In This Public Health Emergency Update:
- Changes to CPT/HCPCS Codes Coming in 2023
- Changes to ICD-10 Codes Coming in 2023
- No Significant COVID PHE Changes
- General Updates
Changes to CPT/HCPCS Codes Coming in 2023
To reiterate a topic mentioned in the last bulletin, the American Medical Association released a proposal for significant changes to the evaluation and management (E/M) portion of CPT coding in 2023. Twenty-five E/M codes have been suggested for deletion, but this is still pending final approval from the proper channels. If these CPT codes are removed, it will affect how you report your encounters to EMB. There will be changes to coding for hospital observations, consultations, nursing facilities, resident services, and prolonged services.
EMB will continue to monitor developments with this, and more updates are expected in November. Once decisions are finalized, we will be creating a reference guide for your convenience.
Changes to ICD-10 Codes Coming in 2023
On August 1, the Hospital Inpatient PPS final rule was put in place for FY 2023. Of note, there are expected changes regarding the use of “unspecified” codes.
“Unspecified” codes are not the same as “other” codes that are utilized when the detailed condition simply does not have an existing specified ICD-10. Codes with “unspecified” in the title can only be used when the medical record information is insufficient to apply a more specific option. The CMS coding guidelines for 2023 state that “unspecified” codes should be used sparingly, but there are instances where they may be necessary.
As you are aware, suggested best practice has always been a thoroughness with medical records and distinct diagnosing. While nearly every active ICD-10 code has been traditionally accepted by insurances, we are starting to see more plans rejecting claims with an “unspecified” diagnosis. We anticipate this becoming a much stricter rule in 2023. Many of our providers already minimize the use of these codes, when possible. For those who may rely more heavily on the codes, we recommend working towards making a shift, as we approach the end of the year. Please reach out to EMB if you have questions or concerns regarding this.
No Significant COVID PHE Changes
Despite some suggestions and indications available in the media, there have been no official developments in the COVID PHE determination. All HHS/CMS waivers will continue to be in place for the duration of the PHE and an additional 151 days beyond that. The next opportunity for the HHS Secretary to update the determination on the PHE comes in the next few weeks. EMB will keep you informed on all developments as they occur.
General Updates
- In early August, the HHS Secretary made a determination that a national public health emergency exists due to an outbreak of monkeypox across multiple states. There is currently little indication as to what, if anything, this means for provider procedures, particularly as this runs simultaneously with the COVID PHE. EMB will continue to monitor updates regarding this PHE.
- EMB’s owners will be out of the country for a few weeks, in mid-October. During this time, you can reach out to your specific biller with questions, and high-level concerns can be handled by upper management. We always strive to have our providers’ needs met in a timely manner.