< Back to Thought Leadership

2023 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

To learn more about how Blue & Co. can help your organization with opportunities surrounding the 2023 Physician Fee Schedule Final Rule, 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

Scott Treida, Director

Maddie Gookins, Director

Consolidated Appropriations Act of 2023 Changes Impacting Rural Health Clinics

The Consolidated Appropriations Act of 2023, also known as the “Omnibus” package, was signed into law by President Biden on December 29, 2022. Rural Health Clinics (RHCs) need to be aware of some of the changes that will impact them including new grant opportunities and behavioral health provisions. Opportunities for Rural Health Clinics from the […]

Learn More
someone handing car keys to another person personal use of auto

The Importance of Personal vs. Business Use of Auto

By Pam Swartout, Manager and Jacoby Shade, Staff Accountant at Blue & Co. Many business owners provide a company vehicle to their employees as part of their employment. This is a company benefit that has tax implications and is extremely important for both the employer and employee to understand these implications. Employers can deduct only […]

Learn More
w-2 and 1099 tax forms

Have You Started to Prepare for Filing Last Year’s 1099s and W-2s?

By Pam Swartout, Manager and Tracey Selig, CPA, Senior Accountant at Blue & Co. The time of year for preparing and filing your 1099s and W-2s is here. In order to ensure timely and accurate submissions of the above-mentioned forms, Blue & Co. wants to inform you of the Form 1099 and W-2 requirements, their […]

Learn More