Did you see? CMS finalized the 2023 Medicare Physician Fee Schedule. Key takeaways include:
- A 4.5% reduction to the CY 2023 Medicare Part B conversion factor will take effect Jan. 1.
- CMS will continue to not recognize subspecialties for defining initial vs. subsequent services. CMS will not allow providers in the same specialty, but different subspecialties to report separate initial visits.
- CMS will apply the 8-to-24-hour rule for inpatient or observation and discharge codes:
- For stays less than eight hours, report only the initial hospital or observation services code (99221-99223).
- For stays that are at least eight but less than 24 hours, report a same day admission and discharge services code (99234-99236).
- For stays that are more than 24 hours, report an initial hospital or observation services code (99221-99223) and a hospital discharge day management code (99238-99239).
- When swing-bed patients are billed by the hospital as nursing facility care, the nursing facility E/M codes apply.
- Although the AMA says that admission to another setting is separately billable with modifier 25, CMS maintains that if a patient s admitted to observation or inpatient status during a visit on the same day at a different site of service (e.g., ED, office, nursing facility) then that visit is bundled as part of the initial observation or inpatient visit.
- CMS will adopt the telehealth waiver extension, which allows many of the telehealth waivers to continue for 151 days after the public health emergency expires.
- Split/Shared visit guidelines to support the substantive portion of the visit will not change for 2023. The reporting provider may continue to support the substantive portion of the visit based on total time, or performance of history, exam, or medical decision making.
- CMS released new prolonged services codes to report with E/M services as CMS will not adopt the AMA CPT codes (99417 and 99418). Be sure to check out the time thresholds for reporting these codes:
- G2212 with office visits – can also use with 99483 for cognitive-assessment
- G0316 with inpatient/observation visits
- G0317 with nursing facility visits
- G0318 for home or residence visits
Resources for the final 2023 Medicare physician fee schedule:
Shea Lunt, RHIA, CPC, CPMA, PMP
Shea is a consultant for The Haugen Consulting Group with 11 years of health care industry experience. Shea has experience working on the professional fee side of coding, auditing, education and compliance serving coders and physicians.
She earned a bachelor’s degree in health information management and a master’s degree in health services administration from the University of Kansas. Shea is a Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA) and a Project Management Professional (PMP).
Shea, her husband, and their daughters, call the wide-open spaces of central Kansas home.