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New
2023 Changes
2021
Revisions
Pediatric
Evaluation and
Management
Coding
Revisions
Facility and
Office Services
Pediatric
Evaluation and
Management
Coding
Revisions
Facility and
Office Services
American Academy of Pediatrics
Linda D. Parsi, MD, MBA, CPEDC, FAAP, Editor
Liaisons
Kathleen K. Cain, MD, FAAP
AAP Section on Administration and Practice Management
Kathryn B. Lalor, MD, FAAP
AAP Section on Early Career Physicians
Benjamin Shain, MD, PhD
American Academy of Child and Adolescent Psychiatry
Samuel D. Smith, MD, FAAP
American Pediatric Surgical Association
AAP Staff
Teri Salus, MPA, CPC, CPEDC
Cindy Hughes, CPC, CFPC, Consulting Editor
Disclaimer
Every effort has been made to include the new and revised 2023 Current Procedural
Terminology (CPT®) codes, their respective guidelines, and other revisions that might
have been made. Because of our publishing deadlines and the publication date of the
American Medical Association CPT, additional revisions and/or additional codes
may have been published subsequent to the date of this printing. It is the responsibil-
ity of the reader to use this manual as a companion to the CPT publication. Vignettes
are provided throughout this publication to illustrate correct coding applications.
They are not intended to offer medical advice on the practice of medicine. Further, it
is the reader’s responsibility to routinely access the American Academy of Pediatrics
website (www.aap.org/errata) for any errata in the published version. At the time of
this publication, final changes for 2023 codes and Medicare payment policies were
pending. See www.aap.org/coding for updates.
Chapter 1. Evaluation and Management Documentation Guidelines
Copyright Acknowledgment
Current Procedural Terminology (CPT) is a listing of descriptive terms and 5-digit
numeric identifying codes and modifiers for reporting medical services and proce-
dures performed by physicians. This presentation includes only the CPT descriptive
terms, numeric identifying codes, and modifiers for reporting medical services and
procedures that were selected by the American Academy of Pediatrics (AAP) for
inclusion in this publication. The inclusion of a CPT service or procedure descrip-
tion and its code number in this publication does not restrict its use to a particular
specialty group. Any procedure or service in this publication may be used to report
the services provided by any qualified physician or, when appropriate, other qualified
health care professional.
The American Medical Association (AMA) and the AAP assume no responsibility
for the consequences attributable to or related to any use or interpretation of any
information or views contained in or not contained in this publication.
Any 5-digit numeric CPT code, service descriptions, instructions, and/or guidelines
are copyright 2022 (or such other date of publication of CPT as defined in the federal
copyright laws) AMA. All rights reserved.
The most current CPT is available from the AMA.
No fee schedules, basic unit values, relative value guides, conversion factors or scales,
or components thereof are included in CPT.
Contents
Introduction...................................................................................................................... IX
Appendix
Evaluation and Management Code and Guideline Changes........................................ 145
Using Evaluation and Management Documentation Guidelines to Define
Problems Addressed.................................................................................................. 150
Data to Be Reviewed and Analyzed............................................................................... 155
Selecting the Level of Risk Associated With Patient Management............................. 161
Selecting the Level of Service Based on Medical Decision-making...............................167
Guidelines for Hospital Inpatient and Observation Services....................................... 173
Inpatient and Observation Consultation Guideline Changes...................................... 179
Same-Date Admission and Discharge Services............................................................ 183
Emergency Department Visits....................................................................................... 186
Outpatient Consultations............................................................................................... 192
Home and Residence Services....................................................................................... 198
Evaluation and Management Total Time and Prolonged Service............................... 203
New Time Requirements for Prolonged Service by Clinical Staff............................... 208
Certificate of Completion
An online quiz is available for you to further enhance your coding knowledge and demon-
strate your understanding of the concepts in this book. Upon successful completion of the
quiz, you will receive a Certificate of Completion from the American Academy of Pediatrics.
To complete the quiz and obtain the certificate, please go to www.aap.org/EMcertificate.
Note: This quiz is not for official credit from any credentialing society.
Updates
Evaluation and management coding continues to evolve. As they become available,
updates will be posted at www.aap.org/errata.
Introduction
The Appendix in the second half of the book contains articles from
the AAP Pediatric Coding Newsletter™. In April 2022, the newsletter began
publishing articles related to these coding revisions. Within these articles,
you will find detailed information on the codes and examples to help guide
implementation. We recommend reading them in the order in which they
appear, as some articles build on the contents of previous articles.
An online quiz is available for you to further enhance your coding
knowledge and demonstrate your understanding of the concepts in this
book. On successful completion of the quiz, you will receive a Certificate
of Completion from the AAP. To complete the quiz and obtain the certificate,
please go to www.aap.org/EMcertificate.
The AAP coding experts are ready to assist you with any coding-related
questions or concerns.
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