January 05, 2023
3 min read
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The AMA’s CPT update went into effect on Jan. 1. According to the organization, the update will free “physicians and care teams from time-wasting administrative tasks that are clinically irrelevant to providing high-quality care to patients.”
The CPT update involves 225 new codes, 93 revisions and 75 deletions, including changes that will impact primary care physicians who provide evaluation and management (E/M) services in hospitals, homes and nursing facilities.
“The rules could help in the sense that they create a more unified set of coding and documentation guidelines for the services most often reported by family physicians,” Tochi Iroku-Malize, MD, MPH, MBA, FAAFP, president of the American Academy of Family Physicians, told Healio. “In theory, the changes should help by simplifying coding for these E/M services.”
For example, Iroku-Malize said “there will be a single set of codes for hospital inpatient and observation care services rather than a set of codes for each.”
The same unified structure will apply to home or residence codes for home visits and domiciliary visits, which will let physicians focus on medical decision-making instead of worrying about history and exams, Iroku-Malize said.
She additionally noted that primary care physicians could be impacted by the corresponding relative value changes for codes under the Medicare Physician Fee Schedule, “and under other payers’ fee schedules, to the extent they use the same relative values or set their allowances as a percentage of the Medicare allowances.”
Update will impact more physician groups
The update’s far-reaching effects is one of the most significant changes it brings. Speaking to Healio, Mark Synovec, MD, FACP, chair of the AMA’s CPT Editorial Panel, noted that the update is a continuation of CPT E/M coding changes that the CPT E/M Workgroup started on in 2018, concentrating on the level of medical decision-making.
“The biggest change that we have instituted in 2023 is expanding the E/M changes to affect additional sites of service, thus affecting additional physician specialties,” he said. “In the past, we concentrated our work in the E/M space, addressing clinic-based (‘outpatient’) services. Now we’re addressing the other places of services. In 2023, the outpatient coding construct is being broadened to impact ED physicians, hospitalists and those physicians providing E/M services in nursing facilities.”
Synovec pointed to the update’s intuitiveness as a substantial benefit to physicians.
“Health care providers can now let the appropriate patient care, based on medical decision-making, to direct the coding, as opposed to allowing a series of check boxes dictate the level of E/M CPT code assignment,” he said. “The coding should result to be more intuitive to the service provided and obviate the need to provide/document irrelevant services to justify the appropriate code assignment.”
New codes could help relieve workloads, burnout
Highlighting the difficult position the health care workforce finds itself due to staffing shortages and supply chain issues amid the COVID-19 pandemic, Synovec explained that the CPT update will not completely resolve physician burnout, but it could help by offering physicians one less duty to worry about.
“Hopefully we’re heading in that direction, and it’s really consistent with what CMS has stated, which is to make it easier for physicians and other providers to get paid by minimizing administrative hassles,” he said.
Because the update builds upon previous iterations, Synovec said implementation should be an easier transition because of the learning curve, especially for physicians who practice in both a clinic and hospital setting. Still, he noted that learning curve may not be the same for some pockets of physicians, especially those providing E/M services without an outpatient component and without group members that have the recent outpatient coding experience.
“I think the one thing is that typically, hospitalists are more often employed with a hospital or a large group,” Synovec said. “So, I think that it will probably will be easier for them to convert, as they will likely have more of that administrative support. They should also have educational resources as well, and I would say ED clinicians should be very similar in that regard.”
Both Synovec and Iroku-Malize encouraged physicians to ensure they review CPT guidelines and revise any templates in the electronic health record.