2023 CPT coding updates
Derm Coding Consult
By Faith C. M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, Manager, Lead Coding and Reimbursement Strategist, December 1, 2022
Academy coding staff address important coding topics each month in DermWorld Coding Consult. Read more Derm Coding Consult articles.
The American Medical Association (AMA) has released the Current Procedural Terminology (CPT®) coding updates that will go into effect on Jan. 1, 2023.
Although the specialty will not see many changes affecting dermatology-specific codes and guidelines, dermatology practices must review the evaluation and management (E/M) changes in inpatient and facility coding. These changes build on the revisions to office/outpatient E/M codes introduced in 2021 that emphasized medical decision-making (MDM) and sought to reduce the documentation burden. These changes will affect how hospital inpatients, observation care visits, consultations, emergency room visits, and nursing facility services along with home, rest home, and domiciliary E/M services are reported.
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Similar to the office and other outpatient services, E/M services for inpatient services will be based on MDM or time. Patient history and physical examination will no longer contribute to the choice of E/M level of service for inpatient services. The only exception will be services rendered in the emergency department (ED) which will be determined based on MDM only — the ED codes do not have a time component.
As part of the inpatient coding guidelines overhaul, AMA has deleted and merged the observation care services with the initial and subsequent hospital care codes. The updates also include a revised definition for “New and Established Patient” to state that to distinguish between new and established patients, professional services are those face-to-face services rendered by physicians and other qualified health care professionals who may report E/M services. According to the AMA, synchronous telehealth services are considered face to face, as they require creation of a health record, an appropriate history, and MDM. A subsequent office visit should be reported for an established patient.
AMA has also revised the Levels of Medical Decision Making table, low complexity of problems addressed element to include one acute, uncomplicated illness or injury requiring hospital inpatient or observation level of care. In addition, there are two other revisions to the examples for high risk of complications and/or morbidity of patient management to include parenteral controlled substances and revision of “Decision regarding hospitalization” to “Decision regarding hospitalization or escalation of hospital-level care.”
Other updates to the E/M service coding guidelines include:
Digital pathology digitization procedures
In the pathology section, the AMA established 13 Category III add-on codes (X0751T-X0762T) to report additional clinical staff work and service requirements associated with digitizing glass microscopes for primary diagnosis. The new sub-heading “Digital Pathology Digitization Procedures” includes guidelines that define digital pathology and outline the appropriate reporting of these codes.
Digital pathology refers to systems in which slides are scanned into a computer so that slides can be examined digitally, rather than directly visualized through microscope digitization of glass microscope slides, facilitating/enabling remote examination by the pathologist. Add-on codes (X0751T-X0762T) may be reported in addition to the appropriate Category I service when the digitization procedure of glass microscope slides is performed.
Evaluation and management toolkit
Use the evaluation and management toolkit to determine the appropriate level of service.
New artificial intelligence (AI) taxonomy appendix
The AMA has created a new AI taxonomy appendix to clarify terms that best describe AI services, how these services are used, and how they can be differentiated within the CPT code set.
This new appendix will describe various applications of AI, such as expert systems, machine learning, and algorithm-based medical services and procedures and help to improve understanding of AI, and clarify how these services are used by physicians or other qualified health professionals.
The classification of AI services will be grouped into one of three categories:
Assistive
Augmentative
Autonomous
See more information from the AMA on 2023 updates to evaluation and management services (PDF).
