Differentials & Billing TEST 1

Question 1

List cardiac causes of chest pain.

Answer 1

Myocardial infarction, aortic dissection, valvular disease, pericarditis, myocarditis, angina, coronary spasm.

Question 2

List pulmonary causes of chest pain.

Answer 2

Pneumothorax, pneumonia, pleuritis, pulmonary embolism, cancer, sarcoidosis.

Question 3

List gastrointestinal causes of chest pain.

Answer 3

Pancreatitis, biliary tract disease, peptic ulcer, gastritis, GERD, esophageal rupture, mediastinitis.

Question 4

When is chest pain an emergency?

Answer 4

Emergencies include MI, PE, pneumothorax, aortic dissection, or esophageal rupture—requiring immediate intervention.

Question 5

What are diagnostic tests for emergency chest pain?

Answer 5

Stat EKG, labs, chest X-ray, CT scan, echocardiogram.

Question 6

List differential diagnoses for shortness of breath.

Answer 6

COPD, asthma, interstitial lung disease, pneumonia, pneumothorax, heart failure, arrhythmias, DKA, acidosis.

Question 7

What tests are used to evaluate shortness of breath?

Answer 7

Chest X-ray, EKG, ABG, CT chest, echocardiogram; PFTs for chronic disease.

Question 8

List causes of abdominal pain.

Answer 8

Appendicitis, pancreatitis, diverticulitis, aortic aneurysm, UTI, kidney stones, ectopic pregnancy, obstruction, GERD, cancer.

Question 9

When is abdominal pain an emergency?

Answer 9

When associated with aortic dissection, bowel necrosis, or pancreatitis; requires stat CT and possible surgery.

Question 10

List causes of altered mental status.

Answer 10

Stroke, seizure, dementia, overdose, infection (meningitis, encephalitis), metabolic issues, hepatic failure, sepsis, hypotension.

Question 11

What tests are needed for altered mental status?

Answer 11

Stat CT/MRI for stroke, EEG for seizures, lumbar puncture if infection suspected.

Question 12

What should you always consider before ordering a test?

Answer 12

Potential harm versus benefit—e.g., avoid contrast CT in CKD unless necessary.

Question 13

Why is billing and coding important?

Answer 13

It communicates care provided, ensures reimbursement, prevents underbilling or fraud, and demonstrates provider value.

Question 14

What did CMS 2023 updates emphasize?

Answer 14

Alignment of CPT and CMS standards, reduced documentation burden, and focus on time-based coding.

Question 15

What are the elements of medical decision making (MDM)?

Answer 15

Number and complexity of problems, data reviewed, and risk of complications/morbidity/mortality.

Question 16

What is a CPT code?

Answer 16

Current Procedural Terminology code used to standardize reporting of medical procedures and services.

Question 17

What are shared/split services?

Answer 17

Services performed jointly by a physician and NP; the provider doing the substantive portion bills using modifier FS.

Question 18

What defines the ‘substantive portion’ in shared services?

Answer 18

The provider performing >50% of time or key elements of MDM (problems, data, risk).

Question 19

What documentation is required for shared services?

Answer 19

Each provider must document their portion; the physician cannot simply cosign the NP note.

Question 20

What qualifies as billable time?

Answer 20

Care coordination, counseling, documentation, ordering, reviewing labs/tests, communication, and referrals.

Question 21

What is an ICD code?

Answer 21

International Classification of Diseases code representing patient diagnoses and used for billing and analytics.

Question 22

What are required components of a history and physical (H&P)?

Answer 22

Chief complaint, HPI, past medical/surgical/family/social history, allergies, meds, ROS, labs, exam, assessment, plan.

Question 23

What should be included in a discharge summary?

Answer 23

Admission/discharge dates, principal & secondary diagnoses, hospital course, procedures, complications, labs, condition, instructions, meds, and follow-up.