fbpx

< Back to Thought Leadership

E/M Coding Changes You Need to Know from the Physician Fee Schedule Final Ruling

New rules for reporting evaluation and management (E/M) services in most places of service took effect January 1, 2023. The coding and documentation revisions, adopted by the American Medical Association’s CPT Editorial Panel and approved by the Centers for Medicare and Medicaid Services (CMS), substantially simplify code selection and documentation.

Effective January 1st, E/M services have their own thresholds of the three medical decision-making elements. When reviewing an encounter, if what was medically necessary, performed, and documented meets the threshold of two of the three elements for that level, that E/M level may be selected.

Although you should still perform a medically appropriate history and/or physical exam, it/they do not determine the level of service.

Coding Based on MDM

The four levels of MDM remain the same: straightforward, low, medium, and high. To qualify for a level of MDM, two of the three elements for that level of decision-making must be met.

The three core elements have remained essentially the same and they are:

  1. Number and complexity of problem(s)
  2. Amount and/or complexity of data to be reviewed and analyzed.
  3. Risk of complications and/or morbidity or mortality of patient management decisions made at the visit.

Coding Based on Time

The biggest change in E/M coding and documentation is that code selection for patient visits can now be based entirely on time spent on the day of the encounter – even if counseling and coordination of care do not dominate the encounter. Clinical staff time does not count.

Contact Us about E/M Coding Changes

To learn more about how Blue & Co. can help your organization with opportunities surrounding the 2023 Physician Fee Schedule Final Rule and E/M coding changes, reach out to your local Blue & Co. advisor or contact a member of our Revenue Cycle team below.

Beverly Strube, CPC, COC, CPC-I, CPMA, CEMC, COBGC, Senior Physician Coding Consultant
317-713-7928

Scott Treida, Director
317-713-7950

Maddie Gookins, Director
317-713-7945

one big beautiful bill signed into law

The One Big Beautiful Bill Is Law—Now What?

By Amy L. Sandlin, CPA, Tax Quality at Blue & Co. On July 4, 2025, President Trump signed into law a sweeping budget reconciliation bill, informally titled the “One Big […]

Learn More
Network Integrity: Understanding the Basics | Part One of a Four Part Series | Text overlay on a photo of a hospital | An Introduction to Network Integrity

Network Integrity: Understanding the Basics

In the ever-evolving healthcare landscape, prioritizing initiatives to improve margins is crucial to maintain financial stability. As inflationary pressures continue to impact labor, purchased services, and supplies, it is imperative […]

Learn More
Photo of M. Jane Shawver | Jane Shawver Named President of Blue Benefits Consulting

Jane Shawver Named President of Blue Benefits Consulting

COLUMBUS, Ohio. (July 1, 2025) – Blue & Co., LLC and Blue Benefits Consulting, Inc. are delighted to share that M. Jane Shawver, QKC, QKA, has been named President of […]

Learn More