NR511 Midterm
Define diagnostic reasoning ANS: 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? ANS: Anything the patient tells you or complains of regarding their symptoms
Chief complaint
HPI
ROS
What is objective data? ANS: 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 ANS: Specifically related to the chief complaint only
Detailed breakdown of CC
OLDCARTS
Describe the differences between medical billing and medical coding. ANS: 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. ANS: 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? ANS:
Specificity: ability of a test to 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. ANS: Pt's preferences and
actions
Research evidence
Clinical state/circumstances
Clinical expertise
Describe the components of medical decision making in E&M coding. ANS: 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. ANS: New
pt:
1. Minimal/RN visit: 99201
2. Problem focused: 99202
3. Expanded problem focused: 99203
4. Detailed: 99204
5. Comprehensive: 99205
Established pt:
1. Minimal/RN visit: 99211
2. Problem focused: 99212
3. Expanded problem focused: 99213
4. Detailed: 99214
5. Comprehensive: 99215
Define diagnostic reasoning ANS: 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? ANS: Anything the patient tells you or complains of regarding their symptoms
Chief complaint
HPI
ROS
What is objective data? ANS: 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 ANS: Specifically related to the chief complaint only
Detailed breakdown of CC
OLDCARTS
Describe the differences between medical billing and medical coding. ANS: 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. ANS: 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? ANS:
Specificity: ability of a test to 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. ANS: Pt's preferences and
actions
Research evidence
Clinical state/circumstances
Clinical expertise
Describe the components of medical decision making in E&M coding. ANS: 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. ANS: New
pt:
1. Minimal/RN visit: 99201
2. Problem focused: 99202
3. Expanded problem focused: 99203
4. Detailed: 99204
5. Comprehensive: 99205
Established pt:
1. Minimal/RN visit: 99211
2. Problem focused: 99212
3. Expanded problem focused: 99213
4. Detailed: 99214
5. Comprehensive: 99215
