New E & M Guidelines for Emergency Medicine

The following is a guest article by Amit Kayaker, Vice President Commercial Development at Fathom. Earlier this year, the American Medical Association (AMA) released its CPT Evaluation and Management (E/M) Code and Guideline Changes for 2023.  These changes directly affect medical coding teams and providers’ day-to-day job responsibilities and how they capture services to receive quick and accurate reimbursements. From the perspective of revenue cycle management (RCM), the updates may create revenue uncertainty.  While any changes to the status quo can cause anxiety, especially when they tie directly into revenue, with the proper knowledge, preparation, and technology, medical organizations can stay on track to reach their 2023 RCM goals.  What’s Changing?  Beginning January 1, 2023, emergency department E/M guidelines are shifting to focusing on Medical Decision Making (MDM). MDM is a provider ranking system that determines the complexity of establishing a patient’s diagnosis and treatment. These rankings range from very straightforward to high complexity. Per the current guidelines, whichever level the provider decides on is one factor that informs which E/M code gets assigned to a specific encounter. The other two factors are patient history and a physical exam.  According to the 2023 CPT updates, patient history and physical exam components will no longer factor into the final code. Instead, code selection is based solely on MDM. The AMA notes that whil...
Source: EMR and HIPAA - Category: Information Technology Authors: Tags: Ambulatory Health IT Company Healthcare IT Revenue Cycle Management AMA American Medical Association Amit Kayaker CPT CPT Codes Emergency Medicine Fathom ICD-10 MDM Medical Billing Medical Decision Making RCM Relative Value Source Type: blogs