NR 511 FINAL EXAM STUDY GUIDE (LATEST)
Week 1
1. Define diagnostic reasoning
a. Involves critical thinking in a way that evaluates new data to support
the hypothesis and reduce alternative hypothesis. This is done by
evaluating all the avenues to reach a conclusion that gives the best
evidence to support the main theory or hypothesis.
b. Examples of diagnostic reasoning are problem solving, health
promotion, and screening for disease or illness. All of these will
require sensitivity, complexity, contest, and a sense of probability and
uncertainty.
2. Discuss and identify subjective & objective data
a. Subjective- what the patient reports as the CC and the responses to the
questions in the interview. Includes ROS, CC, and HPI
b. Objective – Information gained through exam, labs, imaging and other
diagnostic tests.
3. Discuss and identify the components of the HPI
a. Describes the reason the patient came in and include information
using the acronym OLDCARTS
i. Onset
ii. Location
iii. Duration
iv. Characteristics
v. Aggravating factors
vi. Relieving Factors
vii. Treatments tried
viii. Severity of the level of pain
4. Describe the differences between medical billing and medical coding
a. 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.
b. Medical coding is the use of code to communicate with payers about
the procedures performed and why.
,5. Compare and contrast the 2 coding classification systems that are currently
used in the US healthcare system – The two systems need to be in line i.e.
the CPT code for the activity performed should be followed with a relevant
Diagnosis for the procedure performed.
a. ICD 10- the newest version of shorthand for the patients diagnosis. It
is necessary for all diagnosis and procedures performed.
b. CPT- common procedural terminology represented by a 5 digit code
that provides a uniform language to describe medical, surgical, and
diagnostic services. Allows for tracking of treatments, trend and
outcomes. Therer is 3 levels of CPT codes: Category I- used in
contemporary medical practice, Category II -tracking codes used for
new or performance measurement, and Category III- Temporary
coding used for new procedures, technology and services.
i. Catergory I has six sections
1. Evaluation and Management
2. Anesthesiology
3. Surgery
4. Radiology
5. Pathology
6. Medicine
6. Discuss how specificity, sensitivity & predictive value contribute to the
usefulness of the diagnostic data
a. 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
b. 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
c. Predictive value = is in part dependent on the prevalence of the
condition
true +
positive predictive value = -----------
all +
, true -
Negative predictive value = ----------
all –
False positive - when a pt that does not have the condition has a
positive reading
False negative - when a pt that does have the condition but has a
negative reading
7. Discuss the elements that need to be considered when developing a plan
a. Diagnostic testing-what tests need to be conducted to clarify
assessment
b. Education-specific problems being managed
c. Follow-up: when will the patient be seen again
d. Be honest
e. Negotiate what to cover
8. Describe the components of Medical Decision Making in E&M coding
a. There is three key components the determine risk-based E&M codes
i. History
ii. Physical
iii. Medical Decision Making- a way of quantifying the complexity
of the thinking that is required for the visit. And gives credit for
the excess work involved in management of a more complex
patient.
1. Complexity of a visit is based on
a. Risk
b. Data
c. diagnosis
b. Reason for consultation
c. HPI
d. ROS
e. Physical exam
f. Recommendation for testing and treatment
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. 992022 (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
a. Provides documentation about the findings in the history and physical
exam
b. Provides an outline for addressing the issues that prompted the visit.
c. Form of communication about care involved in patients.
d. Medical legal document
e. Essential for accurately coding and billing for services.
11.Accurately document why every procedure code must have a corresponding
diagnosis code
a. 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
a. New patient- who has not received services from the provider before
or who has not seen the provider/ group for over 3 years
b. Established patient- has been seen within the last 3 years,
13.Identify the 3 components required in determining an outpatient, office visit
E&M code
a. Place of service
b. Type of Service
c. Patient status
14.Describe the components of Medical Decision Making in E&M coding
a. Risk
b. Data
c. Diagnosis
15.Correctly order the E&M office visit codes based on complexity from least
to most complex
Week 1
1. Define diagnostic reasoning
a. Involves critical thinking in a way that evaluates new data to support
the hypothesis and reduce alternative hypothesis. This is done by
evaluating all the avenues to reach a conclusion that gives the best
evidence to support the main theory or hypothesis.
b. Examples of diagnostic reasoning are problem solving, health
promotion, and screening for disease or illness. All of these will
require sensitivity, complexity, contest, and a sense of probability and
uncertainty.
2. Discuss and identify subjective & objective data
a. Subjective- what the patient reports as the CC and the responses to the
questions in the interview. Includes ROS, CC, and HPI
b. Objective – Information gained through exam, labs, imaging and other
diagnostic tests.
3. Discuss and identify the components of the HPI
a. Describes the reason the patient came in and include information
using the acronym OLDCARTS
i. Onset
ii. Location
iii. Duration
iv. Characteristics
v. Aggravating factors
vi. Relieving Factors
vii. Treatments tried
viii. Severity of the level of pain
4. Describe the differences between medical billing and medical coding
a. 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.
b. Medical coding is the use of code to communicate with payers about
the procedures performed and why.
,5. Compare and contrast the 2 coding classification systems that are currently
used in the US healthcare system – The two systems need to be in line i.e.
the CPT code for the activity performed should be followed with a relevant
Diagnosis for the procedure performed.
a. ICD 10- the newest version of shorthand for the patients diagnosis. It
is necessary for all diagnosis and procedures performed.
b. CPT- common procedural terminology represented by a 5 digit code
that provides a uniform language to describe medical, surgical, and
diagnostic services. Allows for tracking of treatments, trend and
outcomes. Therer is 3 levels of CPT codes: Category I- used in
contemporary medical practice, Category II -tracking codes used for
new or performance measurement, and Category III- Temporary
coding used for new procedures, technology and services.
i. Catergory I has six sections
1. Evaluation and Management
2. Anesthesiology
3. Surgery
4. Radiology
5. Pathology
6. Medicine
6. Discuss how specificity, sensitivity & predictive value contribute to the
usefulness of the diagnostic data
a. 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
b. 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
c. Predictive value = is in part dependent on the prevalence of the
condition
true +
positive predictive value = -----------
all +
, true -
Negative predictive value = ----------
all –
False positive - when a pt that does not have the condition has a
positive reading
False negative - when a pt that does have the condition but has a
negative reading
7. Discuss the elements that need to be considered when developing a plan
a. Diagnostic testing-what tests need to be conducted to clarify
assessment
b. Education-specific problems being managed
c. Follow-up: when will the patient be seen again
d. Be honest
e. Negotiate what to cover
8. Describe the components of Medical Decision Making in E&M coding
a. There is three key components the determine risk-based E&M codes
i. History
ii. Physical
iii. Medical Decision Making- a way of quantifying the complexity
of the thinking that is required for the visit. And gives credit for
the excess work involved in management of a more complex
patient.
1. Complexity of a visit is based on
a. Risk
b. Data
c. diagnosis
b. Reason for consultation
c. HPI
d. ROS
e. Physical exam
f. Recommendation for testing and treatment
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. 992022 (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
a. Provides documentation about the findings in the history and physical
exam
b. Provides an outline for addressing the issues that prompted the visit.
c. Form of communication about care involved in patients.
d. Medical legal document
e. Essential for accurately coding and billing for services.
11.Accurately document why every procedure code must have a corresponding
diagnosis code
a. 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
a. New patient- who has not received services from the provider before
or who has not seen the provider/ group for over 3 years
b. Established patient- has been seen within the last 3 years,
13.Identify the 3 components required in determining an outpatient, office visit
E&M code
a. Place of service
b. Type of Service
c. Patient status
14.Describe the components of Medical Decision Making in E&M coding
a. Risk
b. Data
c. Diagnosis
15.Correctly order the E&M office visit codes based on complexity from least
to most complex
