It is appropriate to bill an E/M for pregnant patients seeking care before the first prenatal visit. This would not be considered part of the global package. It would not be a consult because as you say another MD has not requested one. You would not use the V23.7 because at this point insufficient prenatal care has not been established. If the conditions the patient is taking medications for or coming in with are complicating the pregnancy then code it as such.
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