#188 17 OB Codes Just Got Deleted. Your Real Deadline Is Not 2027

Show notes 

On January 1, 2027, every global OB code your practice has billed for the last thirty years is being deleted. Seventeen CPT codes. Gone. Replaced with a completely new structure for how every dollar of maternity revenue is earned, attributed, and collected. And the real deadline for your practice is not January 1, 2027. The real deadline is right now. 

What is actually going away 

For over thirty years, OB practices have lived in a bundled global world: one patient, one pregnancy, one code. Effective January 1, 2027, 17 global obstetric CPT codes (including 59400 for a global vaginal delivery and 59510 for a global C-section) are being deleted entirely. The AMA and ACOG determined the global model no longer reflects modern OB standard of care, and so the structure is being fully replaced, not patched. 

The four new phases of maternity billing 

• Phase 1, Antepartum care. All bundled antepartum codes deleted. Every prenatal visit billed as individual E/M with TH modifier (99202 through 99215). 
• Phase 2, Labor management. New dedicated code category for the first time in CPT history. Reported per calendar day, with straightforward vs complex management distinction. 
• Phase 3, Delivery. Vaginal vs cesarean restructured. VBAC coded differently than first-time vaginal. Add-on procedures (3rd/4th degree laceration repair, uterine tamponade) now separately billable. 
• Phase 4, Postpartum care. All existing postpartum codes deleted. Hospital care codes for inpatient day-after-delivery. Office E/M for outpatient follow-up. Same-date postpartum bundled into delivery. 

Why the real deadline is Q3 and Q4 2026 

Cash flow in January 2027 will be decided this Q3 and Q4. Payer contracts reference CPT codes by number, so contracts that reference deleted codes need renegotiation now. Documentation habits have to change before the new codes go live, because every prenatal visit now needs to support E/M level selection. A 200-patient OB practice undercoding prenatal visits by even $40 each is leaving close to $100,000 a year on the table from day one. 

The multi-provider attribution problem 

Under the global model, attribution was easy: one practice, one fee, regardless of which provider saw which visit. Under the new model, every encounter is attributed to the individual provider who performed it. Practices with midlevels, hospitalists, or shared call need a clear protocol for labor management billing, on-call coverage, and cross-coverage now, or they will either double-bill (compliance risk) or miss charges (phantom revenue) from day one. 

Three actions this week 

• Pull a payer contract audit. List every commercial contract referencing global OB codes that needs renegotiation before January 1. 
• Run a prenatal documentation review. Pull 10 recent prenatal charts per provider and assess them against current 99213 and 99214 E/M standards. The gap is your single biggest revenue risk. 
• Map your provider attribution workflow. Write out exactly how labor management, on-call coverage, cross-coverage, and same-day postpartum care will be tracked when every encounter is attributed individually. 

Episode breakdown 

1. The 17 deleted codes 

2. The four new phases of maternity billing 

3. Why Q3 and Q4 of this year is your real deadline 

4. The multi-provider attribution gap 

5. What patients will see on their EOBs 

6. Your 90-day action plan 

7. What is ahead in the rest of the OB Global Coding Series 

Resources 

→ Live OB Global Updates Webinar (PRIMARY): eligibility.natrevmd.com/obgyn-global-updates-webinar 

→ Book a call with Heather: calendly.com/heather-natrevmd 

→ Payment Posting Audit Checklist: eligibility.natrevmd.com/payment-posting-checklist 

→ Practice Revenue Leak Scorecard: eligibility.natrevmd.com/nrm-revenue-scorecard-v3 

→ Coming next in the series: EP189 — How to Bill Antepartum Care Under the New E/M Model 

Transcript

SPEAKER_00 0:04

January 2027, just a few months away, every global OB code your practice has ever billed for the last 30 years is being deleted. Essentially, you're placed with a complete new structure for how every dollar during the maternity period is earned. Welcome to NatrevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency so you can have the business of your dreams. I'm your host, Dr. Heather Signorelli, founder of Nat RevMD. Let's get started. The real deadline is actually right now because we've got to make sure that your documentation, your payer contracts, your provider attribution workflows, like everything that you have built for your practice is reworked this year. So right now, quarter three, quarter four, so that you can spend that first quarter in 2027 without losing any revenue or concerned about pre-prenatal visit coding. Today we're gonna be talking to OB practice owners, right? If you work in an OB practice or maybe you oversee an OB practice, today we're gonna talk about what's going on and what we're hearing right now. Things that you need to be doing now. I think the biggest thing is really around documentation. The coding changes are important, and we'll go through through a few of those today. Obviously, everything that we are walking through is based on the current information released by AMA and ACOG for education purposes, but we will be updating you guys more as things come out. So today we're going to cover exactly what is going away, what the four new phases of maternity billing look like, and why there are important tasks that you need to be doing right now, Q3, Q4 of 2026, so that you can protect your revenue and just get organized with regards to workflows. Number one, what is actually going away? You see a patient for the entire pregnancy, you deliver the baby, you see her postpartum, and you bill one code, right? So 59400 for a global vaginal delivery, 59510 for global C-section, etc. It was built for a completely different era of medicine. And it was built in a time when there was fewer screenings, fewer chronic conditions in moms, and less complex counseling. And it really assumed that there was one physician who managed that entire episode of care. Today, OBCARE looks so different, even when I had my own kids. We are managing complex maternal health care conditions. Moms are getting, you know, pregnant later in life. And so there just are different challenges with managing pregnancy today than 30 years ago. Um, you know, we see physicians who are appropriately doing mental health screenings, handling genetic test and testing. Maybe they're sharing care across multiple physicians. Maybe that's in a single practice, maybe it's in multiple practices, maybe you have a hospitalist delivering uh the babies. So AMA and ACOG recognize that the global codes really no longer reflect that standard of care. And so effective January 1, 2027, 17 of those global obstetric CPT codes are being deleted, gone. And this is not a minor tweak in your fee schedule. This is actually a complete restructuring of how you earn money in the maternity period. Let's talk about the four phases of maternity billing, which will give you an idea of how you need to start planning documentation. So instead of one global payment, maternity care is gonna be broken into four discrete phases. And each phase has its own code set, and you will bill for each of these phases separately. Now, not all of these codes are new codes. So phase one is gonna be that antipartum care. And under this new model, every single prenatal visit is gonna be billed using those codes. You're basically going to be billing those 99202s through the 99215s, and you're gonna be using that TH modifier to indicate pregnancy-related care. Obviously, there's gonna be some nuances between different pairs and uh how quickly they get this into the system. Are they recognizing the TH modifier? All of these things are somewhat unknown. So we're gonna be talking about some of these in a in a general sense, but I think some of the things we don't know is how quickly are these things gonna go into effect. We all know and have seen how new codes get built and takes a minute for some of this to get built into the PM software. Is it built on the payer side? And so some of this is gonna be a little unknown. So phase two is actually the labor management part. And so this is gonna be a big structural change. They're gonna have their own dedicated code categories. And so there are going to be new codes specifically for clinical work of managing labor, right? And so the day-to-day assessment, monitoring, decision making, what happens during actor active liberty and induction. And these codes are reported per calendar day, and they distinguish between straightforward labor management and complex management because we all know that labor's not clinically equal. So this is work you have always done, but it's previously been invisible to some degree. Now we do have practices that have been really trying to outline this complexity, but now it's going to be separately recognized and separately paid. And then there's going to be phase three, which is obviously delivery. Delivery codes have been restructured to clearly separate out vaginal deliveries from C-sections and account for prior cesarean history. So there's going to be a really big emphasis on documenting all of these different phases correctly. So that you capture those ICD 10s, so you capture that clinical history within the note. And so for some of you guys, this may mean really extending your clinical notes. So a V back, for example, is going to be coded differently than a first-time vaginal delivery. And the delivery only codes will continue to exist, but they now apply strictly to the delivery event itself, not the surrounding care. And then then, of course, there's certain add-on procedures like third and fourth degree laceration repairs, uterine, a temp nod, uh, you know, for hemorrhage are all separately billable, so which is great to see. Now, phase four is postpartum care. So all existing postpartum codes are deleted. And if you are seeing a patient in the hospital the day after delivery, you use hospital care codes. And then when you see her in the office for outpatient follow-up, you'll again use those ENM codes. So the critical rule here is that the postpartum EM codes cannot be reported on the same calendar day as delivery care and same day postpartum management is included in the delivery code. So there's just some nuances with all of this. Like I said, we are going to be doing a webinar actually with our OBGYN certified coders to walk through some of these. We are also going to be doing a QA session at the end of the webinar so that you guys could come and bring your questions. And so we have a link to sign up for this session. It is eligibility.natrevmd.com backslash obyn slash global slash update slash webinar. So the link is in the show notes. Please go and sign up. So if you want to send questions ahead of time, you can at infotnatrevmd.com. Um if you are listening and you're not an OBGYN, share it with your OBGYN colleagues. We know that these codes go into effect in January of 2027. But here's the thing: the real deadline is actually now, because we're not really just talking about a massive change in coding. We're actually talking about a massive change in documentation. So if you're not used or your practice isn't used to documenting in detail what's going on in these prenatal visits or during labor management or during delivery, it is going to change your revenue. If you're seeing patients prenatally and you're only billing level threes in those prenatal or visits, or your documentation only warrants a level three, but in reality it could be a four or five based on what's going on clinically with your patient, then you're missing out on a revenue opportunity. So today, you know, when you're billing those global fees, you know, what you necessarily document within your notes doesn't directly impact the revenue of that visit. And obviously we have some of you guys who have really complex patients. You're billing modifier 25 and additional things going on in those prenatal visits today, which is great because you're already thinking ahead of how do I document the complexity of what's going on with these patients. But for some of you, that may not be happening today. And obviously, we know that payers are going to need time to update the systems. They're going to need time to uplet, upload new fee schedules for those new codes. Um, my fear is if you're not used to documenting or you don't have templates built within your system, those are the things that we can start working on now so that in January you are ready to rock and roll. And if you're waiting to November to December to start having those conversations, it's the holidays, it's the end of year craziness, and you're gonna struggle to get everybody in your practice on board. So we really, really want to make sure these documentation habits have changed now. Um so this is a perfect time to sit down with the physician, sit down with your practice manager and go through the new changes and sign up for the webinar. It's gonna be in July. So obviously we recognize that under this global model, those prenatal visits were charted as routine encounters. Documentation was standard and it was, you know, limited in terms of potentially the level of detail you provided. And under this new model, that's going to need to change, right? Because you're having to now support EM level selection. And so we're talking about history, exam, medical decision making, really so that you can capture and get those level four, level five visits. You know, obviously, if if that means clinically, that is what was necessary to bill. And we'll talk a little bit more about that in the webinar. So obviously, from a math perspective, if your practice manages 200 active OB patients and each patient averages roughly uh 12 prenatal visits over the course of the pregnancy, that is, you know, 2,400 prenatal encounters a year. And if they are not trained to document at the EM level that they need to be doing for those, then you're gonna be default by undercut undercoating and maybe losing up to $40 per visit. And that is well into the six figures in terms of revenue for your practice that you could be leaving on the table in 2027. So obviously, this is real money. Uh, and you are already seeing these patients and you have patients who are gonna be bridging that OB period between seeing them now and them delivering next spring. So you could theoretically consider submitting EM codes for prenatal visits in Q3 and Q4. I was actually talking to our AVP of ops, um, who is an OBGYN certified coder, and she is concerned about denials because they're not ready for that now. And so some of this we're, you know, working out ourselves and trying to figure out the best approach. But we really want to focus right now on documentation because even if the billing drops later, you want to make sure that those charts that you're dropping now for babies that are going to be delivered in the spring do have the necessary documentation for those EM levels. Um, so that, you know, if you're having to go back and bill those as a 99214, that those codes and those visits, visit notes qualify for that 99214. Um, last but not least, we do want to make sure that, you know, if you have multiple providers that manage patients both within your group or outside of your group, you're really gonna want to make sure that you understand those workflow gaps when it comes to the global model, because the global model, you had one person who was billing for that global period for the most part. And we work with a wide range of OB practices. And some have mid-level, some are using hospitalists, and some share call across multiple physicians and even across multiple groups. And so under that global model, you know, you had one uh code that you were doing, and then you were sharing money across different providers and different mechanisms. And there's a lot of different models that we have within our own practices of how this is done. But again, the practice got paid one global fee. Now you have multiple visits, both within the prenatal period during labor management, postpartum. And so you really want to make sure that if you have arrangements or contracts with other groups or even within your own group of how you're going to manage that workflow in these patients, you'll just want to think through how that money is going to be moved, which may be different than what you do today. So obviously, under the new model, every encounter is going to be attributed to the physician who actually performed it or the provider who performed it. And so if your practice does not really think through this clear protocol, then you, you know, just may be scrambling at the end. And this is especially true for labor management on call coverage, cross coverage arrangements, et cetera. You just want to model that out of, okay, now everybody's going to be billing for it. So that just may change, you know, how you set up and reimburse cross coverage. So if you are listening to this and realizing, you know, shoot, I don't really have a plan for this. Obviously, you're not alone. Everybody's trying to figure this out together. We are also trying to figure this out, watching the webinars, reading the AMA materials, pulling this together. We have OBGYN specific certified coders who are a part of our group. They're amazing. And so we're going to be doing some shared podcasts with them, as well as that live webinar. And just we're going to be going through the timelines, the new codes, head on over to the show notes and we'll have that link of where you can sign up for the OBGYN webinar. And again, it's going to be in early July. So save your seat and we'll be able to go through all of these details. And if you're not an OBGYN, you're listening, please share it with a friend. We would appreciate it. Obviously, massive shift for your billing team. So hopefully they are working to understand what this means. We all know that the vast majority of commercial health plans in the United States are ACA compliant. And so under the ACA plans cannot require cost sharing for preventative services. So these prenatal visits are going to be classified as preventative care. So they may not have a copay. But again, they'll, you know, there's going to be plans that have deductibles and all of that. So we're going to have to pay attention to all of this. So even though you are shifting from a global bill to individual billing for those prenatal visits, the thought is that ACA compliant plans should not see copies for these visits. But again, your billing structure around all of this is changing and that out-of-pocket experience. So labor delivery and postpartum services are actually not going to be classified as preventative care. So those will continue to have, again, those standard cost sharing. So you'll want to make sure that you are understanding what plan they're on and what co-pays deductibles, et cetera. So this is going to be a very important point for your front desk. So in summary, we are seeing a major shift in terms of how OB fees are billed. Those 17 global OB codes are being deleted. Maternity care is being broken into, again, those four phases. So we're going to have antipartum codes, where labor delivery, and postpartum codes. Every prenatal visit then becomes an individual documented E ⁇ M counter. And this is where I'm most concerned is that just making sure that you're documenting clearly showing everything you're doing, because that's going to that's going to impact the leveling of those codes. And then of course, labor management is going to have its own code. And so again, you're going to want to make sure that you're documenting complexity there. And every encounter is attributed to the individual physician or provider who's performing it. So big changes. Excited to help prepare you guys for this, at least as we figure things out as well. So last but not least, reminder while the new codes and everything are anticipated to drop January 1, we all know that the planning around the impact to your practice needs to happen now. So a few things that you can do now is really understanding the volume of your global fees that you've been billing, understanding what those rates are, understanding the average number of times that you're seeing those patients prenatally, going through and looking and making sure, okay, do my templates need to be updated so that we're documenting correctly for all of those prenatal visits? What is our average EM across the different levels of, and you know, if you were to see those patients X number of times, how close are you getting to your global fee that you're currently getting paid? So that you can understand if there's a gap in revenue expected. And if there is a gap, how large is that gap? And is it time to start having contract conversations or negotiation conversations with those payers now? Really important that if you do have an opportunity around templates and building those out for those EM codes for those prenatal visits or even during labor management or postpartum, you'll just want to get all those templates built out so that you can ensure that your physicians are documenting appropriately so that they're billing for that 99214 and the documentation meets that versus undercoding it in 99213 and missing that revenue. So these are just some of the important things. Obviously, make sure last that you are thinking about those provider attribution workflows, right? So who's seeing the patient when? And does that change any of your contracts either amongst your group or outside of your group with regards to cross coverage for those patients? I do want to call out that this episode is actually going to be the opening of a five-part OB Global Coding series. So over the next few episodes, we are going to walk through exactly how to build these codes. We're actually going to be having on some of our OBGYN certified coders who are amazing, incredible individuals who are going to help kind of spell these out. So we'll be sprinkling these in amongst some of our other episodes. But really important if you subscribe now so that you can catch all of these coding series. All right. Hopefully, you guys have a good rest of your day. We'll talk soon.