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
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, 99245
Rationale: The client has been referred (24), has complex medical decision-
making needs (5) based on one undiagnosed new problem with an uncertain
prognosis, required review of referral notes, and requires prescription drug
management. No psychotherapy provided.
Phases of Therapy
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Initiation
Working
Termination
Maslow's Hierarchy of Needs Pyramid
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TOP: Self-actualization
-Morality, creativity, spontaneity, lack of prejudice, acceptance of facts
Esteem
-Self-esteem, respect, achievement, confidence
Love/Belonging
-Friendship, family, intimacy, sense of connection with others
Safety
-Security of body, of employment, of resources, of morality, of the family, and
of health, of property
, Bottom: Physiological
-Air, food, water, shelter, clothing, sleep
Termination
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number of therapy sessions is often dependent on the type of therapy
-CBT typically engage in 5-20 sessions
-Discussion of therapy termination should begin at the initiation of therapy
-Ideally, when goals have been met, the client and therapist mutually decide
to terminate the therapy relationship
-client can choose to terminate non-court-ordered therapy at any time
-Reasons for premature termination include:
• inability to afford therapy
• feelings that therapy is no longer beneficial
• relocation out of the therapist's service area
Hildegard Peplau therapeutic relationship six nurse roles
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• Stranger: Nurse creates an environment to build trust
• Teacher: Nurse imparts relevant knowledge and provides instructions and
training
• Resource person: Nurse provides specific information needed by the client,
answers questions, and interprets clinical data
• Counselor: Nurse helps the client understand and integrate meaning into
life's circumstances, provides guidance and encouragement for change
, • Surrogate: Nurse helps clarify domains of dependence, interdependence,
and independence and acts as an advocate for the client
• Leader: Helps client take maximum responsibility for meeting treatment
goals
Ruben is a 36-year-old who has been in therapy for 5 months. He is in the process of
divorcing his wife of 12 years and is seeking custody of his daughter. His attorney has
requested copies of his psychotherapy notes to use in support of the custody hearing.
Can the therapist choose to share the psychotherapy notes?
Yes, no client authorization necessary
Yes with written authorization from the client
No
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Yes with written authorization from the client
Rationale: the client must provide written authorization for his notes to be
shared with his attorney.
Reimbursement
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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
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
Give this one a try later!
, 99245
Rationale: The client has been referred (24), has complex medical decision-
making needs (5) based on one undiagnosed new problem with an uncertain
prognosis, required review of referral notes, and requires prescription drug
management. No psychotherapy provided.
Phases of Therapy
Give this one a try later!
Initiation
Working
Termination
Maslow's Hierarchy of Needs Pyramid
Give this one a try later!
TOP: Self-actualization
-Morality, creativity, spontaneity, lack of prejudice, acceptance of facts
Esteem
-Self-esteem, respect, achievement, confidence
Love/Belonging
-Friendship, family, intimacy, sense of connection with others
Safety
-Security of body, of employment, of resources, of morality, of the family, and
of health, of property
, Bottom: Physiological
-Air, food, water, shelter, clothing, sleep
Termination
Give this one a try later!
number of therapy sessions is often dependent on the type of therapy
-CBT typically engage in 5-20 sessions
-Discussion of therapy termination should begin at the initiation of therapy
-Ideally, when goals have been met, the client and therapist mutually decide
to terminate the therapy relationship
-client can choose to terminate non-court-ordered therapy at any time
-Reasons for premature termination include:
• inability to afford therapy
• feelings that therapy is no longer beneficial
• relocation out of the therapist's service area
Hildegard Peplau therapeutic relationship six nurse roles
Give this one a try later!
• Stranger: Nurse creates an environment to build trust
• Teacher: Nurse imparts relevant knowledge and provides instructions and
training
• Resource person: Nurse provides specific information needed by the client,
answers questions, and interprets clinical data
• Counselor: Nurse helps the client understand and integrate meaning into
life's circumstances, provides guidance and encouragement for change
, • Surrogate: Nurse helps clarify domains of dependence, interdependence,
and independence and acts as an advocate for the client
• Leader: Helps client take maximum responsibility for meeting treatment
goals
Ruben is a 36-year-old who has been in therapy for 5 months. He is in the process of
divorcing his wife of 12 years and is seeking custody of his daughter. His attorney has
requested copies of his psychotherapy notes to use in support of the custody hearing.
Can the therapist choose to share the psychotherapy notes?
Yes, no client authorization necessary
Yes with written authorization from the client
No
Give this one a try later!
Yes with written authorization from the client
Rationale: the client must provide written authorization for his notes to be
shared with his attorney.
Reimbursement
Give this one a try later!
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
