Expert Toni Elhoms will be live for Navigating the 2023 Evaluation and Management (E/M) Changes. The coding guidelines for office-based/outpatient services have seen a roll into significant changes, which led to major developments in the Evaluation and Management (E/M) services. And YES, it will impact the clinical documentation of providers and the required reimbursement rates. How do calculate the E/M services appropriately when such examinations are present in between? Side-away the worries! The live session will help you in reviewing 2023 E/M guideline changes, the updated elements of historical and physical examinations, medical decision-making requirements, and the needed methodologies. While the E/M services are portrayed as avoiding the burden on healthcare sectors, then keeping pace with the changed methodology is substantial for inpatient, observation, consultations, and skilled nursing E/M facilities. The Healthcare industry is known for high regulative activities, and even a single error in its management could lead to disasters. Regulate the compliance parameters by Navigating the 2023 Evaluation and Management (E/M) Changes. Learning Objectives Understand the 2023 E/M Guideline Changes Recall new medical-decision-making requirements Recall new time-based coding requirements Understand clinical documentation requirements Understand new prolonged service codes Recall best practice E/M coding tips Areas Covered Discuss the 2023 E/M Guideline Changes Discuss how history and physical examination elements have changed Review updates for medical-decision-making requirements Review updates for time-based coding requirements Outline clinical documentation requirements Dissect new leveling methodology Review new prolonged service leveling methodology Outline clinical documentation scenarios to demonstrate the proper application of new guidelines Discuss best practice tips for E/M coding in 2023

1. Deconstructing the 2023
Evaluation and Management (E/M) Changes
PRESENTED BY:
TONI ELHOMS, CCS, CPC, CPMA, CRC,
AHIMA-APPROVED ICD-10-CM / PCS TRAINER
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2. Toni Elhoms, CCS, CPC, CPMA, CRC,
AHIMA Approved ICD-10-CM/PCS
Trainer
❑ CEO – Alpha Coding Experts
❑ Podcast Host – Alpha Coding Podcast
❑ National Speaker - Coding, Compliance
and Reimbursement SME
❑ Former President of Orlando, Florida
AAPC Chapter
❑ Expert Witness
❑ Published Author
❑ Consultant/Educator/Trainer
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3. Agenda
Deconstruct 2023 Changes for E/M services
Discuss levelling methodology for all E/M services
Discuss Inpatient vs. Outpatient E/M Coding Differences
Deconstruct new split/shared service reporting rules for 2023
Review various E/M case studies and coding rationale together
Q&A at the end
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4. 2023
E/M
Updates
Source: AMA
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5. 2023 E/M Guidelines
❑ MDM - straightforward, low, moderate, high
complexity
❑ Number and complexity of problems
addressed
❑ Amount and/or complexity of data to be
reviewed and analyzed
❑ Risk of complication and/or morbidity or
mortality of patient management
❑ Total Time on the encounter DOS
❑ Time ranges
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6. Split/Shared Services
❑ Split/Shared E/M visits = shared service between a
physician and a non-physician practitioner (NPP)
in a facility setting
❑ Physician and NPP must be in the same group
❑ Not applicable in the office or other outpatient
setting
❑ Facility – hospital or SNF
❑ Documentation must identify the two individuals
(physician and NPP) who performed the visit
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7. Split/Shared Services
❑ Split/Shared E/M visits
❑ Admissions
❑ H&Ps
❑ Rounds
❑ Critical Care
❑ Prolonged Services
❑ SNF visits (outside of any required physician-specific
services)
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8. Split/Shared Services
Guidelines Applicable For 2023:
❑ Split/Shared E/M visits must be billed
under the NPI of the individual who
provides more than 50% of total visit
time
❑ FS Modifier - identify all claims for
split/shared E/M visits
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9. Provider Education Tips
❑ It’s a LOT to keep track of and
overwhelming!
❑ Use Pocket-Guides, Tip-Sheets, Coding
Matrix
❑ Map out most common scenarios with the
provider’s own clinical documentation
❑ Establish a consistent feedback loop
❑ Audit. Educate. Rinse and Repeat!
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10. Who is Impacted?
Physicians/NPPs/ Other Healthcare Providers
Nurses/Medical Assistants
Revenue Cycle - Coders/Billers/Auditors
Compliance Professionals
EMR/PM Vendors
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11. Workflows Impacted
Clinical Documentation
Templates/Forms
Medical Necessity
Coding/Billing/Auditing
Quality Measures
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12. Compliance
Considerations
❑ Service requirements met
❑ Provider signature requirements met
❑ Copy/Forward edited for current
presentation and encounter
❑ Avoid Cookie cutter documentation and
overuse of MACROs
❑ Level of service aligns with clinical
documentation
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13. Resources
❑ American Academy of Family Physicians (AAFP)
❑ American Academy of Professional Coders
(AAPC)
❑ American Health Information Management
Association (AHIMA)
❑ American Medical Association (AMA)
❑ Centers for Medicare and Medicaid Services
(CMS)
❑ Code of Federal Regulations
❑ PYA
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