Wiki Why was I marked wrong? (Practicode Case ID: OPD7289)

[Elund]

The documentation:

Spoiler

OFFICE - ESTABLISHED

SEX: Female

AGE: 25

Date: 01/01/20XX

CHIEF CONCERN: She is here for medication check.

PROBLEM LIST

1. She is now 38 weeks pregnant.

2. Inappropriate sinus tachycardia.

ALLERGIES: known drug allergies.

MEDICATIONS

Children’s Chewable Vitamins q.d.

Folic acid q.d.

Iron q.d.

B12 p.r.n.

Metoprolol succinate 25 mg q.d. (not regularly)

INTERVAL HISTORY: This is a pt that had tachycardia before becoming pregnant at last office visit, metoprolol 25 mg a day was added with significant improvement in palpitations. She states she has had three episodes only over the last month that lasted greater than 10 minutes. Occasional minor episodes, but overall much improved; however, she does forget doses approximately two times a week. She has no definite correlation between day’s missed and significant episodes, although this is likely.

PHYSICAL EXAMINATION

VITAL SIGNS: Weight 218 lbs. BP 108/68 in the left arm, pulse 87 and regular,

oxygen saturation 98% on room air.

CONSTITUTIONAL: In no acute distress.

HEENT: Obvious dental caries. Tongue midline. Mucous membranes moist. No cyanosis.

RESPIRATORY: Respirations even and unlabored. Good air entry bilaterally. No

adventitious sounds. Chest has normal contour.

CARDIOVASCULAR: S1, S2 normal with a low-frequency systolic murmur that decreases during Valsalva maneuver. No gallops. No clicks. No leg swelling.

GASTROINTESTINAL: Abdomen: Fundus normal for this stage in pregnancy. Positive

bowel sounds. No tenderness.

SKIN: Pink, warm and dry. Skin intact. No rashes. No lesions. No clubbing or cyanosis.

NEUROLOGIC/PSYCH: Cranial nerves II-XII grossly intact. Grips and pushes strong and equal bilaterally. Alert and oriented x3. Affect normal.

ASSESSMENT

1. Improved sinus tachycardia on low-dose metoprolol.

2. Medication unintentionally forgets and misses doses approximately two times a week has been underdosing.

PLAN

1. She is to take metoprolol daily as directed.

2. We will see her back in approximately one month after delivery.

Robert Jones, MD

Electronically signed by ROBERT JONES, MD 1/1/20XX

Why shouldn't I report the weeks of gestation?

 

[sls314]

The documentation:

Spoiler

OFFICE - ESTABLISHED

SEX: Female

AGE: 25

Date: 01/01/20XX

CHIEF CONCERN: She is here for medication check.

PROBLEM LIST

1. She is now 38 weeks pregnant.

2. Inappropriate sinus tachycardia.

ALLERGIES: known drug allergies.

MEDICATIONS

Children’s Chewable Vitamins q.d.

Folic acid q.d.

Iron q.d.

B12 p.r.n.

Metoprolol succinate 25 mg q.d. (not regularly)

INTERVAL HISTORY: This is a pt that had tachycardia before becoming pregnant at last office visit, metoprolol 25 mg a day was added with significant improvement in palpitations. She states she has had three episodes only over the last month that lasted greater than 10 minutes. Occasional minor episodes, but overall much improved; however, she does forget doses approximately two times a week. She has no definite correlation between day’s missed and significant episodes, although this is likely.

PHYSICAL EXAMINATION

VITAL SIGNS: Weight 218 lbs. BP 108/68 in the left arm, pulse 87 and regular,

oxygen saturation 98% on room air.

CONSTITUTIONAL: In no acute distress.

HEENT: Obvious dental caries. Tongue midline. Mucous membranes moist. No cyanosis.

RESPIRATORY: Respirations even and unlabored. Good air entry bilaterally. No

adventitious sounds. Chest has normal contour.

CARDIOVASCULAR: S1, S2 normal with a low-frequency systolic murmur that decreases during Valsalva maneuver. No gallops. No clicks. No leg swelling.

GASTROINTESTINAL: Abdomen: Fundus normal for this stage in pregnancy. Positive

bowel sounds. No tenderness.

SKIN: Pink, warm and dry. Skin intact. No rashes. No lesions. No clubbing or cyanosis.

NEUROLOGIC/PSYCH: Cranial nerves II-XII grossly intact. Grips and pushes strong and equal bilaterally. Alert and oriented x3. Affect normal.

ASSESSMENT

1. Improved sinus tachycardia on low-dose metoprolol.

2. Medication unintentionally forgets and misses doses approximately two times a week has been underdosing.

PLAN

1. She is to take metoprolol daily as directed.

2. We will see her back in approximately one month after delivery.

Robert Jones, MD

Electronically signed by ROBERT JONES, MD 1/1/20XX

Why shouldn't I report the weeks of gestation?

With these Practicode questions, it might be beneficial for you to use the rationale given and do some research to understand it. Building those skills to research information will benefit you far more in the long run than having the question answered here.

(It's unclear if you're doing any research on the rationale or just pasting the note here when you get a question wrong. If you are already doing research and still don't understand why it was wrong, I'd recommend posting what reviewed and why it still isn't clear to you. That way, we can help you hone your research skills and make additional suggestions.)

For this case, I'd refer you to read the description of Z3A in the ICD-10-CM book. That code category has very specific notes in the ICD-10-CM book for "Code first..." and "Do not assign a code from this category with..."

You'll likely find the answer to your own question by reviewing Z3A in the tabular index and also the ICD-10-CM guideline references for weeks of gestation.

If reviewing those doesn't clear things up for you, then please come back so we can offer additional guidance.

 

[Elund]

I always read the rationale when I don't understand an answer, but it often doesn't give any explanation, or at least any explanation that answers my question.

I had also already checked the general Z-code guidelines again, as well as the Z3A guidelines before asking here.

I just now checked the guidelines for obstetrics on page G32, and that doesn't answer my question either.

 

[kelly.carpenter610@gmail.com]

I am currently working through Practicode and have become pretty frustrated at times. Like you, I ALWAYS read the rationale to try to figure out why on earth I was marked wrong on some things. There have been multiple occasions now where credit has been given to me because I was incorrectly marked wrong. I highly advise you to always submit a question if something looks wrong. I have had good responses to my questions. DO NOT RELY ON THE RATIONALE BEING CORRECT! I was told that as things have been updated to 2023, there are a lot of things that haven't been caught. It has been extremely confusing and frustrating. Good luck to you!

 

[kelly.carpenter610@gmail.com]

With these Practicode questions, it might be beneficial for you to use the rationale given and do some research to understand it. Building those skills to research information will benefit you far more in the long run than having the question answered here.

(It's unclear if you're doing any research on the rationale or just pasting the note here when you get a question wrong. If you are already doing research and still don't understand why it was wrong, I'd recommend posting what reviewed and why it still isn't clear to you. That way, we can help you hone your research skills and make additional suggestions.)

For this case, I'd refer you to read the description of Z3A in the ICD-10-CM book. That code category has very specific notes in the ICD-10-CM book for "Code first..." and "Do not assign a code from this category with..."

You'll likely find the answer to your own question by reviewing Z3A in the tabular index and also the ICD-10-CM guideline references for weeks of gestation.

If reviewing those doesn't clear things up for you, then please come back so we can offer additional guidance.

With all due respect, the rationales are frequently unhelpful and even wrong in multiple cases.

 

[Elund]

I have often submitted tickets to the Practicode help desk whenever the answer key seemed wrong or I didn't understand why I was marked wrong. Since the migration though, they've never gotten back to me. (And before the migration, they would often take many days to reply, and even sometimes give bare-minimum, unsatisfactory responses.)

 

[sls314]

With all due respect, the rationales are frequently unhelpful and even wrong in multiple cases.

I always read the rationale when I don't understand an answer, but it often doesn't give any explanation, or at least any explanation that answers my question.

I had also already checked the general Z-code guidelines again, as well as the Z3A guidelines before asking here.

I just now checked the guidelines for obstetrics on page G32, and that doesn't answer my question either.

Did your case have a code from O09-O60 or O80-O82 on it? You would need a code from those ranges first before assigning Z3A.

Did your case have a code from O00-O08 or code Z33.2 on it? If so, you would not assign a Z3A code with codes from those ranges.



Weeks of gestation

Codes from category Z3A are for use, only on the maternal record, to indicate the weeks of gestation of the pregnancy, if known.

Code first obstetric condition or encounter for delivery (O09-O60, O80-O82)

AHA: 2022, 2Q, 3; 2019, 2Q, 11; 2016, 2Q, 34; 2014, 3Q, 17; 2014, 2Q, 9; 2013, 2Q, 33

Physician Tip: Do not assign a code from this category with codes from categories O00-O08 or code Z33.2.

 

[Elund]

The only other pregnancy-related code that I used was Z33.1 (pregnant state, incidental).

 

[sls314]

The only other pregnancy-related code that I used was Z33.1 (pregnant state, incidental).

You've answered your own question. The pregnant state was incidental.

Z3A has a code first note for O09-O60, O80-O82. You're not assigning any of those codes, so you wouldn't report the weeks of gestation.

 

[Elund]

Ah, so those would be required. (I thought I just had to code them first if they happened to be reported also.)

Thanks for your help.