2023 reveals the significant differences in how CPT® and CMS count time in relation to Evaluation and Management (E/M) services. Both organizations are holding their ground, at least for this year, which creates unique problems for practices that use both the prolonged care add on codes for E/M  services and Critical Care services.

The 2023 Physician Fee Schedule Final Rule discusses CMS’ position on their changes to prolonged care and E/M services. This is precipitated by the AMA’s changes to E/M codes (other than Office and Other Outpatient services). The 2023 PFS final rule also has a “technical correction” regarding Critical Care.  This concerns when the 99292 add on code can be assigned and an error that was found in the 2022 PFS Final rule

CMS has created their own add on codes, temporary G codes, for prolonged care services.  Understanding what the differences are, understanding how code selection differs because of this and suggestions of different ways your practice can be sure the correct code and number of units of that code are assigned are all a part of this webinar. 

Webinar Objectives

Assigning proper codes when working with time based E/M codes requires an understanding of the rules of both CPT and CMS – both will be provided with references

Documentation for time based codes is essential for compliant coding – what carriers have published on this topic will be presented

Medical Necessity is still the overarching criterion for payment of E/M services – what does this mean for time based codes and documentation

Webinar Agenda

• The presentation present current CPT® guidelines and codes regarding E/M services
  • Included in this will be the times assigned to each code
• The webinar will then review CMS’s information from the 2023 PFS final rule on the topic of prolonged care add on codes to E/M services and why it differs from CPT’s policy
• Differences in how these prolonged codes are assigned will be discussed
• CMS’s technical correction for Critical Care from the 2023 PFS final rule will be discussed and how it revealed, for some, a change in policy
• Lastly, office flow ideas for compliant assignment of both sets of codes

Webinar Highlights

• CPT’s time frames for E/M codes
• CMS’s differing opinion on CPT’s definition of time
• CPT’s codes for prolonged care
• CMS’s codes for prolonged care
• CPT’s time frames for Critical Care
• CMS’s time frames for Critical care
• Ideas on how your practice can properly code these differing scenarios

Who Should Attend

• Coders
• Billers
• Auditors
• Office Managers
• Practice Managers