are also face to face and non-face to face codes in addition to codes for prolonged services that you can report for staff time in some instances.
Be sure you know the appropriate code to submit for prolonged services and ensure you are reporting it correctly for face to face, non-face to face, etc.
Time Based Coding
Make sure your providers documentation is bullet proof and educate them not to state on or about in their time documentation. They need to state exact times that were spent and a brief statement about what that time was spent for. Payers will be comparing times documented to hours spent in office or at the facility you are making rounds at to ensure there is enough time in the day for you to have performed all those services you code by time. Some providers times added up equaled more than 24 hours and that is an immediate red flag.
Medical Decision-Making Coding
Ensure that if you are coding by Medical Decision Making that there is evidence in the chart of a physician/practitioner managing, treating, assessing conditions. In other words, do not just list a diagnosis on your assessment and plan without saying what you are doing to treat, manage or assess that diagnosis. You must have documentation to support your involvement in management of that condition for an auditor to count it.
Protect your organization with education and audits. Make sure providers understand the documentation requirements and that they are meeting them. 2023 is gearing up to be the year of the audit. We want your practice to be prepared.
We can help with audits, documentation reviews and education to ensure your organization is audit proof. Please contact us for additional information.
