2023 ED Evaluation & Management Services

For several years, the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) have been working to revise the code descriptors and coding guidelines for Evaluation and Management services. 

 AMA and CMS adopted new guidelines for the Office or Other Outpatient E/M codes 99202-99215 in 2021.  In 2022, CMS announced that these revised guidelines would be applied to the emergency department.  On July 1st, AMA released the 2023 E&M Guidelines that will be applied to all E&M services.

The AMA E&M Workgroup indicated several guiding principles that steered their process.

·         Decrease the administrative burden of documentation and coding

·         Decrease the need for audits via the addition and expansion of key definitions and guidelines

·         Decrease unnecessary documentation in the medical record

·         Ensure that payment for E&M services is resource-based

·         No direct goal of payment redistribution among specialties


This once-in-a-generation shift in the coding process will significantly impact how the E&M codes are assigned in the emergency department.  Therefore, emergency physicians and ED coders need to understand how to incorporate these changes into their documentation and coding processes.

For 2023, the revised E&M guidelines:

Eliminate history and physical as elements for code selection:

·         ED E&M codes now require a “medically appropriate history and/or examination.” The treating physician determines the nature and extent of the history and/or physical examination.

·         The extent of history and physical examination are NOT used in selecting E&M codes.No more counting HPI elements or the number of systems reviewed, no need to document irrelevant past family social history information for the sole purpose of satisfying the coding staff.  ED physicians can look forward to never again using the statement “All other systems negative” after January 1st, 2023.

Allows physicians to choose E&M codes based on Medical Decision Making or Total Time.

·         ED E&M codes will be selected based on MDM. For 2023, emergency medicine is still exempt from the time component.  Per CPT 2023, “Time is not a descriptive component for the emergency department levels of E/M services because emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time.”

Modifies the criteria for Medical Decision Making

·         The AMA workgroup made extensive edits to the MDM calculation process.

·         No more Marshfield scoring, i.e., “new problem to the examiner and/or “additional workup planned.”

·         Revised and/or created numerous clarifying definitions in the E&M guidelines.

·         Modified the titles and scoring process for the MDM subcomponents.

ERcoder has two presentations available to prepare ED physicians and their coding staff for the E&M changes on the horizon.

Introduction to the New MDM Grid and Its Application in the Emergency Department

This 90-minute presentation will explain the new coding process to physicians, physician assistants, nurse practitioners, and ED residents working in the emergency department.  It will discuss the individual MDM components and what needs to be documented to assign the E&M code that accurately reflects the service rendered. 

Attendees will be shown several areas where slight modifications in their documentation routine will help when the time comes to implement the 2023 coding guidelines.  Not only that, but these tips will strengthen their current ED chart notes and help support the E&M codes reported through the rest of 2022.

This presentation is geared toward ED clinicians but will also provide a valuable overview of the MDM grid for ED coders as well.

ED Coders Workshop – 2023 E&M Coding Guidelines

This 2-3 hour training session will be a deep dive into the E&M scoring process for 2023.  Coders will be led step by step through the revised MDM scoring and how a dozen pages of guidelines and definitions tie into the bullet points in each MDM component. 

After an in-depth review of the MDM grid, attendees will put this new knowledge to use as they are led through coding real-world ED charts. These hands-on case studies will illustrate the coding process in 2023 and highlight documentation habits that may need to be modified in 2023 to satisfy the new MDM scoring. 

While coders are the primary target for this in-depth discussion, clinicians are welcome to participate.  They can usually add clinical insight into the conversation that helps everyone have a better understanding of not just the coding but also the clinical thought process that goes into the evaluation of the patient.

Due to the level of detail in these presentations, as well as the attendee questions and group discussions generated by this topic, these courses will be most beneficial and offer the most educational value if presented in person.  While an on-site live presentation to your staff is highly recommended, we recognize that getting your staff together in cyberspace may be a more realistic option.  

2023 is coming soon, and the calendar is already filling up with presentations for ED physicians and coders from all over the country.

Contact ERcoder today to schedule either or both presentations