Part B Insider - 2022 Issue 10
Coding Updates: Find Out Which 2023 Code Changes Affect Office/ Outpatient Consultations
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Article Overview
This article explains the 2023 changes to CPT E/M consultation coding for office and outpatient settings. It is aimed at coders, billers, and provider documentation teams who need to understand revised guideline language, code set changes, and time-based selection concepts for consultation services. The discussion also highlights payer-policy considerations and the role of mandated-service modifier use in consultation reporting.
Why This Topic Matters
These updates affect how consultation services are documented and reported in 2023, making it important for practices to align coding workflows, documentation practices, and payer review processes with the revised CPT E/M framework.
Article Sections
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See What’s New in Consultation Section Guidelines
This section reviews the revised consultation guideline language for 2023 and describes broad changes to places of service and reporting expectations in office and outpatient settings.
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Mandatory modifier
This section discusses the required consultation modifier referenced in the 2023 guidance and notes the article’s general discussion of payer-requested consultations.
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Focus on Revised Office/Outpatient Consultation Codes
This section introduces the updated office and outpatient consultation code set for 2023, including time-based selection concepts and prolonged-services reporting at a high level.
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Choose the Correct Consultation Code via Time or MDM
This section explains the overall shift to documenting consultation services by either time or medical decision making and discusses documentation and payer-related considerations.
What You Will Learn
- What changed in 2023 consultation guideline language
- How office and outpatient consultation reporting was revised
- Which consultation code set changes were made for 2023
- How time and medical decision making are discussed for consultation selection
- What broad guidance is given about prolonged services and mandated-service reporting
Who Should Read This
- Medical coders
- Medical billers
- Physician documentation staff
- Compliance teams
- Practice managers
- E/M coding educators
Codes Discussed
Modifiers Discussed
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