The new 2023 CPT code set aims to expand the 2021 modifications to reduce coding and documentation burdens with evaluation and management (E/M) services beyond the office visit services to include:

– Inpatient and care observation services
– Consultations
– Emergency department services
– Nursing facility services
– Home and residence services
– Prolonged services

While this modification is a step in a helpful direction to care teams and patients, some health plans are disputing the E/M code levels being submitted and implementing programs that downcode claims and reduce payment for services provided.

The AMA has created a resource to assist practices in navigating these downcoding programs. The resource includes sample communications to the health plans, examples of downcoding scenarios, tips to support successful appeals, and guidance on reviewing remittance advice to identify downcoding.

In addition to this resource, the AMA is asking for practices to complete an informational survey to track health plans’ downcoding programs and help the AMA and state medical societies support medical practices in addressing payer downcoding initiatives.