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the American Medical Association AMA released a preview of the 2023 CPT documentation guidelines for evaluation and Management Services to the American College of Emergency Physicians for review 30 years ago an ER visit level was based on a combination of History physical exam and medical decision-making ailments beginning in 2023 the emergency department em services will be based only on medical decision making practices the existing 2021 guidelines implemented by the center of Medicare and Medicaid services and American Medical Association allowed Healthcare Providers to document em visits based on medical decision making practices or total time this was a major departure from the previous guidelines that required them to adjust three elements in the patients progress notes patient history patient exam and medical decision making for code selection the new em guidelines for 2023 built on the flexibilities of this 2021 office outpatient em coding and documentation rules documenting