NR 511 LATEST EXAM QUESTIONS AND 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
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
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
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)
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
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
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
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)
