NR 511 FINAL EXAM WEEK 8 STUDY GUIDE|Questions
with 100% Correct Answers
Define diagnostic reasoning
-A type of critical thinking
-Includes 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, promote health, screen for dz/illness: all require sensitivity to complex stories,
contextual factors, sense of probability/uncertainty
Discuss & identify subjective & objective data
Subjective: what a pt reports, complains of, tells me in response to my questions.
Includes ROS, CC, HPI
Objective: info you can see/feel
Lab results/data
Discuss & identify the components of the HPI
O: onset
L: location
D: duration (does it come and go?)
C: characteristics
A: aggravating factors
R: relieving factors
T: treatments attempted
S: severity of pain
Specifically related to CC only
Detailed breakdown of CC
Describe the differences between medical billing and medical coding
Billing: process of submitting and following up on claims made to a payer in order to receive payment for
medical services rendered by healthcare provider.
Coding: the use of codes to communicate with payers about which procedures were performed and
why.
,Compare & contrast the 2 coding classification systems that are currently used in the US healthcare
system
CPT: common procedural terminology
Offical procedural rules and guidelines required when reporting services/procedures performed by
providers
Recognized universally
Provide logical means to be able to tract healthcare data, trends, outcomes
Represented by 5 digit code
Every CPT must have dx that corresponds/explains why procedure was done
ICD-10: 10th version
Shorthand for pt's dx used to provide payer info on necessity of visit/procedure
Which of the following statements are true?
Eliciting a detailed hx through open-ended questioning and active listening offers critical clues to
determining a dx.
Obtaining meaningful hx involves collecting subjective info and organizing it into meaningful chunks of
knowledge.
Data acquisition in hx taking is most effective if it is hypothesis driven.
All of the above
All of the above
Which of the following statements is NOT true regarding insurance?
Providers are not required to follow the billing carrier's guidelines
Discuss how specificity, sensitivity, predictive value contribute to usefulness of diagnostic data
Specificity: greater when it has few false positives
The number of true negatives divided by the number of all tested individuals who do not have the dz
Sensitivity: greater when it has few false negatives
The number of true positives divided by the number of tested individuals that do have the dz
Predictive value: in part dependent on prevalence of condition
Positive predictive value: the number of true positives divided by all those that are positive
Negative predictive value: the number of true negatives divided by all those that are negative
False positive: when a pt does NOT have dz, but has positive reading
False negative: when a pt that DOES have dz, but has negative reading
,Discuss the elements that need to be considered when developing a plan
Pt's preferences/actions
Research evidence
Clinical state/circumstances
Clinical expertise
Diagnostic testing (what tests need to be conducted to clarify assessment)
Education (specific problems being managed)
Follow-up (when will the pt need to be seen again)
Be honest
Negotiate what to cover
Describe the components of medical decision making (MDM) in E&M coding
Three key components that determine risk based E&M codes:
History
Physical
MDM
E&M coding requires a decision-maker
MDM is another way of quantifying complexity of the thinking that is required for the visit
Complexity of visit is based on 3 criteria:
Risk
Data
Dx
MDM score gives us credit for the excess work involved in management of a more complex pt.
Correctly order the E&M office visit codes based on complexity from least to most complex
New:
99201 (minimal/RN visit)
99202 (problem-focused)
99203 (expanded problem-focused)
99204 (detailed)
99205 (comprehensive)
Established:
99211 (minimal/RN visit)
99212 (problem-focused)
99213 (expanded problem-focused
99214 (detailed)
99215 (comprehensive)
Discuss a minimum of 3 purposes of the written H&P in relation to the importance of documentation
, -Important reference that gives concise info about pt's Hx and exam findings
-Outlines plan for addressing issues that prompted visit. Info should be presented in logical fashion that
prominently features all data immediately relevant to pt's condition.
-A means of communicating info to all providers who are involved in care of the pt.
-Important medical-legal document
-Essential in order to accurately code and bill for services.
Why does every procedure code need a corresponding dx code?
To explain necessity of why it was done
May represent actual procedure or nonprocedural encounter (like office visit)
Correctly ID a pt as new or established given the historical info
New: a pt who has not received services from this provider before or who has not been seen by provider
in >3yrs
Established: pt who has seen provider within last 3yrs
ID 3 components required in determining an outpt office visit E&M code
Plan of service
Type of service
Pt status
Describe the components of MDM in E&M coding
Risk
Data
Dx
Explain what a well-rounded clinical experience means
To experience a variety of pts during clinical across the lifespan
15% peds of total clinical time in program
15% women's health of total clinical time in program
State max number of hrs that time can be spent rounding in a facility
No more than 25% of total practicum hrs in that course
State 9 things that must be documented when inputting data into clinical encounter
Date of service
Age
Gender & ethnicity
Visit E&M code
Chief concern
Procedures
Tests performed/ordered
with 100% Correct Answers
Define diagnostic reasoning
-A type of critical thinking
-Includes 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, promote health, screen for dz/illness: all require sensitivity to complex stories,
contextual factors, sense of probability/uncertainty
Discuss & identify subjective & objective data
Subjective: what a pt reports, complains of, tells me in response to my questions.
Includes ROS, CC, HPI
Objective: info you can see/feel
Lab results/data
Discuss & identify the components of the HPI
O: onset
L: location
D: duration (does it come and go?)
C: characteristics
A: aggravating factors
R: relieving factors
T: treatments attempted
S: severity of pain
Specifically related to CC only
Detailed breakdown of CC
Describe the differences between medical billing and medical coding
Billing: process of submitting and following up on claims made to a payer in order to receive payment for
medical services rendered by healthcare provider.
Coding: the use of codes to communicate with payers about which procedures were performed and
why.
,Compare & contrast the 2 coding classification systems that are currently used in the US healthcare
system
CPT: common procedural terminology
Offical procedural rules and guidelines required when reporting services/procedures performed by
providers
Recognized universally
Provide logical means to be able to tract healthcare data, trends, outcomes
Represented by 5 digit code
Every CPT must have dx that corresponds/explains why procedure was done
ICD-10: 10th version
Shorthand for pt's dx used to provide payer info on necessity of visit/procedure
Which of the following statements are true?
Eliciting a detailed hx through open-ended questioning and active listening offers critical clues to
determining a dx.
Obtaining meaningful hx involves collecting subjective info and organizing it into meaningful chunks of
knowledge.
Data acquisition in hx taking is most effective if it is hypothesis driven.
All of the above
All of the above
Which of the following statements is NOT true regarding insurance?
Providers are not required to follow the billing carrier's guidelines
Discuss how specificity, sensitivity, predictive value contribute to usefulness of diagnostic data
Specificity: greater when it has few false positives
The number of true negatives divided by the number of all tested individuals who do not have the dz
Sensitivity: greater when it has few false negatives
The number of true positives divided by the number of tested individuals that do have the dz
Predictive value: in part dependent on prevalence of condition
Positive predictive value: the number of true positives divided by all those that are positive
Negative predictive value: the number of true negatives divided by all those that are negative
False positive: when a pt does NOT have dz, but has positive reading
False negative: when a pt that DOES have dz, but has negative reading
,Discuss the elements that need to be considered when developing a plan
Pt's preferences/actions
Research evidence
Clinical state/circumstances
Clinical expertise
Diagnostic testing (what tests need to be conducted to clarify assessment)
Education (specific problems being managed)
Follow-up (when will the pt need to be seen again)
Be honest
Negotiate what to cover
Describe the components of medical decision making (MDM) in E&M coding
Three key components that determine risk based E&M codes:
History
Physical
MDM
E&M coding requires a decision-maker
MDM is another way of quantifying complexity of the thinking that is required for the visit
Complexity of visit is based on 3 criteria:
Risk
Data
Dx
MDM score gives us credit for the excess work involved in management of a more complex pt.
Correctly order the E&M office visit codes based on complexity from least to most complex
New:
99201 (minimal/RN visit)
99202 (problem-focused)
99203 (expanded problem-focused)
99204 (detailed)
99205 (comprehensive)
Established:
99211 (minimal/RN visit)
99212 (problem-focused)
99213 (expanded problem-focused
99214 (detailed)
99215 (comprehensive)
Discuss a minimum of 3 purposes of the written H&P in relation to the importance of documentation
, -Important reference that gives concise info about pt's Hx and exam findings
-Outlines plan for addressing issues that prompted visit. Info should be presented in logical fashion that
prominently features all data immediately relevant to pt's condition.
-A means of communicating info to all providers who are involved in care of the pt.
-Important medical-legal document
-Essential in order to accurately code and bill for services.
Why does every procedure code need a corresponding dx code?
To explain necessity of why it was done
May represent actual procedure or nonprocedural encounter (like office visit)
Correctly ID a pt as new or established given the historical info
New: a pt who has not received services from this provider before or who has not been seen by provider
in >3yrs
Established: pt who has seen provider within last 3yrs
ID 3 components required in determining an outpt office visit E&M code
Plan of service
Type of service
Pt status
Describe the components of MDM in E&M coding
Risk
Data
Dx
Explain what a well-rounded clinical experience means
To experience a variety of pts during clinical across the lifespan
15% peds of total clinical time in program
15% women's health of total clinical time in program
State max number of hrs that time can be spent rounding in a facility
No more than 25% of total practicum hrs in that course
State 9 things that must be documented when inputting data into clinical encounter
Date of service
Age
Gender & ethnicity
Visit E&M code
Chief concern
Procedures
Tests performed/ordered
