2023 E/M changes, part 5: Home and residence services

Dec. 14, 2022 / By Colleen Ejak, RHIA

The American Medical Association (AMA) announced major revisions to Evaluation and Management (E/M) Services for Jan 1, 2023. The E/M categories that will undergo revision in 2023 are: 

For 2023, revisions to the E/M category home or residence services include two deleted categories, deleted codes, revised codes and guidelines revisions. To start, the E/M category domiciliary, rest home (e.g., boarding home), or custodial care services and the E/M category domiciliary, rest home (e.g., assisted living facility), or home care plan oversight services are deleted for 2023. The parenthetical notes direct the provider or coder to report these services elsewhere: 

  • For E/M category domiciliary, rest home (e.g., boarding home), or custodial care services in 2023 these services should be reported using the home or resident services E/M codes for new or established patients. 
  • For E/M category domiciliary, rest home (e.g., assisted living facility), or home care plan oversight services these services should be reported using the care management services codes, or principal care management codes. 

The home or residence sub-section parenthetical notes or guidelines indicate that these codes are used to report services provided in a home or residence. Home may be defined as a private residence, temporary lodging or short-term accommodation (e.g., hotel, campground, hostel or cruise ship). These codes are also used to report services when the residence is in an assisted living facility, group home that is not licensed as an intermediate care facility for individuals with intellectual disabilities, a custodial care facility or resident substance abuse treatment facility.

For services in an intermediate care facility for individuals with intellectual disabilities and services provided in a psychiatric resident treatment center the parenthetical notes direct the provider or coder to the nursing facility services E/M category. The Medicare Claims Processing Manual states that “a home visit cannot be billed by a provider unless the provider is actually present in the beneficiary’s home.” The parenthetical notes also state that travel time should not be counted towards total time when time is used for selecting the level of service.

Home services are divided into two subcategories: New patient and established patient with the subcategories are currently divided into four or five levels of service. For 2023 the category title is revised to home or residence services and the new patient subcategory levels of service will have four levels of services with E/M code 99344 deleted. For 2023 both categories will have four levels of service.

As with the above mentioned E/M categories, the home and resident services E/M category, align the 2023 E/M codes with the 2021 revisions made to the office and other outpatient services codes. The three key components, history, exam and medical decision making (MDM) are no longer required for reporting these services.

A medical appropriate history or physical as determined by the physician or advanced practice provider (APP) should be documented; the level of service is determined solely be the level of MDM or time. The AMA redefined what “time” includes for selection of the level of service, time is now the total time on the date of the encounter and includes both face-to-face time and non-face-to-face time.

Coding professionals should be aware of these revisions; home calls or home visits are increasing for patients who can’t leave their house and for those who prefer home visits. Some steps to take to be prepared include reviewing current documentation practices and revise documentation templates not needed for patient care. Also consider how your providers can track total time to correctly reporting/billing for these services.

Tune in for my next blog when I discuss the revisions to prolonged services from both the AMA’s E/M revisions and the 2023 Medicare Physician Fee Schedule Proposed Rule.

Colleen Ejak, RHIA, CCS, CCDS-O, is a consultant with 3M Health Information Systems.

References 

American Medical Association 2023 E/M Code and Guideline changes, available at: 2023 CPT E/M descriptors and guidelines (ama-assn.org)

Center for Medicare & Medicaid Services Calendar Year (CY) 2023 Medicare Physician Fee Schedule Proposed Rule Fact Sheet, available at https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-proposed-rule

Medicare Claims Processing Manual Chapter 12 – Physicians/Nonphysician Practitioners (Rev.11288 03-04-22), available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

AMA CPT® Professional 2022 Codebook © 2021 American Medical Association

AMA CPT® Assistant, August 2022, Page 3, E/M Revisions for 2023: An Overview

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