How to Answer What First Listed Questions (Complete Guide)

This type of question evaluates analytical and critical thinking skills.

What This Question Is About

This question relates to what first listed and requires a structured academic response.

How to Approach This Question

Use appropriate theories and support your answer with clear reasoning.

Key Explanation

This topic involves what first listed. A strong answer should include explanation, application, and examples.

Original Question

1) What is the ICD-10-CM first-listed diagnosis code? 2) What are the secondary diagnosis codes? (there are 4) 3) The principal CPT procedure code? (CPT’s 10004-69990) enter the CPT, otherwise enter the correct E/M CPT code 4) Secondary Procedure Code(s) LEAVE THIS BLANK or enter the CPT code if secondary surgical procedure is performed. CHIEF COMPLAINT: “My stomach hurts. I think I may have an ulcer.” HPI: Sandra Emerson is a 58 yo woman who presents with her daughter to the clinic with complaints of epigastric pain that radiates to the chest and occurs mostly at night. The pain is exacerbated by spicy foods and caffeine and is relieved by milk and antacids. She reports a 50-pound weight loss over the past year, 10 pounds of which occurred over the past month, despite a good appetite. She began experiencing palpitations a few months ago that come and go but are not associated with CP. However, she does note that her heart seems to “beat too fast” for the amount of activity she is doing. She has also had difficulty swallowing solid food for the past few months and has been unable to sleep for the last 3 days. She has noticed that her legs have been swollen for approximately 2 weeks and her neck “pulsates.” Her daughter reports that the patient is “more nervous and hyper than usual.” PMH: Patient entered menopause 10 years ago. FH: She has a daughter with hyperthyroidism and a half-sister with Graves’ disease. Her father had arthritis and multiple MIs; her mother had breast cancer; her grandmother had leukemia. SH: She lives with her husband and smokes 1/2 ppd x 35 years (she may have smoked more in the past). She does not drink alcohol. ROS: She notes that her hair has become more fine and thinner in distribution recently. She has no visual changes, CP, or dyspnea. She has occasional N/V/D. MEDS: None ALLERGIES: PCN(rash) PE: GEN: The patient is a thin, tan-appearing WF in NAD. VS: BP 120/80, P 120-160 irreg., RR 18, T 37.1 degrees C; Wt 118lb., Ht 62 in. SKIN: Hyperpigmented on upper back and lower extremities, warm and moist. Hair is fine and sparse on crown of head. HEENT: PERRI, EOMI, (+) lid lag, mild proptosis(no ophthalmoplegia), mild lid retraction. NECK/LN: Supple, (+) smooth, symmetrically enlarged thyroid, (+) thyroid bruit, (+) JVD to jaw, prominent pulsations in neck vessels. LUNGS: CTA bilaterally, no wheezes or rales. CV: Irregularly irregular rhythm, tachycardic without murmurs; (+) carotid bruits bilaterally. ABD: Soft, NT/ND; (+) BS; no HSM or masses; mild naval erythema with some slight crusting with no exudate. Aortic pulsations palpable. Rectal: Guaiac(-)stool EXT: 2 + pitting edema bilaterally in LE, 2+ DP pulses bilaterally, no calf tenderness. No cyanosis. Fingernails and toenails are flaking. Thumbnails have prominent ridges. NEURO: A&O x3; hyperreflexia at knees; no proximal muscle weakness or tremor. LABS: Na 140 mEq/mL K 3.8 mEq/mL Cl 106 mEq/mL CO2 25 mEq/mL BUN 9 mg/dL SCr 0.4 mg/dL Glu N/A Hgb 10.2 Hct 30.7% RBC 3.48 Plt 156 MCV 78.8 MCH 25.3 pg MCHC 32.1 g/dL RDW 16.4% WBC 5.5 Polys 45% Lymphs 39% Monos 13% Eos 2% Basos 1% AST 32 IU/L ALT 29 IU/L Amylase 54 IU/L T. bili 0.8 mg/dL Ca 8.5 mg/dL Mg 1.5 mEq/L Phos 4.3 mg/dL Total T4 24.3ug/dL TSH<0.018 uIU/mL T3 resin uptake 49% Total T3 720ng/dL Free thyroxine index 41.3 ASSESSMENT: 58 yo female with goiter, probable hyperthyroidism, and new onset atrial fibrillation. Most likely cause is Graves' disease PLAN: Start patient on methimazole 60 mg daily in 3 divided doses. Begin on metoprolol 25mg q6h with meals and hs snack. F/U in 1 month

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