Update from the Healthcare Economics Committee: Current issues in Coding and Reimbursement

CMS Coding Update 2023
  • Only 2% cut in Medicare payment 
    • 8.5% Medicare cut averted with year-end legislation
  • Telehealth extended through 2024
    • Current codes for provision of telehealth service will remain unchanged this year
  • Update to E/M codes
    • Change documentation requirements and use Medical Decision Making or Total Time the day of service to determine level of service 
    • When using total time and the time exceeds the highest-level code - a prolonged services code can be added
    • Initial Inpatient/Observation codes (99221-3)   
      • *Note:  observation visits to use these codes as all observation specific codes have been deleted
    • Subsequent Inpatient/Observation codes (99231-3)
    • Same day observation/discharge codes (99234-6)
    • Inpatient consultation codes (99252-5)
    • Outpatient consultation codes (99242-5)
  • New abdominal wall hernia codes any method (open, laparoscopic, robotic) based on size, reducible/incarcerated and initial/recurrent
    • The new codes have zero-day global period so all preop visits and postoperative visits are billable using outpatient or inpatient E/M visit codes
    • Mesh placement is included in the new hernia codes
    • If you are removing the mesh, there is a new code for removal
    • All abdominal wall hernia types are included: epigastric, ventral, umbilical and parastomal  
    • Inguinal, femoral and lumbar hernias are excluded from this change
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