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NR 605 / NR605 Midterm Exam
Diagnosis & Management in PMH
Across the Lifespan I | Questions &
Answers with Rationales | Grade A
Exam Structure:
Subject: Nursing / Psychiatric Mental Health, Psychotherapy, Legal/Ethical Issues,
Theoretical Models
Source: NR605 MIDTERM EXAM
Format: Multiple-Choice, True/False, and Fill-in-the-Blank Questions with Correct
Answers and Rationales
Theoretical Foundations
1. Illness Perception
Answer: psychodynamic approach - attributes mental illness to
environmental and psychosocial problems; biophysical model - attributes
mental illnesses to chemical imbalances of neurotransmitters
Rationale:
1. Different theoretical models explain mental illness through various
lenses.
2. The psychodynamic approach emphasizes environmental and
psychosocial factors.
3. The biophysical model focuses on neurochemical imbalances.
2. Epigenetics
Answer: the study of how the environment and other factors change the
way genes are expressed
Rationale:
, 2|Page
1. Epigenetics examines modifications in gene expression that do not
involve changes to the DNA sequence.
2. Environmental factors can influence whether genes are turned on or
off.
3. This field is increasingly relevant in understanding mental health
disorders.
Documentation and Reimbursement
3. Documentation Requirements
Answer: standard format of chief complaint, history of present illness,
review of systems, past psychiatric history, mental status exam, diagnostic
formulation, and treatment plan; Psychotherapy sessions must include:
target symptoms, goals of therapy, method of monitoring outcomes,
frequency of treatment, clinical records to support relevant medical history,
results of diagnostic tests or procedures, prognosis or progress to date,
estimated duration of treatment
Rationale:
1. Comprehensive documentation ensures continuity of care and meets
legal/regulatory standards.
2. Specific elements are required for psychotherapy sessions to justify
medical necessity.
3. Proper documentation supports reimbursement and protects against
liability.
4. Reimbursement
Answer: Clinical procedural terminology (CPT) codes - standardized codes
used to communicate services completed to Medicare and other insurance
companies for reimbursement; PMHNPs can bill for stand-alone
psychotherapy using psychiatry specialty codes - if the encounter includes
diagnosing and/or prescribing medications, a medical evaluation and
management (E/M) base code should be used with an add-on
psychotherapy procedure code
Rationale:
1. CPT codes are essential for billing and reimbursement.
2. Correct coding depends on the type of service provided
(psychotherapy only vs. medication management plus
psychotherapy).
, 3|Page
3. Understanding coding rules is critical for financial viability of
practice.
5. Medical Evaluation and Management Codes
Answer: specific five-digit E/M code - based on the type of client, location
of service, and level of service; XX = 20 new client office/inpatient visit; XX
= 21 established client office/outpatient visit; XX = 24 consultation for
office/outpatient; XX = 22 inpatient care
Rationale:
1. E/M codes vary based on patient status, setting, and complexity.
2. The first two digits indicate the type of visit (e.g., 99 for
office/outpatient).
3. Correct coding ensures appropriate reimbursement and reflects the
work performed.
6. Medical Decision Making
Answer: level of medical-decision-making (MDM) is rated as
straightforward, low, moderate, or high - based on three components:
number of diagnoses, amount of data being reviewed, risk of
mortality/morbidity; The level of MDM is selected based on complexity
Rationale:
1. MDM is a key factor in determining the appropriate E/M code.
2. Higher complexity (more diagnoses, more data, higher risk) justifies
higher-level codes.
3. Accurate assessment of MDM supports medical necessity.
7. Psychotherapy Codes
Answer: 90832 - psychotherapy duration 16-37 minutes; 90833 -
psychotherapy duration 16-37 minutes used as an add-on code to an E/M
code; 90834 - psychotherapy 38-52 minutes; 90836 - psychotherapy
duration 38 or more minutes used as an add-on code to an E/M code;
90837 - psychotherapy 53 or more minutes; 90846 - family psychotherapy
client not present; 90847 - family psychotherapy with client present; 90853
- group psychotherapy
Rationale:
1. Psychotherapy codes are time-based and distinguished by duration.
2. Add-on codes (90833, 90836) are used when psychotherapy is
provided in addition to an E/M service.
3. Family and group codes address specific therapy formats.
, 4|Page
8. Lori, a 42-year-old female, presents to the office for an initial
consultation. She has just experienced a breakup after a 5-year
relationship and is feeling "depressed." A comprehensive initial
evaluation which includes chief complaint, history of present illness,
medical history, previous psychiatric history, family history and a
comprehensive review of systems was completed. Psychotherapy was
included in the session - 18 minutes time. Provide the appropriate
CPT code.
Answer: 99205 + 90833
Rationale:
1. The client is new to the practice, requiring a new patient E/M code
(99201-99205).
2. The comprehensive history and exam, along with moderate-to-high
complexity MDM, support the highest-level new patient code
(99205).
3. Psychotherapy of 18 minutes requires the add-on code 90833 (16-37
minutes) in addition to the E/M code.
9. Hannibal, a 23-year-old male, is admitted to an inpatient psychiatric
facility with symptoms of auditory hallucinations, paranoia, and
suicidal ideations. A comprehensive initial evaluation which includes
chief complaint, history of present illness, medical history, previous
psychiatric history, family history and a comprehensive review of
systems was completed. Provide the appropriate CPT code.
Answer: 99223
Rationale:
1. Initial hospital care codes (99221-99223) are used for new inpatient
admissions.
2. The patient's acute symptoms and high risk (suicidal ideation)
indicate a high level of MDM.
3. 99223 is the highest-level initial hospital care code, appropriate for
comprehensive history and high complexity.
10. Shakina, a 19-year-old transgender female, has been referred to
the PMHNP from primary care. The PMHNP reviews the primary
provider's note and identifies symptoms of bipolar I disorder. The
PMHNP completes a comprehensive assessment and prescribes
medications for the client. Provide the appropriate CPT code.
NR 605 / NR605 Midterm Exam
Diagnosis & Management in PMH
Across the Lifespan I | Questions &
Answers with Rationales | Grade A
Exam Structure:
Subject: Nursing / Psychiatric Mental Health, Psychotherapy, Legal/Ethical Issues,
Theoretical Models
Source: NR605 MIDTERM EXAM
Format: Multiple-Choice, True/False, and Fill-in-the-Blank Questions with Correct
Answers and Rationales
Theoretical Foundations
1. Illness Perception
Answer: psychodynamic approach - attributes mental illness to
environmental and psychosocial problems; biophysical model - attributes
mental illnesses to chemical imbalances of neurotransmitters
Rationale:
1. Different theoretical models explain mental illness through various
lenses.
2. The psychodynamic approach emphasizes environmental and
psychosocial factors.
3. The biophysical model focuses on neurochemical imbalances.
2. Epigenetics
Answer: the study of how the environment and other factors change the
way genes are expressed
Rationale:
, 2|Page
1. Epigenetics examines modifications in gene expression that do not
involve changes to the DNA sequence.
2. Environmental factors can influence whether genes are turned on or
off.
3. This field is increasingly relevant in understanding mental health
disorders.
Documentation and Reimbursement
3. Documentation Requirements
Answer: standard format of chief complaint, history of present illness,
review of systems, past psychiatric history, mental status exam, diagnostic
formulation, and treatment plan; Psychotherapy sessions must include:
target symptoms, goals of therapy, method of monitoring outcomes,
frequency of treatment, clinical records to support relevant medical history,
results of diagnostic tests or procedures, prognosis or progress to date,
estimated duration of treatment
Rationale:
1. Comprehensive documentation ensures continuity of care and meets
legal/regulatory standards.
2. Specific elements are required for psychotherapy sessions to justify
medical necessity.
3. Proper documentation supports reimbursement and protects against
liability.
4. Reimbursement
Answer: Clinical procedural terminology (CPT) codes - standardized codes
used to communicate services completed to Medicare and other insurance
companies for reimbursement; PMHNPs can bill for stand-alone
psychotherapy using psychiatry specialty codes - if the encounter includes
diagnosing and/or prescribing medications, a medical evaluation and
management (E/M) base code should be used with an add-on
psychotherapy procedure code
Rationale:
1. CPT codes are essential for billing and reimbursement.
2. Correct coding depends on the type of service provided
(psychotherapy only vs. medication management plus
psychotherapy).
, 3|Page
3. Understanding coding rules is critical for financial viability of
practice.
5. Medical Evaluation and Management Codes
Answer: specific five-digit E/M code - based on the type of client, location
of service, and level of service; XX = 20 new client office/inpatient visit; XX
= 21 established client office/outpatient visit; XX = 24 consultation for
office/outpatient; XX = 22 inpatient care
Rationale:
1. E/M codes vary based on patient status, setting, and complexity.
2. The first two digits indicate the type of visit (e.g., 99 for
office/outpatient).
3. Correct coding ensures appropriate reimbursement and reflects the
work performed.
6. Medical Decision Making
Answer: level of medical-decision-making (MDM) is rated as
straightforward, low, moderate, or high - based on three components:
number of diagnoses, amount of data being reviewed, risk of
mortality/morbidity; The level of MDM is selected based on complexity
Rationale:
1. MDM is a key factor in determining the appropriate E/M code.
2. Higher complexity (more diagnoses, more data, higher risk) justifies
higher-level codes.
3. Accurate assessment of MDM supports medical necessity.
7. Psychotherapy Codes
Answer: 90832 - psychotherapy duration 16-37 minutes; 90833 -
psychotherapy duration 16-37 minutes used as an add-on code to an E/M
code; 90834 - psychotherapy 38-52 minutes; 90836 - psychotherapy
duration 38 or more minutes used as an add-on code to an E/M code;
90837 - psychotherapy 53 or more minutes; 90846 - family psychotherapy
client not present; 90847 - family psychotherapy with client present; 90853
- group psychotherapy
Rationale:
1. Psychotherapy codes are time-based and distinguished by duration.
2. Add-on codes (90833, 90836) are used when psychotherapy is
provided in addition to an E/M service.
3. Family and group codes address specific therapy formats.
, 4|Page
8. Lori, a 42-year-old female, presents to the office for an initial
consultation. She has just experienced a breakup after a 5-year
relationship and is feeling "depressed." A comprehensive initial
evaluation which includes chief complaint, history of present illness,
medical history, previous psychiatric history, family history and a
comprehensive review of systems was completed. Psychotherapy was
included in the session - 18 minutes time. Provide the appropriate
CPT code.
Answer: 99205 + 90833
Rationale:
1. The client is new to the practice, requiring a new patient E/M code
(99201-99205).
2. The comprehensive history and exam, along with moderate-to-high
complexity MDM, support the highest-level new patient code
(99205).
3. Psychotherapy of 18 minutes requires the add-on code 90833 (16-37
minutes) in addition to the E/M code.
9. Hannibal, a 23-year-old male, is admitted to an inpatient psychiatric
facility with symptoms of auditory hallucinations, paranoia, and
suicidal ideations. A comprehensive initial evaluation which includes
chief complaint, history of present illness, medical history, previous
psychiatric history, family history and a comprehensive review of
systems was completed. Provide the appropriate CPT code.
Answer: 99223
Rationale:
1. Initial hospital care codes (99221-99223) are used for new inpatient
admissions.
2. The patient's acute symptoms and high risk (suicidal ideation)
indicate a high level of MDM.
3. 99223 is the highest-level initial hospital care code, appropriate for
comprehensive history and high complexity.
10. Shakina, a 19-year-old transgender female, has been referred to
the PMHNP from primary care. The PMHNP reviews the primary
provider's note and identifies symptoms of bipolar I disorder. The
PMHNP completes a comprehensive assessment and prescribes
medications for the client. Provide the appropriate CPT code.
