NR511 MIDTERM QUESTIONS AND
ANSWERS
1. Define diagnostic reasoning: 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.
2. What is subjective data?: Anything the patient tells you or complains of
regarding their symptoms
Chief
complaint HPI
ROS
3. What is objective data?: Anything YOU can see, touch, feel, hear, or smell as
part of your exam
Includes lab data, diagnostic test results, etc.
4. Identify components of HPI: Specifically related to the chief
complaint only Detailed breakdown of CC
OLDCARTS
5. Describe the differences between medical billing and
medical coding.: 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
,NR511 MIDTERM QUESTIONS AND
ANSWERS
Medical coding: the use of codes to communicate with payers about which procedures
were performed and why.
6. Compare and contrast the two coding classification
systems that are cur-rently used in the US healthcare system.: 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 otter the oflcial procedural coding rules and
guidelines required when reporting medical services and procedures performed by
physician and non-physician providers. Must have corresponding ICD.
7. How do specificity, sensitivity, and predictive value
contribute to the useful-
ness of diagnostic data?: 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.
,NR511 MIDTERM QUESTIONS AND
ANSWERS
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.
8. Discuss the elements that need to be considered when
developing a plan.-
: Pt's preferences and
actions Research
evidence
Clinical
state/circumstances
Clinical expertise
9. Describe the components of medical decision making in
E&M coding.: Risk,
, NR511 MIDTERM QUESTIONS AND
ANSWERS
data, diagnosis
The more time and consideration involved in dealing with a pt, the higher the reimbursement
from the payer. Documentation must reflect MDM
10. Correctly order the E&M office visit codes based on
complexity from least to most complex.: 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
ANSWERS
1. Define diagnostic reasoning: 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.
2. What is subjective data?: Anything the patient tells you or complains of
regarding their symptoms
Chief
complaint HPI
ROS
3. What is objective data?: Anything YOU can see, touch, feel, hear, or smell as
part of your exam
Includes lab data, diagnostic test results, etc.
4. Identify components of HPI: Specifically related to the chief
complaint only Detailed breakdown of CC
OLDCARTS
5. Describe the differences between medical billing and
medical coding.: 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
,NR511 MIDTERM QUESTIONS AND
ANSWERS
Medical coding: the use of codes to communicate with payers about which procedures
were performed and why.
6. Compare and contrast the two coding classification
systems that are cur-rently used in the US healthcare system.: 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 otter the oflcial procedural coding rules and
guidelines required when reporting medical services and procedures performed by
physician and non-physician providers. Must have corresponding ICD.
7. How do specificity, sensitivity, and predictive value
contribute to the useful-
ness of diagnostic data?: 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.
,NR511 MIDTERM QUESTIONS AND
ANSWERS
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.
8. Discuss the elements that need to be considered when
developing a plan.-
: Pt's preferences and
actions Research
evidence
Clinical
state/circumstances
Clinical expertise
9. Describe the components of medical decision making in
E&M coding.: Risk,
, NR511 MIDTERM QUESTIONS AND
ANSWERS
data, diagnosis
The more time and consideration involved in dealing with a pt, the higher the reimbursement
from the payer. Documentation must reflect MDM
10. Correctly order the E&M office visit codes based on
complexity from least to most complex.: 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
