Keeping up with the Changes: A Review of 2023 E/M Guidelines

• January 9, 2023

The current documentation guidelines that are in place for hospital inpatient, hospital observation, emergency department, nursing facility, and home or residence services are over 25 years old.

They were first released in 1992, revised in 1995, and again in 1997 with specialty guidelines.

With the 2021 and 2023 documentation and coding requirements for Evaluation and Management (E/M) services, CMS and the American Medical Association (AMA) have updated the requirements to streamline the process and address the administrative burdens. In addition, the upcoming changes also allow CPT and CMS to align whenever possible.