NR605 Midterm Exam Questions with Correct
Answers
Documentation requirements - ANSWER --standard format of chief complaint, history of
present illness, review of systems, past psychiatric history, mental status exam, diagnostic
formulation, and treatment plan
-Psychotherapy sessions must include the following:
• target symptoms
• goals of therapy
• method of monitoring outcomes
• frequency of treatment
• clinical records to support relevant medical history
• results of diagnostic tests or
• procedures
• prognosis or progress to date
• estimated duration of treatment
Reimbursement - ANSWER -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 codes
• if the encounter includes diagnosing and/or prescribing medications, a medical evaluation and
management (E/M) base code should be used with an add-on psychotherapy procedure code
Medical Evaluation and Management Codes - ANSWER -specific five-digit E/M code
-based on the type of client, location of service, and level of service
XX=20 new client office/inpatient visit
XX=21 established client office/outpatient visit
XX=24 consultation for office/outpatient
XX=22 inpatient care
Medical Decision Making - ANSWER -level of medical-decision-making (MDM) is rated as
straightforward, low, moderate, or high
-based on three components:
• number of diagnoses
• amount of data being reviewed
• risk of mortality/morbidity
,-The level of MDM is selected based on complexity
Psychotherapy Codes - ANSWER -• 90832- psychotherapy duration 16-37 minutes
• 90833- psychotherapy duration 16-37 minutes used as an add on code to a E/M code
• 90834- psychotherapy 38-52 minutes
• 90836- psychotherapy duration 38 or more minutes used as an add on code to a E/M code
• 90837- psychotherapy 53 or more minutes
• 90846- family psychotherapy client not present
• 90847- family psychotherapy with client present
• 90853- group psychotherapy
Lori, a 42-year-old female, presents to the office for an initial consultation. She has just
experienced a breakup after a 5-year relationship and is feeling "depressed." A comprehensive
initial evaluation which includes chief complaint, history or present illness, medical history,
previous psychiatric history, family history and a comprehensive review of systems was
completed. Psychotherapy was included in the session - 18 minutes time.
provide the appropriate CPT code - ANSWER -99205+90833
Rationale: The client is new to the practice (20) and presents with one problem which addressed
4 or more elements, had a comprehensive history and interview. No additional testing was
needed, treatment was initiated (05). Psychotherapy was included in the session- 18 minutes
time. Therapy goals were established and reviewed with the client.
Hannibal, a 23-year-old male, is admitted to an inpatient psychiatric facility with symptoms of
auditory hallucinations, paranoia, and suicidal ideations. A comprehensive initial evaluation
which includes chief complaint, history or present illness, medical history, previous psychiatric
history, family history and a comprehensive review of systems was completed.
provide the appropriate CPT code - ANSWER -99223
Rationale: The client presents for initial hospital care (22) and has a high level of medical
decision-making due to an acute illness that poses a threat to life (3).
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 - ANSWER -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.
Steve, a 30-year-old married client returns for a follow up appointment. He was initially seen 3
months ago due to increased anxiety over his marriage. His diagnoses include generalized
anxiety disorder (F41.1) and major depressive disorder (F32.1) The PMHNP has provided both
medication management and cognitive behavioral therapy (CBT). Today the PMHNP obtains a
chief complaint, history of present illness, reviews medical history, and a focused review of three
systems was completed. Medications - ANSWER -99214 + 90833
Rationale: This is a returning client with two documented diagnoses. A focused encounter was
conducted that included psychotherapy.
The PMHNP has initiated a grief support group at her practice. The support group is one hour in
length and can include the client and family members.
provide the appropriate CPT code - ANSWER -90853
Rationale: This is group psychotherapy with no medication management. Only a psychotherapy
code is necessary.
Interprofessional Collaboration and Referrals - ANSWER --PMHNPs may receive client
referrals from primary care providers to address mental health problems
-refer clients to primary care providers for medical care
-PMHNPs may collaborate with social workers to address clients' needs for social support
-vocational counselors to assist with employment needs
-refer clients to other therapists
• geriatrics, psychiatric emergencies, eating disorders, family therapy, or pediatrics
-telehealth services or a support group
Disparities in Mental Health Services - ANSWER -Racial, ethnic, gender, and sexual minorities
-often experience poor mental health outcomes due to inaccessibility of quality mental health
services, discrimination, a cultural stigma surrounding mental health care, and lack of knowledge
about mental health
• To address disparities, the American Psychological Association (2022) advocates for the
expansion and use of culturally and linguistically competent psychological and behavioral
research and services
Legal & Ethical Considerations - ANSWER -Provider initiated termination for cause
, Termination letters
Court mandated treatment
Process and progress notes
Code of Ethics for Nurses - ANSWER -Respect for the Individual
Commitment to the Healthcare Consumer
Advocacy for the Healthcare Consumer
Responsibility and Accountability for Practice
Duties to Self and Others
Contributions to Healthcare Environments
Advancement of the Nursing Profession
Collaboration to Meet Health Needs
Promotion of the Nursing Profession
A client who is alert and oriented declines the PMHNP's treatment recommendation for an
antipsychotic in a non-emergent situation.
Informed consent required
Exception to informed consent - ANSWER -Informed consent required
Rationale: The client has the capacity to consent and the situation is not emergent. The ethic of
autonomy provides for the client to refuse treatment options.
An agitated, hallucinating client with a diagnosis of schizophrenia and no designated decision-
maker threatens to shoot his neighbors. The client acts out violently towards the security guard in
the emergency department. The PMHNP orders haloperidol and lorazepam for the client.
Exception to informed consent
Informed consent required - ANSWER -Exception to informed consent
Rationale: The client does not have the capacity to provide consent.
A very anxious client is seeking treatment for anxiety symptoms. When the PMHNP begins to
explain the treatment options, the client says she is too anxious to hear them and asks that the
PMHNP select the best option.
Exception to informed consent
Informed consent required - ANSWER -Exception to informed consent
Rationale: Clients may choose to waive their right to informed consent.
Answers
Documentation requirements - ANSWER --standard format of chief complaint, history of
present illness, review of systems, past psychiatric history, mental status exam, diagnostic
formulation, and treatment plan
-Psychotherapy sessions must include the following:
• target symptoms
• goals of therapy
• method of monitoring outcomes
• frequency of treatment
• clinical records to support relevant medical history
• results of diagnostic tests or
• procedures
• prognosis or progress to date
• estimated duration of treatment
Reimbursement - ANSWER -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 codes
• if the encounter includes diagnosing and/or prescribing medications, a medical evaluation and
management (E/M) base code should be used with an add-on psychotherapy procedure code
Medical Evaluation and Management Codes - ANSWER -specific five-digit E/M code
-based on the type of client, location of service, and level of service
XX=20 new client office/inpatient visit
XX=21 established client office/outpatient visit
XX=24 consultation for office/outpatient
XX=22 inpatient care
Medical Decision Making - ANSWER -level of medical-decision-making (MDM) is rated as
straightforward, low, moderate, or high
-based on three components:
• number of diagnoses
• amount of data being reviewed
• risk of mortality/morbidity
,-The level of MDM is selected based on complexity
Psychotherapy Codes - ANSWER -• 90832- psychotherapy duration 16-37 minutes
• 90833- psychotherapy duration 16-37 minutes used as an add on code to a E/M code
• 90834- psychotherapy 38-52 minutes
• 90836- psychotherapy duration 38 or more minutes used as an add on code to a E/M code
• 90837- psychotherapy 53 or more minutes
• 90846- family psychotherapy client not present
• 90847- family psychotherapy with client present
• 90853- group psychotherapy
Lori, a 42-year-old female, presents to the office for an initial consultation. She has just
experienced a breakup after a 5-year relationship and is feeling "depressed." A comprehensive
initial evaluation which includes chief complaint, history or present illness, medical history,
previous psychiatric history, family history and a comprehensive review of systems was
completed. Psychotherapy was included in the session - 18 minutes time.
provide the appropriate CPT code - ANSWER -99205+90833
Rationale: The client is new to the practice (20) and presents with one problem which addressed
4 or more elements, had a comprehensive history and interview. No additional testing was
needed, treatment was initiated (05). Psychotherapy was included in the session- 18 minutes
time. Therapy goals were established and reviewed with the client.
Hannibal, a 23-year-old male, is admitted to an inpatient psychiatric facility with symptoms of
auditory hallucinations, paranoia, and suicidal ideations. A comprehensive initial evaluation
which includes chief complaint, history or present illness, medical history, previous psychiatric
history, family history and a comprehensive review of systems was completed.
provide the appropriate CPT code - ANSWER -99223
Rationale: The client presents for initial hospital care (22) and has a high level of medical
decision-making due to an acute illness that poses a threat to life (3).
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 - ANSWER -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.
Steve, a 30-year-old married client returns for a follow up appointment. He was initially seen 3
months ago due to increased anxiety over his marriage. His diagnoses include generalized
anxiety disorder (F41.1) and major depressive disorder (F32.1) The PMHNP has provided both
medication management and cognitive behavioral therapy (CBT). Today the PMHNP obtains a
chief complaint, history of present illness, reviews medical history, and a focused review of three
systems was completed. Medications - ANSWER -99214 + 90833
Rationale: This is a returning client with two documented diagnoses. A focused encounter was
conducted that included psychotherapy.
The PMHNP has initiated a grief support group at her practice. The support group is one hour in
length and can include the client and family members.
provide the appropriate CPT code - ANSWER -90853
Rationale: This is group psychotherapy with no medication management. Only a psychotherapy
code is necessary.
Interprofessional Collaboration and Referrals - ANSWER --PMHNPs may receive client
referrals from primary care providers to address mental health problems
-refer clients to primary care providers for medical care
-PMHNPs may collaborate with social workers to address clients' needs for social support
-vocational counselors to assist with employment needs
-refer clients to other therapists
• geriatrics, psychiatric emergencies, eating disorders, family therapy, or pediatrics
-telehealth services or a support group
Disparities in Mental Health Services - ANSWER -Racial, ethnic, gender, and sexual minorities
-often experience poor mental health outcomes due to inaccessibility of quality mental health
services, discrimination, a cultural stigma surrounding mental health care, and lack of knowledge
about mental health
• To address disparities, the American Psychological Association (2022) advocates for the
expansion and use of culturally and linguistically competent psychological and behavioral
research and services
Legal & Ethical Considerations - ANSWER -Provider initiated termination for cause
, Termination letters
Court mandated treatment
Process and progress notes
Code of Ethics for Nurses - ANSWER -Respect for the Individual
Commitment to the Healthcare Consumer
Advocacy for the Healthcare Consumer
Responsibility and Accountability for Practice
Duties to Self and Others
Contributions to Healthcare Environments
Advancement of the Nursing Profession
Collaboration to Meet Health Needs
Promotion of the Nursing Profession
A client who is alert and oriented declines the PMHNP's treatment recommendation for an
antipsychotic in a non-emergent situation.
Informed consent required
Exception to informed consent - ANSWER -Informed consent required
Rationale: The client has the capacity to consent and the situation is not emergent. The ethic of
autonomy provides for the client to refuse treatment options.
An agitated, hallucinating client with a diagnosis of schizophrenia and no designated decision-
maker threatens to shoot his neighbors. The client acts out violently towards the security guard in
the emergency department. The PMHNP orders haloperidol and lorazepam for the client.
Exception to informed consent
Informed consent required - ANSWER -Exception to informed consent
Rationale: The client does not have the capacity to provide consent.
A very anxious client is seeking treatment for anxiety symptoms. When the PMHNP begins to
explain the treatment options, the client says she is too anxious to hear them and asks that the
PMHNP select the best option.
Exception to informed consent
Informed consent required - ANSWER -Exception to informed consent
Rationale: Clients may choose to waive their right to informed consent.
