Steps For CPT Coding

Created by edi2do 

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From Handout on 1/25/2010. Eight steps for getting the proper CPT code. These must be listed in order.

#1

determine the category and subcategory of service based on the location of service and the patient's status

#2

determine the extent of the history that is documented

#3

determine the extent of the examination that is documented

#4

determine the complexity of medical decision making (MDM) that is documented

#5

analyze the requirements to report the service level

#6

review the nature of the presenting problem and the time spent with the patient

#7

verify that the documentation is complete

#8

assign the code

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