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01/26/2026
Some coders at this year’s Advanced Specialty Coding Virtual Summit reported increased denials for E/M visits billed at the same encounter as an X-ray. Practices should be watchful for these and challenge them when they occur, billing experts advise.
01/26/2026
Up to 30 proposals will be accepted under a new $100 million Center for Medicare and Medicaid Innovation (CMMI) model. While details about the MAHA ELEVATE (Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence) model are scarce, early signs suggest that behavioral health providers, and those currently coordinating complex care, will have an advantage.
01/26/2026
Cigna’s new E/M Coding Accuracy (R49) policy, which took effect October 1, will automatically review — and in some cases, downcode — level 4 and 5 E/M claims that the insurer believes are inconsistent with typical coding patterns.
01/26/2026
by: Julia Kyles, CPC
Question: The provider performs a service that they believe meets the requirements for critical care services. They document the service and the total time. However, the documentation does not support the severity or complexity required for a critical care service. Can the practice use the time to report a level-based hospital E/M code, or does it have to use medical decision-making (MDM)?
01/26/2026
Utilization of the e-visit codes established before the pandemic in 2020, represented by 99421-99423 (Online E/M for physicians) and 98970-98972 (Online assessment and management [A/M] for non-physician qualified health professionals), suffered in the aftermath of the public health emergency.

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