| Course | HI253 Medical Coding I |
|---|---|
| Unit | Unit 10 |
| Paper type | Full record coding case |
| Length | About 1,250 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BS in Health Information Management |
| Updated | October 2026 |
Free sample paper for HI253 Unit 10
Gallbladder First, Creatinine Unnamed: A Unit 10 Full Record Coding Case Sequencing Acute Calculous Cholecystitis Ahead of Diabetes, Sleep Apnea and a Day Two Low Potassium, With Present on Admission Flags and a Query on the Kidney Numbers
[Student Name]
Purdue University Global
HI253: Medical Coding I
Unit 10 Full Record Coding Case
[Instructor Name]
[Date]
The patient, the record and its page numbers are composite; the code entries, guideline sections and sources cited are real and follow the FY 2026 ICD-10-CM and ICD-10-PCS.
The Record in Brief
A composite 61-year-old woman came to the emergency department with eighteen hours of right upper quadrant pain, a temperature of 38.4 degrees and a white count of 14,600. On ultrasound there were stones in the gallbladder, its wall measured thick and fluid lay beside it, and the surgeon's admission note reads acute calculous cholecystitis (record pages 2 to 4). No stone was seen in the common bile duct and the liver tests were normal. She was given intravenous antibiotics and taken to the operating room on day two for a laparoscopic cholecystectomy, completed without conversion (operative report, page 7). The pathology report confirms acute cholecystitis with cholelithiasis (page 12). Her history and physical lists type 2 diabetes on metformin, hypertension on lisinopril, obstructive sleep apnea treated with a home CPAP machine and a former smoking habit that ended eleven years ago. Admission glucose was 248, and the attending wrote type 2 diabetes with hyperglycemia and ordered correctional insulin. On day two the potassium fell to 3.1 after a day of nothing by mouth and intravenous fluids; the progress note says hypokalemia and orders oral replacement. The same day creatinine rose from 0.9 on arrival to 1.5, and the progress note reads only creatinine up, push fluids, recheck in the morning. It was 1.0 at discharge on day four.
Coding Summary
1. K80.00, calculus of gallbladder with acute cholecystitis without obstruction. POA: Y. Support: admission note page 3, pathology page 12. Rule: Section II, principal diagnosis.
2. E11.65, type 2 diabetes mellitus with hyperglycemia. POA: Y. Support: history and physical page 5, admission glucose. Rule: Section III, condition treated during the stay.
3. G47.33, obstructive sleep apnea. POA: Y. Support: history and physical page 5, CPAP ordered nightly. Rule: Section III, condition requiring ongoing care.
4. I10, essential hypertension. POA: Y. Support: history and physical page 5, medication continued. Rule: Section III.
5. E87.6, hypokalemia. POA: N. Support: progress note day two, page 9, oral potassium ordered. Rule: Section III, condition that developed after admission and was treated.
6. Z79.84, long term use of oral hypoglycemic drugs. POA: exempt. Rule: Section I.C.4, which pairs this status code with type 2 diabetes treated by oral medication.
7. Z87.891, personal history of nicotine dependence. POA: exempt. Rule: Section III, history relevant to the anesthetic and airway plan.
Principal procedure: 0FT44ZZ, resection of gallbladder, percutaneous endoscopic approach, day two. Not coded: the right upper quadrant pain, fever and leukocytosis, all integral to the cholecystitis, and the creatinine rise, which has no diagnosis behind it yet.
Why the Gallbladder Leads
Section II assigns first place to whatever the work-up shows was mainly behind the admission (National Center for Health Statistics, 2025). Nothing else on this list brought the patient in. Her diabetes needed insulin, but only because the infection and the fasting around surgery disturbed it, and her blood pressure and sleep apnea were managed as they would be at home. The ultrasound findings, the admission note and the pathology all describe one condition, so the work of sequencing is short. What takes care is choosing the code itself. Category K80 combines the stone and the inflammation in one entry, so a separate cholecystitis code is not added, and the fifth character records that no obstruction was found. Had the duct been blocked, the code would change to K80.01, and the coder would need the imaging or operative report to say so. The procedure follows the same logic. The ICD-10-PCS root operation resection means the whole body part was cut out, and the gallbladder was removed entirely through laparoscopic ports, which the system calls the percutaneous endoscopic approach (Centers for Medicare & Medicaid Services, 2025). The operative report states the gallbladder was placed in a retrieval bag and removed, which settles resection over excision.
Present on Admission Flags
Four of the five diagnoses were present when the order to admit was written; the low potassium was not, and its N is the flag a reviewer will check first. The guidelines treat a condition as present on admission when it is already there once the inpatient order is signed, including conditions found in the emergency department (National Center for Health Statistics, 2025). The cholecystitis, diabetes with hyperglycemia, sleep apnea and hypertension all appear in the emergency record or the history and physical, so each takes Y. The hyperglycemia is part of the Y for E11.65 because the admission glucose was 248 before any treatment began. Hypokalemia was not in the admission labs, which showed a potassium of 3.9, and first appears on day two after a period of fasting, so it takes N. Both Z codes are on the exempt list and carry no indicator. Assigning Y to the hypokalemia because diabetes was present on arrival would be the most common error in this case; the flag belongs to the condition, not to the patient.
The Creatinine and the Query
A creatinine that rises from 0.9 to 1.5 in a day meets the laboratory part of the KDIGO definition of acute kidney injury, an increase of at least 0.3 within 48 hours (Kellum et al., 2013). A coder cannot act on that. Diagnoses are assigned from provider documentation, and abnormal results are coded only when the provider indicates their clinical significance (National Center for Health Statistics, 2025). The progress note records the number and a plan, which shows the result mattered, but it names no condition. Coding N17.9 from the laboratory value would be assigning a diagnosis no clinician made, and leaving the episode out entirely may miss a condition that affected the stay. The compliant step is a query. The drafted query reads: Dr. [surgeon], the record for this admission shows creatinine of 0.9 on arrival, 1.5 on day two after surgery and 1.0 on day four, with intravenous fluids increased on day two (progress note, page 9). Based on your clinical judgment, can the significance of these values be documented? Options: acute kidney injury; prerenal azotemia; dehydration; expected values for the clinical situation, no further diagnosis; other; unable to determine. The options include a no diagnosis choice, the indicators are dated with their source page, and nothing in the wording suggests which answer would change the payment (American Health Information Management Association & Association of Clinical Documentation Integrity Specialists, 2022).
Three Orders Rejected
Diabetes first was rejected because the hyperglycemia was a reaction to the infection and the fasting, not the reason for the stay, and Section II gives first place to the condition that occasioned the admission. The pain code first was rejected because a symptom integral to a confirmed diagnosis is not sequenced as principal when the diagnosis is known. A separate code for acute cholecystitis listed after a stone code was rejected because the K80 combination already carries both, and listing them apart would report one condition twice. If the surgeon answers the query with acute kidney injury, N17.9 would be added with POA N, and the principal diagnosis would not change.
References
American Health Information Management Association & Association of Clinical Documentation Integrity Specialists. (2022). Guidelines for achieving a compliant query practice (2022 update). American Health Information Management Association.
Centers for Medicare & Medicaid Services. (2025). ICD-10-PCS official guidelines for coding and reporting 2026. U.S. Department of Health and Human Services.
Kellum, J. A., Lameire, N., & KDIGO AKI Guideline Work Group. (2013). Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1). Critical Care, 17(1), 204. https://doi.org/10.1186/cc11454
National Center for Health Statistics. (2025). ICD-10-CM official guidelines for coding and reporting FY 2026. Centers for Disease Control and Prevention.
What the HI253 Unit 10 assignment asks for
The final unit usually hands you a longer record, often ten to fifteen pages, and asks for a complete code set with sequencing and present on admission indicators. You are expected to read the whole record, choose the principal diagnosis, list every secondary diagnosis that affected the stay and assign procedure codes when the instructions include them. Most prompts want each code tied to the document and page that supports it. Many also ask for a short narrative defending the order and a query wherever the documentation leaves a gap. Expect at least one abnormal result with no diagnosis attached and one condition that arose after admission. A reference to the current ICD-10-CM and, where needed, ICD-10-PCS guidelines in APA format is standard. Some sections grade the case like a mini audit.
How this HI253 Unit 10 example is built
The case begins with a summary of the record so every later code can be checked against the same facts. A numbered coding summary follows: each diagnosis with its code, indicator, supporting page and guideline section, then the principal procedure and a short list of what was left out. The defense explains why the gallbladder leads, what the fifth character of K80.00 records and why the procedure is a resection. A section on present on admission flags carries a highlighted line on the one condition marked N. The creatinine section sets the laboratory definition beside the rule that coders work from provider documentation, then gives the drafted query with dated values and a no diagnosis option. A final section rejects three plausible orders and states what would change if the surgeon answered the query.
Reading the HI253 Unit 10 grading rubric
Full record cases are usually graded in layers. The largest share goes to the principal diagnosis and the completeness of the secondary list, since missing a treated condition or adding one that did nothing to the stay both cost points. Present on admission indicators form a separate block, and a single wrong N or Y is a common deduction. Procedure codes, where required, are checked character by character. The written defense earns credit when each sequencing decision cites its guideline, and the query is graded on neutrality, dated indicators and balanced options. Smaller amounts cover the summary layout, the link from each code to its page and an APA reference list. Cases that code every abnormal value without provider support tend to lose more than they gain.
HI253 Unit 10 help: mistakes that cost points
The costliest error is coding a diagnosis from a laboratory value, such as kidney injury from a creatinine trend the surgeon never named. Students also assign Y to every indicator without reading when each condition first appears. Some code the pain and fever beside the cholecystitis, or add a separate cholecystitis code after the combination category. Others put the diabetes first because insulin was given. Procedure codes go wrong on the root operation, with excision used for a whole organ removed. We can code the record in your assignment, flag every place where a query belongs and write the defense in the form your instructor uses. Send the full record as provided, the edition required and a note on whether procedures are included.
Get an HI253 Unit 10 example written to your instructions
Upload the full Unit 10 record your section provides, with identifiers masked, plus the instructions, any answer template and the rubric. The case returns with its coding table, a defense of the order and a drafted query wherever the record leaves a question open. It lands in 24-48h, and the first custom sample costs nothing. 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.
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HI253 Unit 10 questions, answered
What do present on admission indicators add to a coding case?
They distinguish conditions the patient arrived with from conditions that developed during the stay, which matters for quality reporting and for how hospital-acquired conditions are tracked. Each diagnosis gets Y, N, U, W or an exempt status. A case that assigns every code Y without reading the timeline in the notes misses one of the things the record is built to show.
Where can I find a free HI253 Unit 10 sample paper?
The finished Unit 10 full record coding case is on this page: a gallbladder admission coded with present on admission flags, a principal procedure and a query on a creatinine rise.
Why is the creatinine rise not coded as acute kidney injury?
Diagnoses come from provider documentation. The values meet the laboratory definition, but the progress note never names a condition, so the sample sends a query and adds N17.9 only if the surgeon documents it.
Is a condition found on day two present on admission?
Not unless the provider documents it was there at admission. The low potassium in the sample appears only after a day of fasting, so it carries N while the other diagnoses carry Y.
Does a full record case need procedure codes?
When the record documents an operation and the instructions include procedures, yes. The sample reports 0FT44ZZ for the laparoscopic removal of the whole gallbladder.