Leveled element by element, then audited against its own text, one composite office note shows a finished NU605 Unit 4 coding and billing exercise, codes bracketed. Searches like "nu 605 unit 4 assignment example", "nu605 unit 4 sample" and "nu605 unit 4 example" land here.
Leveling One Return Visit for Diabetes and Hypertension by Medical Decision Making, Then Auditing the Note Against Its Own Text
[Student Name]
Purdue University Global
NU605: Transition to Practice
Unit 4 Coding and Billing Exercise
[Instructor Name]
[Date]
The office note, patient and provider are composite; every code value is a bracketed placeholder, since the exercise shows reasoning rather than answers.
The Note
Established patient, [62]-year-old man, return visit, [date]. Subjective: here for diabetes and blood pressure follow-up. Checking sugars "a few times a week," fasting readings 150s to 180s. Taking metformin 1,000 mg twice daily and lisinopril 20 mg daily. Also reports right knee pain for [three] weeks after gardening, worse on stairs, no swelling or injury. Objective: BP 148/92, repeat 146/90. BMI [31]. Right knee: no effusion, full range of motion, tenderness at the medial joint line, stable ligaments. Data: labs reviewed. Assessment and plan:
1. Type 2 diabetes, not at goal. Add empagliflozin 10 mg daily. Discussed genital hygiene and hydration. Recheck A1c in [three] months.
2. Hypertension, not at goal. Increase lisinopril to 40 mg daily. Recheck BMP in [two] weeks.
3. Right knee pain, likely medial compartment osteoarthritis. Acetaminophen as needed, quadriceps exercises handout. Return if not improved in [six] weeks.
Level selected by provider: [99215].
Leveling by Medical Decision Making
Under the office visit guidelines, the level of medical decision making depends on three elements, and a level is met when two of the three reach it (American Medical Association, 2023).
Element 1, number and complexity of problems addressed. The note addresses two chronic illnesses, each explicitly "not at goal," which the guidelines treat as chronic illness with exacerbation, progression or side effects of treatment. That alone meets moderate. It also addresses a new problem, knee pain, which the note treats as an uncomplicated condition. High complexity would require a chronic illness with severe exacerbation or a threat to life or bodily function; nothing in the note supports that. Finding: moderate.
Element 2, amount and complexity of data. The note says only "labs reviewed." It does not name which tests or their results. A data element that the text does not show cannot be counted, however likely it is that the provider looked. Orders are documented: A1c and BMP, two unique tests. Ordering a test counts toward data, and a later review of that same result is included in the order rather than counted again. Two orders without a named review meet limited, not moderate, which needs three items from the first category or an independent interpretation or discussion with another clinician. Finding: limited as written.
Element 3, risk of complications from patient management. The plan includes prescription drug management: a new drug started and a dose increased. The guidelines list prescription drug management as an example of moderate risk. High risk would require, for example, drug therapy requiring intensive monitoring for toxicity or a decision about hospitalization. Finding: moderate.
The Level
Two of three elements, problems and risk, meet moderate. Data meets only limited. Moderate medical decision making supports [99214]. The note does not support [99215], because no element reaches high.
The Audit
The audit reverses direction and starts from the provider's choice, [99215], asking what the note would need to say.
Problems would need a chronic illness with severe exacerbation. Uncontrolled diabetes at this A1c is not severe exacerbation, and nothing suggests urgent risk. Risk would need a high-risk management option, which the plan does not contain. Data would need extensive review: for example, three unique tests reviewed plus independent interpretation of a test, or a discussion of management with an external physician.
None of these is present, and adding them would mean documenting work that did not happen. The correct response is to code [99214], not to expand the note.
The audit does find a sentence that should be rewritten, because it hid real work. "Labs reviewed" should read: "Reviewed A1c from [date], 8.3 percent, compared with 7.4 percent in [month]; BMP from [date], creatinine 1.2, eGFR [58], potassium 4.6." With that sentence, the provider has reviewed two unique results and ordered two new tests. Under the guidelines, the review of a result that was ordered at a previous encounter counts separately from a new order, so the data element would reach moderate. The level would still be [99214], but with three elements rather than two supporting it, the claim would survive an external audit more comfortably.
The note has a second, smaller gap. Starting empagliflozin in a patient whose eGFR is [58] is appropriate, but the plan does not mention kidney function as part of the reason or the monitoring. One sentence would close it: "eGFR [58]; empagliflozin appropriate and may offer kidney benefit; BMP in two weeks will also check kidney function after the lisinopril increase."
Time as an Alternative
Office visits may also be leveled by the provider's total time spent that day on the patient's care. The note records no time. If the provider spent, for example, [42] minutes including chart review, the visit and documentation, and wrote that in the note, time would support a higher level than decision making does. A note should state time only when it has been tracked; estimating afterward to reach a level is not documentation.
Billing Under the Nurse Practitioner's Number or Incident-To
Billed under the nurse practitioner's own number, Medicare pays the visit at [85] percent of the physician fee schedule amount. Incident-to billing lets the service be billed under the supervising physician's number at the full rate, but only when conditions are met: the patient is established with the physician, the physician initiated the course of treatment, the service follows that established plan, and direct supervision is available because the physician is in the same office suite at the time (42 C.F.R. § 410.26, 2024). The benefit policy manual sets out the same conditions for services furnished incident to a physician's professional service (Centers for Medicare & Medicaid Services, 2024).
This visit fails incident-to on the knee. A new problem is being evaluated and a new plan started, which is not following a course of treatment the physician initiated. Changing the diabetes and blood pressure plan is closer to the line, but the new problem alone is enough. The visit should be billed under the nurse practitioner's own number at [99214].
The exercise leaves one question for the practice: whether its schedules route new-problem visits for patients already known to a physician in a way that assumes incident-to billing. If they do, the practice may be billing incorrectly, and a new nurse practitioner should raise that before signing their first claim.
References
American Medical Association. (2023). CPT evaluation and management (E/M) services guidelines. https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf
Centers for Medicare & Medicaid Services. (2024). Medicare benefit policy manual, Chapter 15: Covered medical and other health services. https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c15.pdf
42 C.F.R. § 410.26 (2024). https://www.ecfr.gov/current/title-42/section-410.26
How this NU605 Unit 4 example is structured
Note, leveling, audit and billing context, in that order. Leveling follows the guideline's own logic, so each element is scored before any level is named, and the level is stated only once two of three are met. Every finding quotes the note, since an element the text does not show cannot be counted. The audit reverses direction, starting from the level the composite provider selected and testing the documentation against it; where the note falls short, the exercise names the missing documentation and rewrites the sentence that would have carried it. A final section compares billing under the nurse practitioner's own number with incident-to billing, setting out the conditions incident-to requires and why a visit for a new problem usually fails them. All code values stay as bracketed placeholders, because the exercise shows reasoning rather than answers.
Get an NU605 Unit 4 example written to your instructions
Forward the visit note or scenario your section provides, the Unit 4 instructions and rubric, and the guideline year your course follows. The exercise returns with each element scored against the note's own words, the level held as a bracketed placeholder and an audit of what the documentation supports. Expect it inside 24-48h, free as a first sample. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU605 Unit 4 questions, answered
Why are the codes shown as placeholders?
Because the exercise is graded on reasoning, and your answer has to be your own. A sample shows how each element is scored and how the level follows from them; the actual code values for your scenario come from your analysis and the current code set. Placeholders keep the method visible without handing over an answer.
Should I level by medical decision making or by time?
The prompt decides first. If it leaves the choice to you, analyze both and say which the documentation supports better. Decision making usually fits a visit where problems and management are well documented; time fits one dominated by counseling. Showing both routes, with the chosen one explained, tends to earn more than either alone.
What is incident-to billing?
A Medicare arrangement under which services a nurse practitioner provides can be billed under a physician's number when specific conditions are met, including that the physician initiated the plan of care and provides the supervision the rules require, traditionally presence in the office suite. A new problem addressed by the nurse practitioner usually cannot be billed that way, and your exercise may ask you to explain why.