NR 511 Week 1 exam UPDATED Exam
Questions and CORRECT Answers
Define diagnostic reasoning - CORRECT ANSWER - 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.
What is subjective data? - CORRECT ANSWER - What the patient tells you, complains
of, etc.
Chief complaint
HPI
ROS
What is objective data? - CORRECT ANSWER - What YOU can see, hear, or feel as part
of your exam.
Includes lab data, diagnostic test results.
Components of HPI - CORRECT ANSWER - Specifically related to the chief complaint
only.
Detailed breakdown of CC.
OLDCART
Why must every procedure code have a corresponding diagnosis code? - CORRECT
ANSWER - Diagnosis code explains the necessity of the procedure code.
,Insurance won't pay if they don't correspond.
What are the three components required in determining an outpatient office visit E&M code? -
CORRECT ANSWER - Place of service
Type of service
Patient status
What is medical coding? - CORRECT ANSWER - The use of codes to communicate with
payers about which procedures were performed and why
What is medical billing? - CORRECT ANSWER - 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.
What are CPT codes? - CORRECT ANSWER - Common procedural terminology
Offers the official procedural coding rules and guidelines required when reporting medical
services and procedures performed by physician and non-physician providers.
What are ICD codes? - CORRECT ANSWER - International classification of disease
Used to provide payer info on necessity of visit or procedure performed.
What is specificity? - CORRECT ANSWER - The ability of the test to correctly detect a
specific condition.
If a patient has a condition but test is negative, it is a false negative.
If a patient does NOT have a condition but the test is positive, it is a false positive.
, What is sensitivity? - CORRECT ANSWER - 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.
What is predictive value? - CORRECT ANSWER - The likelihood that the patient 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. answer is true
What elements need to be considered when developing a plan? - CORRECT ANSWER -
Pt's preferences and actions
Research evidence
Clinical state/circumstances
Clinical expertise
What are the components of medical decision making in E&M coding? - CORRECT
ANSWER - Risk
Data
Diagnosis
The more time and consideration involved in dealing with a pt, the higher the reimbursement
from the payer.
Documentation must reflect MDM!
Correctly order the E&M office visit codes based on complexity from least to most complex. -
CORRECT ANSWER - New patient:
1. Minimal/RN visit: 99201
Questions and CORRECT Answers
Define diagnostic reasoning - CORRECT ANSWER - 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.
What is subjective data? - CORRECT ANSWER - What the patient tells you, complains
of, etc.
Chief complaint
HPI
ROS
What is objective data? - CORRECT ANSWER - What YOU can see, hear, or feel as part
of your exam.
Includes lab data, diagnostic test results.
Components of HPI - CORRECT ANSWER - Specifically related to the chief complaint
only.
Detailed breakdown of CC.
OLDCART
Why must every procedure code have a corresponding diagnosis code? - CORRECT
ANSWER - Diagnosis code explains the necessity of the procedure code.
,Insurance won't pay if they don't correspond.
What are the three components required in determining an outpatient office visit E&M code? -
CORRECT ANSWER - Place of service
Type of service
Patient status
What is medical coding? - CORRECT ANSWER - The use of codes to communicate with
payers about which procedures were performed and why
What is medical billing? - CORRECT ANSWER - 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.
What are CPT codes? - CORRECT ANSWER - Common procedural terminology
Offers the official procedural coding rules and guidelines required when reporting medical
services and procedures performed by physician and non-physician providers.
What are ICD codes? - CORRECT ANSWER - International classification of disease
Used to provide payer info on necessity of visit or procedure performed.
What is specificity? - CORRECT ANSWER - The ability of the test to correctly detect a
specific condition.
If a patient has a condition but test is negative, it is a false negative.
If a patient does NOT have a condition but the test is positive, it is a false positive.
, What is sensitivity? - CORRECT ANSWER - 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.
What is predictive value? - CORRECT ANSWER - The likelihood that the patient 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. answer is true
What elements need to be considered when developing a plan? - CORRECT ANSWER -
Pt's preferences and actions
Research evidence
Clinical state/circumstances
Clinical expertise
What are the components of medical decision making in E&M coding? - CORRECT
ANSWER - Risk
Data
Diagnosis
The more time and consideration involved in dealing with a pt, the higher the reimbursement
from the payer.
Documentation must reflect MDM!
Correctly order the E&M office visit codes based on complexity from least to most complex. -
CORRECT ANSWER - New patient:
1. Minimal/RN visit: 99201
