#190 Every Prenatal Visit Is Now a Billable Event

Send us Fan MailStarting January 1, 2027 every antepartum visit becomes its own billable E/M charge. The global OB code goes away. The seventeen deleted codes include 59400, 59510, 59425, and 59426. And the way most prenatal notes are written today supports a 99212 at best, even when the visit was genuinely a 99214. Dr. Heather Signorelli and Maria Reynoso, Director of RCM at NatRevMD, walk through what changes, what the notes have to say, and the three actions every OB practice should take this week. What changes January 1, 2027: Antepartum-only codes (59425, 59426) and global OB codes (59400, 59510) are deleted. Every prenatal visit is now a standard E/M visit with modifier TH. New patient 99202–99205. Established patient 99211–99215. What the notes actually look like today: Notes have been written for speed because the global model did not reward note detail. A typical 16-week prenatal note (BP, fundal height, FHTs, “patient doing well, return in 4 weeks”) supports a 99212. The provider did much more during that visit. None of it is in the note. Under 2027, that gap is real revenue. What a 99214 note has to say: ACOG’s position: pregnancy is a chronic illness with exacerbation and progression for E/M purposes. The complexity is built in. The note has to reflect it. For a 99214, document the ongoing management of the pregnancy as a condition, the data reviewed with your interpretation, and moderate risk decisions like prescription management or monitoring a condition that could escalate. “Anatomy scan reviewed, normal” is a 99212. “Anatomy scan reviewed, normal four-chamber heart, no CNS abnormality, EFW consistent with dates, AFI normal, counseled patient” is a 99214. High-risk patients finally pay for the complexity of their care: Under the global model the complex patient and the low-risk patient paid the same. The new model fixes that two ways. Complex visits code at a higher level (99214 / 99215). And more frequent visits equal more claims. For 99215 the note needs the specific complicating diagnosis named, data reviewed with interpretation, the management decision and the reason behind it, and specialist coordination if applicable. Same-day procedures and modifier 25: Antepartum procedures (NSTs, ultrasounds, amniocentesis, CVS) still bill separately. The E/M visit on the same day is now also billable with modifier 25. The note must independently support the E/M, not just the procedure. Three actions this week: Audit twenty random prenatal notes against the 2021 E/M guidelines to set your baseline Rebuild EHR templates to prompt for MDM elements, not for speed Start documentation training in Q3, using providers’ own notes side by side with the corrected version and the dollar difference Quick Reference Table:       Topic                                                                                    What to knowDeleted codes count                     -      17 codes deleted total Antepartum-only codes                  -       59425, 59426 — deleted Jan 1, 2027Global OB codes                                  -       59400, 59510 — deleted Jan 1, 2027 New patient E/M range                    -       99202–99205 + modifier TH Established patient E/M range    -       99211–99215 + modifier TH 99214 vs 99213                              -       ~$46 per visit at Medicare ratesModifier 25               -       On the E/M when a procedure is also billed same dayACOG test date         -September 1, 2026 — recommended start for test claimsRVU finalization       - CMS proposes July 2026, finalizes November 2026 RESOURCES BLOCK Save your seat: Live OB/GYN Global Codes Update Webinar (July 7, 2026, 4:00 PM ET) · eligibility.natrevmd.com/obgyn-global-updates-webinar Book a 1:1 with Dr. Signorelli · calendly.com/heather-natrevmd/ Practice Revenue Leak Scorecard · eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Payment Posting Audit Checklist · eligibility.natrevmd.com/payment-posting-checklist RECOVER Diagnostic Quiz · natrevmd.com/quiz Series Part 1 (EP188): https://podcasts.apple.com/us/podcast/188-17-ob-codes-just-got-deleted-your-real-deadline/id1624182351?i=1000773393336Coming next: EP191 · Phase 2 labor management codes (the codes that have never existed in CPT before)