Integrative Billing and Coding

05/07/2026

This week we're diving into Antepartum Care — and there's a lot to unpack! 👆 Check out the slides above for the full breakdown.
The biggest takeaway? Each prenatal visit will now be billed separately using E/M codes based on where care is provided and the complexity of each encounter.
Documentation is going to be everything here. 📝
If you've been following along, you know these changes touch pretty much every part of maternity care billing — and antepartum is no exception!
💬 How is your practice preparing for this? Are you already updating your workflows? Let me know below! ⬇️
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04/20/2026

Starting January 1, 2027, several long-standing maternity care CPT® global codes will be deleted. This marks a major shift away from bundled maternity care reporting toward a more detailed, component-based approach for antepartum, delivery, and postpartum services.

This change will impact documentation, billing workflows, and how OB services are reported across practices.

I’ll be breaking this down step-by-step so it’s easier to understand and apply in real-world coding situations.

Stay tuned and follow for more

04/14/2026

Let’s talk about some important OB/GYN CPT® code updates 👇

There have been some notable changes that can definitely impact how we code and bill—so here’s a simple breakdown:

Summary of CPT® Code Changes:
Deleted: 17
Added: 12
Revised: 6

So what actually changed?

👉 Codes have been restructured
👉 Antepartum, labor management, delivery, and postpartum care are now reported using separate codes instead of bundled reporting
👉 New subsections were created and guidelines were updated
👉 Some existing codes have been relocated

These updates are a big shift—especially for those used to global maternity care coding. It’s important to review documentation carefully and make sure each component of care is captured correctly.

Staying up to date isn’t just about compliance—it directly impacts reimbursement and reduces the risk of denials.Follow my page for more education and updates coming.
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04/14/2026

Modifier 25 case scenario:
Patient: 32-year-old established patient
Reason for visit: Scheduled appointment for IUD insertion

During visit:

Routine counseling about risks/benefits
Consent obtained
Pregnancy test performed
IUD inserted

Coding:

IUD insertion CPT only (58300)
NO modifier 25, NO separate E/M

Why:
All of this is included in the procedure. The counseling and basic evaluation are considered pre-service work.

👉 Common mistake: Billing an E/M just because “we talked a lot.”
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04/13/2026

LET’S TALK ABOUT MODIFIER 25
A lot of physicians struggle to use Modifier 25 appropriately, and it remains one of the most misunderstood — and most audited — modifiers in medical billing. Let’s do a deeper dive and break it down in a way that actually makes sense. I’ll be splitting this into a few posts so you can fully understand not just the definition, but how to apply it correctly in real-world scenarios. Modifier 25 is one of the most commonly used — and most misunderstood — modifier in medical billing. CPT defines Modifier 25 indicates on the day of a procedure, the patient's condition required a significant, separately identifiable E/M service, above and beyond the usual pre- and post-operative care associated with the procedure or service performed. Medicare further clarifies that it is used when, on the day of a procedure, the patient’s condition required a significant, separately identifiable E/M service above and beyond the usual pre- and post-operative care associated with that procedure. In practical terms, every procedure already includes a certain level of evaluation, so Modifier 25 should only be used when the provider performs additional medically necessary work that requires separate clinical judgment beyond what is inherently included. The E/M service may be prompted by the same symptom or condition for which the procedure was performed, and it is acceptable to report the same diagnosis for both the E/M service and the procedure; however, the diagnosis alone does not justify the use of Modifier 25. The determining factor is whether there was distinct medical decision-making that stands on its own. To support Modifier 25, documentation must clearly demonstrate a separate E/M service, including appropriate history, exam, and medical decision-making, along with clear evidence that the work performed was above and beyond routine procedure-related care. This modifier is closely monitored by payers due to frequent misuse, and improper use can result in denials, audits, and recoupments. When used correctly, Modifier 25 supports accurate reimbursement and compliance; when misused, it creates significant financial and regulatory risk. The key is not billing more, but billing correctly, with clear, defensible documentation that supports separate and necessary medical decision-making. , , , , , , ,

Send a message to learn more

03/20/2026

🚨 OB/GYN Practices – BIG Coding Changes Are Coming 🚨

The American Medical Association (AMA) is proposing updates to OB global maternity care coding—and this could significantly impact how your services are billed and reimbursed.

What does this mean for your practice?

✔️ Possible changes to global OB packages
✔️ More detailed, itemized billing requirements
✔️ Increased documentation demands
✔️ Higher risk of denied or underpaid claims

If your billing processes aren’t ready, this could lead to lost revenue and major headaches.
If you’re unsure how these updates may affect your practice, let’s connect. I’d love to help you prepare and protect your revenue.
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Send a message to learn more

09/27/2024

Flu season 2024-25 is already here. Flu shots, coding and NDC numbers are essential for accurate billing and record-keeping in healthcare. Here’s a refined guide to ensure you have the correct CPT codes, ICD-10 codes, and NDC numbers.
1. CPT Codes for Flu Vaccines
These codes are used for reporting and billing the administration of the flu vaccine:

90662: Influenza virus vaccine, preservative-free, enhanced immunogenicity via increased antigen content, for intramuscular use (typically for patients 65 years and older)
90686: Quadrivalent flu vaccine, preservative-free, for intramuscular use
90688: Quadrivalent flu vaccine, for intramuscular use
90756: Quadrivalent flu vaccine, recombinant, preservative-free, for intramuscular use
2. ICD-10 Codes
You need these codes to indicate why the flu shot was administered:

Z23: Encounter for immunization
3. Administration Codes
Report these codes alongside the CPT code for the vaccine itself:

90471: Immunization administration (1 vaccine)
90472: Immunization administration (each additional vaccine)
4. NDC (National Drug Code) Numbers for Flu Vaccines
Each flu vaccine has a corresponding NDC number. Here are some common ones:

Fluzone Quadrivalent (High Dose): NDC 49281-0012-10 (for those 65+)
FluLaval Quadrivalent: NDC 19515-0812-52
Fluarix Quadrivalent: NDC 58160-0905-52
Flublok Quadrivalent: NDC 49281-0720-10 (recombinant flu vaccine, for ages 18+)
5. Best Practices
Always verify the NDC number for the specific product being used, as manufacturers and formulations can vary.
For billing, link the flu vaccine CPT code with the correct administration code and the ICD-10 code (Z23) to ensure proper documentation.
Check for any annual updates to codes or guidelines from the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS).
This setup should streamline your flu shot coding and ensure accuracy in both reimbursement and compliance.
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