Did Your Transition to the New 2023 E&M Guidelines Go Well?

Accurate, complete, and compliant coding and documentation is crucial in every area of healthcare. It is especially important in emergency medicine and to hospitalists, where doctors may be caring for patients with life-threatening conditions. A smooth transition to the new Evaluation and Management (E&M) coding and documentation requirements for 2023 is vital to maintaining payer reimbursement and your revenue. 

Was your transition smooth?

First, What Were the Changes?

The 2023 changes to E&M coding are the most significant to take place in 28 years! Significant revisions were made to categories including Inpatient and Observation Care, Consultation, Emergency Department Services, Nursing Facility Services, and Prolonged Services. According to the AMA Physician panel* these changes seek to provide continuity across all E/M categories and eliminate unnecessary documentation requirements relating to history, exam, and counseling/coordination of care.

Historically, level of service codes has been based on 3 components:

  1. History
  2. Exam
  3. Medical Decision Making (MDM)

But as of January 1st, 2023, coding is based on either MDM or Time. A medically appropriate history and exam are still required but do not impact code selection. 

The following tables summarize the changes. Numerous details must be considered as you optimize your documentation and coding practices to comply with the new rules.

Decision Level Factor
New Coding Guideline 
Previous Guideline
Number and Complexity of Problems Addressed

With levels of “Straightforward”, “Low”, “Moderate” or “High” depending on the number of chronic illnesses or conditions treated.

The number of diagnosis or management options.

Amount and/or Complexity of Data to be Reviewed and Analyzed

This section has been updated to include quantitative data elements.

The complexity and/or amount of data reviewed, without quantitative elements.

Risk of Complications and/or Morbidity or Mortality of Patient Management

This section has been updated to include the need to initiate or forego further testing, treatment and/or hospitalization. Additionally, new risk elements like Social Determinants of Health, Decisions regarding hospitalization, or escalation of hospital level of care have been introduced. Under the new guidelines, if documented properly, consideration of treatment that is withheld can carry the same weight as if it had been performed.

If choosing the CPT code based on Time (note: this does not apply to ED codes 99281-99285.)

Time Includes:
Does Not Include:

Face-to-face interaction, non-face-to-face services such as ordering medications, obtaining and/or reviewing separately obtained history, and documenting in the medical record.

Time spent on separately reportable services or by ancillary staff or teaching activities.

Expertise Matters

At Ventra Health, as we transitioned to the new coding and documentation requirements, we’ve helped our clients improve E&M Work Relative Value Units (RVU) by an average of nearly 7% Year-to-Date, which we anticipate will lead to a commensurate increase of nearly 7% in Collections per Encounter (CPE) in 2023. This results in increased revenue to our partner organizations. 

Our experts in documentation, coding, and Revenue Cycle Management (RCM) can assist your organization in optimizing your documentation and coding by providing:

  • Tools and templates. Creation of tools and templates within your EMR can encourage individualized patient documentation. Our team of documentation experts can assist with creation of templates that prompt for specific information required for coding.
  • Training. Ongoing education is essential for health care providers. Feedback regarding documentation opportunities and coding patterns provide valuable information. We can support your practice with documentation/coding reviews and provider training.
  • Trending. Data analysis provides valuable information regarding denial patterns, potential missed revenue opportunities, and other key performance indicators. Our team of experts can aid with aligning your people, process, and technology to maximize revenue.

Streamline Billing with Ventra Health

At Ventra Health, we are committed to helping physician groups and practices with tailored advisory solutions that make it easier to enhance operations and maximize revenue – so you can focus on providing high-quality patient care. Our team has decades of experience in coding and documentation management for hospitalists and emergency hospital medicine. We even offer clinician training to ensure your team is current on the latest developments in coding and documentation. To learn more about how Ventra Health can help your team navigate critical care billing codes and more, contact us today.