Understanding recent, nuanced changes to American Medical Association (AMA) coding standards will be essential for maintaining financially solid medical practices in 2023. The AMA’s “Current Procedure Terminology (CPT®) Evaluation and Management (E/M) Office or Other Outpatient and Prolonged Services Coding and Guidelines” reforms long relied-on medical coding procedures.
The AMA has said the guidelines largely align with 2023 Centers for Medicare and Medicaid Services (CMS) payment policy revisions, while offering physicians and healthcare providers greater scope to choose an appropriate service level based on the intricacies of medical decision making (MDM).
However, with confusion over the subtleties surrounding CPT E/M changes plus the use of outdated revenue cycle management methods, the risk of potential revenue losses has never been greater.
Plan Your Strategy
Quality clinical care documentation promotes good patient experiences, supports appropriate follow-up, and details critical information for fellow healthcare providers. Precise care evaluation and management records can also simplify claim processing and optimize revenue.
To successfully get up to speed on CPT E/M changes and head off related revenue loss, medical practice leadership and physician owners will want to take a deliberate approach to understanding and implementing the new guidelines – and ensuring that coders and billers have appropriate tools and support.
Begin With Policy and Education
Establish a comprehensive policy around the CPT changes to support healthcare providers chronicling patient visits and those coding these interactions. After educating your team on patient documentation best practices, review adoption and monitor compliance.
Heading into the first half of 2023, providers should frequently evaluate compliance and provide continued feedback to ensure understanding and adoption of new coding and guidelines.
Ramp up Efficiency With Automated Tools
Forecast potential shifts in reimbursement under the new guidelines, and work to actively avoiding demographic data errors. Use an automated insurance discovery tool with patient demographic verification to ensure near real-time, quality patient information.
Employ external data sources to bolster MDM. A platform such as ZOLL® Care Exchange supports access to near real-time aggregated patient data on procedures, medications, and outcomes from across the healthcare ecosystem, including emergency medical services (EMS) patient care reports.
To learn more about updated best practices for navigating the 2023 CPT® E/M Guidelines, read "Documentation Best Practices You Need to Thrive Under the 2023 CPT® E/M Code and Guideline Changes."