NR 511 FINAL EXAM STUDY GUIDE
Week 1
1. Define diagnostic reasoning
- is a type of critical thinking - includes a systematic way of thinking that evaluates
each new piece of data to support some hypothesis and reduce others. - evaluates if
all the avenues have been explored and that the conclusion is based on evidence
-To solve problems, to promote health, and to screen for disease or illness all
require a sensitivity to complex stories, to contextual factors, and to a sense of
probability and uncertainty.
2. Discuss and identify subjective & objective data
Subjective data-what a patient report complaints of and tells me in response to my
questions. - includes ROS, CC and HPI
Objective data- information you can see and feel also lab results lab data
3. Discuss and identify the components of the HPI
O-Onset of CC
L-Location of CC
D-duration of CC for example if it comes and goes
C-characteristics of CC
A-aggravating factors of CC
R-relieving factors of CC
T- treatments tried of cc
S- Severity of CC level of pain
4. Describe the differences between medical billing and medical coding
Medical coding = the use of codes to communicate with payers about which
procedures were performed and why.
Medical billing = is the 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.
5. Compare and contrast the 2 coding classification systems that are
currently used in the US healthcare system
,CPT- common procedural terminology- official procedural rules and guidelines
required when reporting services and procedures performed by physician and non-
physicians recognized universally-provide logical means to be able to track
healthcare data, trends and outcomes. represented by a 5 digit code.
1. Evaluation and Management
2. Anesthesiology
3. Surgery
4. Radiology
5. Pathology
Every CPT code must have a diagnosis that corresponds with it to explain the
necessity whether the code represents an actual procedure performed or a non-
procedural encounter like an office visit.
ICD-codes- it is the 10th version
shorthand for patient’s diagnosis used to provide the payer information on the
necessity of the visit or procedure performed.
6. Discuss how specificity, sensitivity & predictive value contribute to the
usefulness of the diagnostic data
Specificity of a test = greater when it has few false positives
no. of true negatives
specificity = -----------------------------
no. of all tested indiv, who do not have the dz
Sensitivity of a test = greater when it has few false negatives
no. of the true positives
sensitivity = --------------------------------
no. of tested indiv that have the dz
Predictive value = is in part dependent on the prevalence of the condition
true +
+ predictive value = -----------
all +
true -
- predictive value = ----------
all -
,False positive - when a pt that does not have the condition has a positive reading
- dz and +reading
False negative - when a pt that does have the condition but has a negative reading
+ dz and - reading
7. Discuss the elements that need to be considered when developing a plan
- Diagnostic testing- what tests need to be conducted to clarify assessment
- education- specific problems being managed
- follow-up- when will the patient be seen again
- be honest
- negotiate what to cover
8. Describe the components of Medical Decision Making in evaluation &
management (E&M) coding
There are three key components that determine risk-based E&M codes.
-History
-Physical
-Medical Decision Making (MDM) E&M coding requires a medical decision
maker
-Medical decision making is another way of quantifying the complexity of the
thinking that is required for the visit.
-Complexity of a visit is based on three criteria:
-Risk
-Data
-Diagnosis
-Now, medical decision making is a special category. Why is this so important?
Well, the MDM score gives us credit for the excess work involved in management
of a more complex patient.
9. Correctly order the E&M office visit codes based on complexity from
least to most complex
a. New:
i. 99201 (minimal/RN visit)
ii. 99202 (problem-focused)
iii. 99203 (Expanded problem-focused)
iv. 99204 (detailed)
, v. 99215 (comprehensive)
b. Established:
i. 99211 (minimal/RN visit)
ii. 99212 (problem-focused)
iii. 99213 (expanded problem focused)
iv. 99214 (detailed)
v. 99215 (comprehensive)
10.Discuss a minimum of three purposes of the written history and
physical in relation to the importance of documentation
-It is an important reference document that gives concise information about a
patient's history and exam findings.
-It outlines a plan for addressing the issues that prompted the visit. This
information should be presented in a logical fashion that prominently
features all data immediately relevant to the patient's condition.
-It is a means of communicating information to all providers who are
involved in the care of a particular patient.
-It is an important medical-legal document
-It is essential in order to accurately code and bill for services.
11.Accurately document why every procedure code must have a
corresponding diagnosis code
-Every procedure code needs a diagnosis to explain the necessity whether the code
represents an actual procedure performed or a nonprocedural encounter like an
office visit.
12.Correctly identify a patient as new or established given the historical
information
New- a patient who has not received services from the provider (or that group)
before or who has not seen the provider/group for over 3 years
Week 1
1. Define diagnostic reasoning
- is a type of critical thinking - includes a systematic way of thinking that evaluates
each new piece of data to support some hypothesis and reduce others. - evaluates if
all the avenues have been explored and that the conclusion is based on evidence
-To solve problems, to promote health, and to screen for disease or illness all
require a sensitivity to complex stories, to contextual factors, and to a sense of
probability and uncertainty.
2. Discuss and identify subjective & objective data
Subjective data-what a patient report complaints of and tells me in response to my
questions. - includes ROS, CC and HPI
Objective data- information you can see and feel also lab results lab data
3. Discuss and identify the components of the HPI
O-Onset of CC
L-Location of CC
D-duration of CC for example if it comes and goes
C-characteristics of CC
A-aggravating factors of CC
R-relieving factors of CC
T- treatments tried of cc
S- Severity of CC level of pain
4. Describe the differences between medical billing and medical coding
Medical coding = the use of codes to communicate with payers about which
procedures were performed and why.
Medical billing = is the 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.
5. Compare and contrast the 2 coding classification systems that are
currently used in the US healthcare system
,CPT- common procedural terminology- official procedural rules and guidelines
required when reporting services and procedures performed by physician and non-
physicians recognized universally-provide logical means to be able to track
healthcare data, trends and outcomes. represented by a 5 digit code.
1. Evaluation and Management
2. Anesthesiology
3. Surgery
4. Radiology
5. Pathology
Every CPT code must have a diagnosis that corresponds with it to explain the
necessity whether the code represents an actual procedure performed or a non-
procedural encounter like an office visit.
ICD-codes- it is the 10th version
shorthand for patient’s diagnosis used to provide the payer information on the
necessity of the visit or procedure performed.
6. Discuss how specificity, sensitivity & predictive value contribute to the
usefulness of the diagnostic data
Specificity of a test = greater when it has few false positives
no. of true negatives
specificity = -----------------------------
no. of all tested indiv, who do not have the dz
Sensitivity of a test = greater when it has few false negatives
no. of the true positives
sensitivity = --------------------------------
no. of tested indiv that have the dz
Predictive value = is in part dependent on the prevalence of the condition
true +
+ predictive value = -----------
all +
true -
- predictive value = ----------
all -
,False positive - when a pt that does not have the condition has a positive reading
- dz and +reading
False negative - when a pt that does have the condition but has a negative reading
+ dz and - reading
7. Discuss the elements that need to be considered when developing a plan
- Diagnostic testing- what tests need to be conducted to clarify assessment
- education- specific problems being managed
- follow-up- when will the patient be seen again
- be honest
- negotiate what to cover
8. Describe the components of Medical Decision Making in evaluation &
management (E&M) coding
There are three key components that determine risk-based E&M codes.
-History
-Physical
-Medical Decision Making (MDM) E&M coding requires a medical decision
maker
-Medical decision making is another way of quantifying the complexity of the
thinking that is required for the visit.
-Complexity of a visit is based on three criteria:
-Risk
-Data
-Diagnosis
-Now, medical decision making is a special category. Why is this so important?
Well, the MDM score gives us credit for the excess work involved in management
of a more complex patient.
9. Correctly order the E&M office visit codes based on complexity from
least to most complex
a. New:
i. 99201 (minimal/RN visit)
ii. 99202 (problem-focused)
iii. 99203 (Expanded problem-focused)
iv. 99204 (detailed)
, v. 99215 (comprehensive)
b. Established:
i. 99211 (minimal/RN visit)
ii. 99212 (problem-focused)
iii. 99213 (expanded problem focused)
iv. 99214 (detailed)
v. 99215 (comprehensive)
10.Discuss a minimum of three purposes of the written history and
physical in relation to the importance of documentation
-It is an important reference document that gives concise information about a
patient's history and exam findings.
-It outlines a plan for addressing the issues that prompted the visit. This
information should be presented in a logical fashion that prominently
features all data immediately relevant to the patient's condition.
-It is a means of communicating information to all providers who are
involved in the care of a particular patient.
-It is an important medical-legal document
-It is essential in order to accurately code and bill for services.
11.Accurately document why every procedure code must have a
corresponding diagnosis code
-Every procedure code needs a diagnosis to explain the necessity whether the code
represents an actual procedure performed or a nonprocedural encounter like an
office visit.
12.Correctly identify a patient as new or established given the historical
information
New- a patient who has not received services from the provider (or that group)
before or who has not seen the provider/group for over 3 years
