Part B Coding Coach: E/M 2023: Boost Prolonged Service Know-How With This Primer

Why This Topic Matters

Prolonged service reporting can affect claim accuracy, payment, and compliance, especially when CPT and Medicare guidance do not align. Understanding the 2023 updates helps coders choose the correct prolonged-service framework for the payer and E/M setting involved.

Article Sections

1. Background on 2023 prolonged service changes

   Introduces the broader 2023 changes affecting prolonged E/M reporting and the difference between CMS and CPT approaches.

2. +99417 updates for outpatient prolonged services

   Reviews the outpatient prolonged-service code changes and the E/M settings addressed under CPT for 2023.

3. New CPT prolonged service code +99418

   Covers the addition of a new CPT prolonged-service code for inpatient and observation settings and the code families associated with it.

4. Medicare prolonged service G codes

   Summarizes Medicare’s prolonged-service approach for 2023 and the related G code set introduced for different care settings.

5. Clinical scenario

   Presents a practical scenario comparing prolonged service reporting considerations across payer frameworks.