lOMoARcPSD|58626349
Module 1 — NP Role (CPT/MCOs, Documentation, Quality, Ethics)
Core Concepts
● CPT vs. ICD-10-CM:
o CPT = what you did (procedures/E&M), ICD-10 = why. Pair them logically (e.g.,
K59.00 with docusate prescription).
● E/M in primary care:
o History + exam + MDM or time spent. Document independent interpretation and
risk when applicable.
● Incident-to billing:
o Requires established plan by supervising provider, no change in assessment/plan,
and appropriate supervision (state/payer specific).
● MCOs:
o Understand capitated vs. fee-for-service; implications for referrals, prior auths,
and quality metrics.
● Quality metrics examples:
o HEDIS (e.g., HTN control <140/90, diabetes A1C poor control >9%, statin use in
CVD), preventive screenings, vaccination rates.
● Ethics & legal: vAutonomy, beneficence, nonmaleficence, justice. Informed consent =
capacity, disclosure, comprehension, voluntariness.
Documentation Pearls
● SOAP with decision rationale. Link dx ↔ treatment. Safety-netting instructions and
return precautions are risk-reducing.
Module 2 — Adult & Geriatric Wellness
Vaccines (CDC 2025)
● Adults ≥19 y: Review age/indication tables each visit (influenza
annually; Tdap once then Td/Tdap q10y; zoster ≥50y—2-dose series;
pneumococcal using PCV20 once or PCV15→PPSV23; HepB universal to
age 59; HPV catch-up ≤26 and SCDM 27–45; COVID-19 per current
SCDM; RSV ≥60 SCDM or pregnant seasonally). (CDC)
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, lOMoARcPSD|58626349
● Special populations: Immunocompromised, asplenia, liver disease, diabetes—check
“medical condition” table. (CDC)
Prevention Levels
● Primary: Immunizations, lifestyle counseling, chemoprophylaxis (e.g., ASA no longer
routine primary prevention—individualize risk).
● Secondary: Screening (BP, lipids, DM, CRC, cervical, breast), fall risk, depression.
● Tertiary: Complication mitigation, rehab, tight risk-factor control.
Older Adult Considerations
● Functional & cognitive screen (ADLs/IADLs, gait, Timed Up & Go; MoCA/MMSE),
polypharmacy, Beers criteria, orthostatic vitals, shared goals of care.
Module 3 — Pediatric Wellness
Growth & Development
● Tanner staging: I (prepubertal) → V (adult); exam-based sexual maturity rating guides
counseling and sports clearance.
Sports Physicals (PPE)
● Red flags needing cardiology eval: exertional syncope/chest pain, family history of
sudden death, murmur that increases with Valsalva, Marfan stigmata.
● Clearance decisions: condition-specific restrictions; document shared decision and
return-to-play plan.
Immunizations (CDC 2025)
● Birth: HepB #1.
● 2/4/6 mo: DTaP, IPV, Hib, PCV, Rotavirus; consider HepB #2–3 per series.
● 12–15 mo: MMR, Varicella (or MMRV per age/notes), PCV booster, Hib booster, HepA
start.
● 4–6 y: DTaP, IPV, MMR, Varicella.
● 11–12 y: Tdap, HPV series start, MenACWY; 16 y: MenACWY booster; MenB by
SCDM at 16–23.
● Annual influenza ≥6 mo; COVID-19 per SCDM.
messages.downloaded_by
Module 1 — NP Role (CPT/MCOs, Documentation, Quality, Ethics)
Core Concepts
● CPT vs. ICD-10-CM:
o CPT = what you did (procedures/E&M), ICD-10 = why. Pair them logically (e.g.,
K59.00 with docusate prescription).
● E/M in primary care:
o History + exam + MDM or time spent. Document independent interpretation and
risk when applicable.
● Incident-to billing:
o Requires established plan by supervising provider, no change in assessment/plan,
and appropriate supervision (state/payer specific).
● MCOs:
o Understand capitated vs. fee-for-service; implications for referrals, prior auths,
and quality metrics.
● Quality metrics examples:
o HEDIS (e.g., HTN control <140/90, diabetes A1C poor control >9%, statin use in
CVD), preventive screenings, vaccination rates.
● Ethics & legal: vAutonomy, beneficence, nonmaleficence, justice. Informed consent =
capacity, disclosure, comprehension, voluntariness.
Documentation Pearls
● SOAP with decision rationale. Link dx ↔ treatment. Safety-netting instructions and
return precautions are risk-reducing.
Module 2 — Adult & Geriatric Wellness
Vaccines (CDC 2025)
● Adults ≥19 y: Review age/indication tables each visit (influenza
annually; Tdap once then Td/Tdap q10y; zoster ≥50y—2-dose series;
pneumococcal using PCV20 once or PCV15→PPSV23; HepB universal to
age 59; HPV catch-up ≤26 and SCDM 27–45; COVID-19 per current
SCDM; RSV ≥60 SCDM or pregnant seasonally). (CDC)
messages.downloaded_by
, lOMoARcPSD|58626349
● Special populations: Immunocompromised, asplenia, liver disease, diabetes—check
“medical condition” table. (CDC)
Prevention Levels
● Primary: Immunizations, lifestyle counseling, chemoprophylaxis (e.g., ASA no longer
routine primary prevention—individualize risk).
● Secondary: Screening (BP, lipids, DM, CRC, cervical, breast), fall risk, depression.
● Tertiary: Complication mitigation, rehab, tight risk-factor control.
Older Adult Considerations
● Functional & cognitive screen (ADLs/IADLs, gait, Timed Up & Go; MoCA/MMSE),
polypharmacy, Beers criteria, orthostatic vitals, shared goals of care.
Module 3 — Pediatric Wellness
Growth & Development
● Tanner staging: I (prepubertal) → V (adult); exam-based sexual maturity rating guides
counseling and sports clearance.
Sports Physicals (PPE)
● Red flags needing cardiology eval: exertional syncope/chest pain, family history of
sudden death, murmur that increases with Valsalva, Marfan stigmata.
● Clearance decisions: condition-specific restrictions; document shared decision and
return-to-play plan.
Immunizations (CDC 2025)
● Birth: HepB #1.
● 2/4/6 mo: DTaP, IPV, Hib, PCV, Rotavirus; consider HepB #2–3 per series.
● 12–15 mo: MMR, Varicella (or MMRV per age/notes), PCV booster, Hib booster, HepA
start.
● 4–6 y: DTaP, IPV, MMR, Varicella.
● 11–12 y: Tdap, HPV series start, MenACWY; 16 y: MenACWY booster; MenB by
SCDM at 16–23.
● Annual influenza ≥6 mo; COVID-19 per SCDM.
messages.downloaded_by
