NR511 Week 4 Midterm Exam 2026/2027 Actual
Exam Questions and verified answers NR511
Differential Diagnosis & Primary Care Practicum
2. Discuss and identify subjective & objective data
- Subjective: What the pt tells you, complains of, etc. *Chief complaint, HPI, ROS
- Objective: What YOU can see, hear, or feel as part of your exam. *lab, data, dx test results.
3. Discuss and identify the components of the HPI
Specifically related to the CC only. Detailed breakdown of CC. OLDCART.
4. Describe the differences between medical billing and medical coding
- Medical coding: The use of codes to communicate with payers about which procedures
wereperformed and why
- Medical billing: Process of submitting and following up on claims made to a payer in order toreceive
payment for medical services rendered by a healthcare provider.
,5. Compare and contrast the 2 coding classification systems that are currently used in the US
healthcare system
- CPT codes: Common procedural terminology. Offers the official procedural coding rules andguidelines
required when reporting medical services and procedures performed by physician and nonphysician orders.
- ICD codes: International classification of disease. Used to provide payer info on necessity ofvisit or
procedure performed.
6. Discuss how specificity, sensitivity & predictive value contribute to the usefulness of the
diagnostic data
- Specificity: The ability of the test to correctly detect a specific condition. If a patient has acondition
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.
- Sensitivity: Test that has few false negatives. Ability of a test to correctly identify a specificcondition
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.
7. Discuss the elements that need to be considered when developing a plan
Patient’s preferences and actions. Research evidence. Clinical state/circumstances. Clinical expertise.
1. Define diagnostic reasoning
Reflective thinking because the process involves questioning one’s thinking to determining 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.
8. Describe the components of Medical Decision Making in E&M coding
Risk – data – diagnosis. The more time and consideration involved in dealing with a pt, the higher the
reimbursement from the payer. Documentation must reflect the MDM!
9. Correctly order the E&M office visit codes based on complexity from least to most complex
New patient:
1. Minimal/RN visit: 99201
2. Problem focused: 99202
3. Expanded problem focused: 99203
4. Detailed: 99204 5. Comprehensive: 99205 Established patient:
6. Minimal/RN patient: 99211
7. Problem focused: 99212
8. Expanded problem focused: 99213
, 9. Detailed: 99214
10. Comprehensive: 99215
10. Discuss a minimum of three purposes of the written history and physical in relation to the
importance of documentation
- Important reference document that vies concise info about the pt’s hx and exam findings- outlines a
plan for addressing issues that prompted the visit. Info should be presented in a
logical fashion that prominently features all data relevant to the pt’s condition - is a
means of communicating info to all providers involved in patient’s care.
- is a medical legal document
- is essential in order to accurately code and bill for services
11. Accurately document why every procedure code must have a corresponding diagnosis code
Diagnosis code explains the necessity of the procedure code. Insurance won’t pay if they do not correspond.
12. Correctly identify a patient as new or established given the historical informationNew patient:
If that patient has never been seen in that clinic or by that group of providers OR if the pt has not been seen
in the past 3 years
13. Identify the 3 components required in determining an outpatient, office visit E&M code
Place of service, type of service, patient status.
14. Describe the components of Medical Decision Making in E&M codingRisk – data – diagnosis
15. Correctly order the E&M office visit codes based on complexity from least to most complex
· Repeat of #9?
New patient:
a. Minimal/RN visit: 99201
b. Problem focused: 99202
c. Expanded problem focused: 99203
d. Detailed: 99204
e. Comprehensive: 99205Established patient:
f. Minimal/RN patient: 99211
g. Problem focused: 99212
h. Expanded problem focused: 99213
i. Detailed: 99214
j. Comprehensive: 99215
16. Explain what a “well rounded” clinical experience means
Includes seeing kids from birth through young adult visits for well child and acute visits as well as adults for
wellness or acute/routine visits. Seeing a variety of patients including 15% of peds and 15% of women’s health
of total time in the program.
17. State the maximum number of hours that time can be spent “rounding” in a facility No more than
25% of total practicum hours in the program
Exam Questions and verified answers NR511
Differential Diagnosis & Primary Care Practicum
2. Discuss and identify subjective & objective data
- Subjective: What the pt tells you, complains of, etc. *Chief complaint, HPI, ROS
- Objective: What YOU can see, hear, or feel as part of your exam. *lab, data, dx test results.
3. Discuss and identify the components of the HPI
Specifically related to the CC only. Detailed breakdown of CC. OLDCART.
4. Describe the differences between medical billing and medical coding
- Medical coding: The use of codes to communicate with payers about which procedures
wereperformed and why
- Medical billing: Process of submitting and following up on claims made to a payer in order toreceive
payment for medical services rendered by a healthcare provider.
,5. Compare and contrast the 2 coding classification systems that are currently used in the US
healthcare system
- CPT codes: Common procedural terminology. Offers the official procedural coding rules andguidelines
required when reporting medical services and procedures performed by physician and nonphysician orders.
- ICD codes: International classification of disease. Used to provide payer info on necessity ofvisit or
procedure performed.
6. Discuss how specificity, sensitivity & predictive value contribute to the usefulness of the
diagnostic data
- Specificity: The ability of the test to correctly detect a specific condition. If a patient has acondition
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.
- Sensitivity: Test that has few false negatives. Ability of a test to correctly identify a specificcondition
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.
7. Discuss the elements that need to be considered when developing a plan
Patient’s preferences and actions. Research evidence. Clinical state/circumstances. Clinical expertise.
1. Define diagnostic reasoning
Reflective thinking because the process involves questioning one’s thinking to determining 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.
8. Describe the components of Medical Decision Making in E&M coding
Risk – data – diagnosis. The more time and consideration involved in dealing with a pt, the higher the
reimbursement from the payer. Documentation must reflect the MDM!
9. Correctly order the E&M office visit codes based on complexity from least to most complex
New patient:
1. Minimal/RN visit: 99201
2. Problem focused: 99202
3. Expanded problem focused: 99203
4. Detailed: 99204 5. Comprehensive: 99205 Established patient:
6. Minimal/RN patient: 99211
7. Problem focused: 99212
8. Expanded problem focused: 99213
, 9. Detailed: 99214
10. Comprehensive: 99215
10. Discuss a minimum of three purposes of the written history and physical in relation to the
importance of documentation
- Important reference document that vies concise info about the pt’s hx and exam findings- outlines a
plan for addressing issues that prompted the visit. Info should be presented in a
logical fashion that prominently features all data relevant to the pt’s condition - is a
means of communicating info to all providers involved in patient’s care.
- is a medical legal document
- is essential in order to accurately code and bill for services
11. Accurately document why every procedure code must have a corresponding diagnosis code
Diagnosis code explains the necessity of the procedure code. Insurance won’t pay if they do not correspond.
12. Correctly identify a patient as new or established given the historical informationNew patient:
If that patient has never been seen in that clinic or by that group of providers OR if the pt has not been seen
in the past 3 years
13. Identify the 3 components required in determining an outpatient, office visit E&M code
Place of service, type of service, patient status.
14. Describe the components of Medical Decision Making in E&M codingRisk – data – diagnosis
15. Correctly order the E&M office visit codes based on complexity from least to most complex
· Repeat of #9?
New patient:
a. Minimal/RN visit: 99201
b. Problem focused: 99202
c. Expanded problem focused: 99203
d. Detailed: 99204
e. Comprehensive: 99205Established patient:
f. Minimal/RN patient: 99211
g. Problem focused: 99212
h. Expanded problem focused: 99213
i. Detailed: 99214
j. Comprehensive: 99215
16. Explain what a “well rounded” clinical experience means
Includes seeing kids from birth through young adult visits for well child and acute visits as well as adults for
wellness or acute/routine visits. Seeing a variety of patients including 15% of peds and 15% of women’s health
of total time in the program.
17. State the maximum number of hours that time can be spent “rounding” in a facility No more than
25% of total practicum hours in the program
