NR511 MIDTERM STUDY GUIDE
Certification Exam Questions and Correct
Detailed Answers (Verified Answers)
Already Graded A+
Describe the differences between medical billing and medical coding. --
<CORRECT ANSWER>>Medical billing: process of submitting and following
up on claims made to a payer in order to receive payment for medical services
rendered by a healthcare provider
Medical coding: the use of codes to communicate with payers about which
procedures were performed and why.
Compare and contrast the two coding classification systems that are currently
used in the US healthcare system. <Correct Answer>>ICD: International
classification of disease codes are used to provide payer info on necessity of
visit or procedure performed. Shorthand for pt's dx.
CPT: common procedural terminology codes offer the official procedural
coding rules and guidelines required when reporting medical services and
procedures performed by physician and non-physician providers. Must have
corresponding ICD.
How do specificity, sensitivity, and predictive value contribute to the usefulness
of diagnostic data? <Correct Answer>>Specificity: ability of a test to
Page 1 of 67
,correctly detect a specific condition. If a pt has a condition but test is negative,
it is a false negative. If pt does NOT have condition but test is positive, it is
false positive.
Sensitivity: test that has few false negatives. Ability of a test to correctly
identify a specific condition when it is present. The higher the sensitivity, the
lesser the likelihood of a false negative.
Predictive value: The likelihood that the pt actually has the condition and is, in
part, dependent upon the prevalence of the condition in the population. If a
condition is highly likely, the positive result would be more accurate.
Diagnostic tests can be used to confirm or rule out hypotheses.
Diagnostic tests may be used to screen for conditions.
Diagnostic tests may be used to monitor the progress in managing a chronic
condition.
Discuss the elements that need to be considered when developing a plan. --
<CORRECT ANSWER>>Pt's preferences and actions
Research evidence
Clinical state/circumstances
Clinical expertise
Page 2 of 67
,Define diagnostic reasoning <Correct Answer>>Reflective thinking because the
process involves questioning one's thinking to determine if all possible avenues
have been explored and if the conclusions that are being drawn are based on
evidence.
Seen as a kind of critical thinking.
What is subjective data? <Correct Answer>>Anything the patient tells you or
complains of regarding their symptoms
Chief complaint
HPI
ROS
What is objective data? <Correct Answer>>Anything YOU can see, touch,
feel, hear, or smell as part of your exam
Includes lab data, diagnostic test results, etc.
Identify components of HPI <Correct Answer>>Specifically related to the chief
complaint only
Page 3 of 67
, Detailed breakdown of CC
OLDCARTS
Describe the components of medical decision making in E&M coding. --
<CORRECT ANSWER>>Risk, data, diagnosis
The more time and consideration involved in dealing with a pt, the higher the
reimbursement from the payer.
Documentation must reflect MDM
Correctly order the E&M office visit codes based on complexity from least to
most complex. <Correct Answer>>New pt:
1. Minimal/RN visit: 99201
2. Problem focused: 99202
3. Expanded problem focused: 99203
4. Detailed: 99204
5. Comprehensive: 99205
Page 4 of 67
Certification Exam Questions and Correct
Detailed Answers (Verified Answers)
Already Graded A+
Describe the differences between medical billing and medical coding. --
<CORRECT ANSWER>>Medical billing: process of submitting and following
up on claims made to a payer in order to receive payment for medical services
rendered by a healthcare provider
Medical coding: the use of codes to communicate with payers about which
procedures were performed and why.
Compare and contrast the two coding classification systems that are currently
used in the US healthcare system. <Correct Answer>>ICD: International
classification of disease codes are used to provide payer info on necessity of
visit or procedure performed. Shorthand for pt's dx.
CPT: common procedural terminology codes offer the official procedural
coding rules and guidelines required when reporting medical services and
procedures performed by physician and non-physician providers. Must have
corresponding ICD.
How do specificity, sensitivity, and predictive value contribute to the usefulness
of diagnostic data? <Correct Answer>>Specificity: ability of a test to
Page 1 of 67
,correctly detect a specific condition. If a pt has a condition but test is negative,
it is a false negative. If pt does NOT have condition but test is positive, it is
false positive.
Sensitivity: test that has few false negatives. Ability of a test to correctly
identify a specific condition when it is present. The higher the sensitivity, the
lesser the likelihood of a false negative.
Predictive value: The likelihood that the pt actually has the condition and is, in
part, dependent upon the prevalence of the condition in the population. If a
condition is highly likely, the positive result would be more accurate.
Diagnostic tests can be used to confirm or rule out hypotheses.
Diagnostic tests may be used to screen for conditions.
Diagnostic tests may be used to monitor the progress in managing a chronic
condition.
Discuss the elements that need to be considered when developing a plan. --
<CORRECT ANSWER>>Pt's preferences and actions
Research evidence
Clinical state/circumstances
Clinical expertise
Page 2 of 67
,Define diagnostic reasoning <Correct Answer>>Reflective thinking because the
process involves questioning one's thinking to determine if all possible avenues
have been explored and if the conclusions that are being drawn are based on
evidence.
Seen as a kind of critical thinking.
What is subjective data? <Correct Answer>>Anything the patient tells you or
complains of regarding their symptoms
Chief complaint
HPI
ROS
What is objective data? <Correct Answer>>Anything YOU can see, touch,
feel, hear, or smell as part of your exam
Includes lab data, diagnostic test results, etc.
Identify components of HPI <Correct Answer>>Specifically related to the chief
complaint only
Page 3 of 67
, Detailed breakdown of CC
OLDCARTS
Describe the components of medical decision making in E&M coding. --
<CORRECT ANSWER>>Risk, data, diagnosis
The more time and consideration involved in dealing with a pt, the higher the
reimbursement from the payer.
Documentation must reflect MDM
Correctly order the E&M office visit codes based on complexity from least to
most complex. <Correct Answer>>New pt:
1. Minimal/RN visit: 99201
2. Problem focused: 99202
3. Expanded problem focused: 99203
4. Detailed: 99204
5. Comprehensive: 99205
Page 4 of 67
