Keeping Level 5s Under New 1/1/23 E/M Documentation changes
Could a 15% pay cut be coming your way?
VACEP member and president of Augusta Emergency Physicians David Fosnocht MD, FACEP took some time recently to analyze new Current Procedural Terminology (CPT) documentation guideline changes for all evaluation and management (E/M) services, effective as of January 1, 2023. You can get up to speed on those changes here.
At a high level, emergency medicine E/M codes 99281-99285 will be based only on Medical Decision Making (MDM). History, review of symptoms, and exams can be documented as you feel is medically appropriate. There are no longer any coding requirements for them.
Medical Decision Making is based on three areas:
The number and complexity of problems addressed
The amount and complexity of data to be reviewed and analyzed
The risk of complications and morbidity/mortality of patient management
Fosnocht
An audit of current 99285 (Level 5) charts revealed that 10% to 15% of charts will be downcoded using the new coding guidelines. Here, Fosnocht offers five ways to keep your Level 5 visits under the new changes.
Interpret your own imaging studies. For example, review an ECG/rhythm strip or a chest X-ray: "My interpretation of the CXR is no infiltrate."
Document review of “external” records. For example, “I reviewed the patient's echocardiogram from December 2022 showing EF of 20%."
Document history provided by an independent historian (EMS/parent/family). For example, "EMS reports glucose 96 in the field" or "Patient with dementia and spouse reports the patient fell with head injury and is on Coumadin."
Document tests or admission decision considered — even if neither is done. For example, "Low risk for PE based on Wells criteria and CTA not performed after shared decision making with the patient,” or, “Admission for cardiac testing discussed with the patient but will proceed with outpatient cardiology followup based on negative troponin testing and low HEART score."
Consider social determinants of health impacting care. For example, "Case management consulted to assist the patient with scheduling and transportation for primary care followup as they came to the ED tonight by EMS and cannot see primary care due to lack of transportation."
Learn more about the E/M changes:
ACEP ED MDM coding “grid”
ACEP MDM coding FAQS
Questions? Email Dr. Fosnocht if you need help to keep getting paid by insurers for the hard work you do.
