With the new year quickly approaching, many PALTC professionals are wondering what’s in store for them come 2023. Luckily, the Centers for Medicare and Medicaid Services (CMS) have released the CY 2023 Physician Fee Schedule (PFS) final rule, so PALTC practices everywhere can prepare for the upcoming year. This final 2023 PFS changes include an overall cut to payment rates while nursing facility code valuations increase.
But what does this mean exactly? And better yet, how will it impact your practice?
Effective from CY 2023 AMA CPT editorial panel has redefined the E/M visit codes, with the exception of critical care, as the same as Office/Outpatient E/M visits. In this new revision, an E/M visit will be selected based on the following:
- Amount of time practitioners spend with their patient
- Medical decision making
With these changes, history and physical exams would be considered medically appropriate and would no longer be used to select visit level. This also means when selecting an E/M based on time, providers should choose the code based on the whole time spent with a patient rather than by attaining the midpoint/threshold time.
We know, it’s a lot to take in at once. But that’s why we’re here. In this post, we’ll take a look at these E/M code changes and how they will affect the following three areas:
- Nursing facility services
- Prolonged services
- Home services
2023 PFS Changes in Nursing Facility Services
With this proposed review, CMS has finalized specific changes in the coding for the revised nursing facilities visits E/M code set. Along with implementing other coding changes, this code set will be effective beginning CY 2023 on January 1st. These changes brought on by the CMS zero in on the total time on the date of an encounter to select the appropriate level of nursing facility visit service code. In addition to these changes, the codes will have new descriptor times, each assigned for when time is used to select the level of visitation.
Below are a few of the notable code changes for nursing facility services:
But these changes are not the only ones to affect nursing facility services. With these new alterations, multiple codes are poised to be deleted. CPT code 99318, a code detailing the management of a patient involved in an annual nursing facility assessment, will be deleted at the start of CY 2023. In addition, the deletion of Domiciliary, Rest Home (e.g., Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334-99337, 99339, 99340 will also be in effect starting at the beginning of next year.
2023 PFS Changes in Prolonged Services
One of the most prominent amendments the CMS finalized is the transition of prolonged nursing facility services. Starting the first of next year, these services by a physician or non-physician practitioner (NPP) will now be reportable under a new G code, G0317. This, in turn, will be used when the total time (in the time file, of course) is exceeded by 15 or more minutes. With this change, both physicians and NPPs will be able to account for the additional time spent.
G0317, the proposed new nursing facility prolonged service code, and G0318 for Home or Residence care services can be used only when the total time of service exceeds 15 minutes. In addition to this regulation, the following criteria should be met to use this code:
- Only used with E/M 99306 or 99310 and 99345 or 99350
- Total time spent should include the day before the visit, the day of the visit, and up to three days after.
Since G0317 / G0318 includes time without direct patient contact, there would no longer be a need to use CPT codes 99358 and 99359 (prolonged E/M visits without direct patient contact) in conjunction with NF visits. Therefore, proposing to change the payment status for CPT codes 99358 and 99359 to “I” (Not valid for Medicare purposes. Medicare uses another code for reporting and payment for these services). In addition, prolonged services will not be reportable with CPT codes 99315 and 99316 (NF discharge day management).
But with every new beginning comes an ending. On top of these code changes, the CMS has announced the retirement of CPT code 99318. This deletion alters the annual nursing facility assessment code, revising the remaining nursing facility code to better align with the principles included in the E/M office visit services. This code elimination is for documenting and picking level services strictly based on the entire time of medical decision-making.
Changes in Home Services
The threat is never real until it hits us at home. And one form of care delivery that is sure to be altered in the new year is home service. From CY 2023, CPT codes in the Domiciliary, Rest Home (for example, Boarding Home), or Custodial Care Services code family (CPT codes 99324-99328, and 99334-99337) and one CPT code in the Home Services family (CPT code 99343) will be deleted by the CPT panel. All of the services will be merged with “Home visit” services CPT codes 99341, 99342, 99344, 99345, and 99347-99350. While all of these codes will be reported in place of service 12, it’s essential to know that there will be a critical change in the description of POS 12. It follows as “location, other than a hospital or other facility, where the patient receives care in a private residence.”
PFS Changes Wrapped-Up
With these proposed changes set to take effect in 2023, many PALTC professionals are scrambling to prepare themselves for these E/M code changes. While we’ve covered code changes for nursing home facilities, prolonged services, and home services, there’s much more to discover for next year’s PFS schedule.
Click here for an in-depth PDF for further information on all E/M code changes for the 2023 PFS schedule.