HI253 Unit 3 Convention Application Example

Reviewed by Chester Goodwin, MBA Medical Coding I Purdue University Global Free custom sample in 24 to 48h

This HI253 Unit 3 convention application works six pairs of documented conditions through the notes printed in ICD-10-CM. Purdue Global HI 253 uses this unit to test whether BS in Health Information Management students read instructional notes before they report a second code. The pairs cover essential hypertension in pregnancy under an Excludes1 note, vasovagal syncope with orthostatic hypotension where the physician called them unrelated, anxiety with an adjustment disorder under Excludes2, dementia under a code first note, an E. coli urinary infection with use additional code, and diabetes with neuropathy under the with presumption. Each answer names the note, where it sits in the Tabular List, what it means and whether one code or two is reported. A closing section explains why these notes outrank instinct.

CourseHI253 Medical Coding I
UnitUnit 3
Paper typeConvention application
LengthAbout 930 words, 6 pages double-spaced
FormatAPA 7 student paper
SchoolPurdue University Global
ProgramBS in Health Information Management
UpdatedOctober 2026

Free sample paper for HI253 Unit 3

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Six Pairs and the Notes That Decide Them: A Unit 3 Convention Application Working Through Excludes1, the Unrelated-Conditions Exception, Excludes2, Code First, Use Additional Code and the With Presumption

[Student Name]

Purdue University Global

HI253: Medical Coding I

Unit 3 Convention Application

[Instructor Name]

[Date]

The documented conditions are composite; the code entries, notes and sources cited are real and follow the FY 2026 ICD-10-CM.

What this part is doingEvery block follows the same four lines, conditions, note, convention, result, so a grader can compare the six decisions side by side.
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How Each Pair Is Set Out

Each pair below gives the conditions as the composite record documents them, the note with the category where it is printed, the convention in the classification's own terms and the result in one sentence. The conventions are those set out in Section I.A of the official guidelines, which carry the same weight as the guidelines themselves (National Center for Health Statistics, 2025).

Pair 1: Essential Hypertension in a Pregnant Patient

Conditions: a patient at 30 weeks of gestation with essential hypertension diagnosed two years before the pregnancy. Note: category I10 carries an Excludes1 note for hypertensive disease complicating pregnancy, childbirth and the puerperium, codes O10 to O11 and O13 to O16. Convention: Excludes1 means not coded here. The excluded condition and the code it sits under are never reported together. Result: report one. The hypertension is coded from Chapter 15 as pre-existing essential hypertension complicating pregnancy, third trimester, O10.013, with Z3A.30 for the weeks of gestation. I10 is not reported.

Pair 2: Vasovagal Syncope in a Patient With Orthostatic Hypotension

Conditions: a patient on treatment for orthostatic hypotension faints while having blood drawn. The physician documents vasovagal syncope triggered by the needle and states that it is unrelated to the orthostatic hypotension. Note: code R55, syncope and collapse, carries an Excludes1 note for orthostatic hypotension, I95.1. Convention: Excludes1 normally bars reporting both. The guidelines make an exception when the two conditions are unrelated to each other. Result: report both, R55 and I95.1, because the physician's statement that the faint had a separate cause is exactly the circumstance the exception covers. The note says never together; the physician says unrelated. The exception exists for this sentence, and without it the coder would have to drop a real condition.

What this part is doingQuoting the physician's statement of unrelatedness shows the grader where the exception's condition is met, rather than asserting it.
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Pair 3: Generalized Anxiety Disorder and an Adjustment Disorder

Conditions: a patient with long-standing generalized anxiety disorder is newly diagnosed with an adjustment disorder with depressed mood after a job loss. Note: category F41 carries an Excludes2 note listing anxiety in transient adjustment reaction, F43.2. Convention: Excludes2 means not included here. The listed condition falls outside this code's meaning, yet nothing stops a patient from having both, so both may be reported. Result: report both, F41.1 and F43.21.

Pair 4: Alzheimer's Disease With Dementia

Conditions: late-onset Alzheimer's disease with dementia, no behavioral or psychotic disturbance documented, severity not stated. Note: at category F02 the tabular instructs the coder to list the underlying physiological condition first and names Alzheimer's disease, G30, among the examples. Convention: etiology and manifestation. The underlying condition is sequenced first and the manifestation code, which may not be listed first, follows. Result: report both in order, G30.1 and then F02.80.

Pair 5: Urinary Tract Infection Due to Escherichia Coli

Conditions: a urinary tract infection, site not specified, with a urine culture growing Escherichia coli and the provider naming the organism as the cause. Note: code N39.0 carries a use additional code note for the infectious agent, B95 to B97. Convention: use additional code. A second code completes the picture and follows the first. Result: report both, N39.0 and B96.20.

Pair 6: Type 2 Diabetes and Peripheral Neuropathy

Conditions: a patient's problem list shows type 2 diabetes and peripheral neuropathy. The provider does not write that one caused the other and does not attribute the neuropathy to anything else. Note: in the Alphabetic Index, the subterm with under Diabetes, type 2 lists polyneuropathy. Convention: with. When the index joins two conditions with the word with, the classification assumes a causal tie, and only a provider's explicit statement of another cause or of no connection breaks it. Result: report one combination code, E11.42, type 2 diabetes with diabetic polyneuropathy.

What this part is doingThe with presumption is the convention most often missed in this unit, so the result line states plainly that no causal statement from the provider was needed.
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Why the Notes Carry So Much Weight

The move from ICD-9-CM to ICD-10-CM in 2015 multiplied the number of diagnosis codes several times over, and much of the added detail lives in combination codes, laterality and the instructional notes that tie related codes together (Topaz et al., 2013). A coder who treats the notes as optional reading is working with a far smaller and less accurate classification than the one that actually exists. Each pair above is a small case of that larger point: the code that looks right in the index is only a proposal until the notes have been read.

What the Six Pairs Show Together

Three of the six results report a single code and three report two, and the difference never depends on how serious the conditions sound. It depends on the note. Excludes1 and the with presumption both pull conditions into a single assignment, one by forbidding the pairing and the other by building it into a combination. Excludes2, use additional code and code first all permit or require two codes, differing only in whether the order is fixed. The exception in Pair 2 shows the classification bending to documentation: when the provider says two conditions are unrelated, the note gives way. Research on coded data repeatedly finds that misapplied conventions are a source of error that a reviewer can only catch by checking the code against both the record and the tabular notes (O'Malley et al., 2005).

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References

National Center for Health Statistics. (2025). ICD-10-CM official guidelines for coding and reporting FY 2026. Centers for Disease Control and Prevention.

O'Malley, K. J., Cook, K. F., Price, M. D., Wildes, K. R., Hurdle, J. F., & Ashton, C. M. (2005). Measuring diagnoses: ICD code accuracy. Health Services Research, 40(5p2), 1620-1639. https://doi.org/10.1111/j.1475-6773.2005.00444.x

Topaz, M., Shafran-Topaz, L., & Bowles, K. H. (2013). ICD-9 to ICD-10: Evolution, revolution, and current debates in the United States. Perspectives in Health Information Management, 10(Spring), 1d.

Reading the HI 253 Unit 3 instructions

The third unit usually supplies short pairs or trios of conditions documented together and asks you to decide how many codes to report and in what order. You are expected to locate the instructional note that applies, quote or paraphrase it, explain the convention in plain terms and give the final codes. Typical sets include at least one Excludes1, one Excludes2, an etiology and manifestation pair and one combination presumed by the word with. Many prompts add a case where the provider's wording overrides the default, such as a statement that two conditions are unrelated. Some instructors want the location of each note, category or block level, and others ask for the guideline section number as well. A brief closing paragraph about what the conventions do for data accuracy is common.

How this HI253 Unit 3 example is built

The sample starts with a short explanation of how each pair will be set out, so every answer follows the same five parts. Pair 1 shows a pregnancy chapter code taking the place of essential hypertension. Pair 2 is the exception case, with a highlighted line on why the physician's word unrelated lets both codes stand. Pair 3 shows Excludes2 allowing two codes because the conditions are distinct. Pair 4 places the underlying disease ahead of the manifestation as the code first note directs. Pair 5 adds the organism code after the infection. Pair 6 applies the with presumption to link diabetes and neuropathy in one combination entry. A section on why the notes carry weight cites coding accuracy research, and the close compares the six outcomes in a single paragraph.

Where the points sit in the HI253 Unit 3 rubric

Rubrics for this unit usually reward each pair separately: a point for the right number of codes, another for the order and another for naming the correct convention. Explaining what the note means, not only that it exists, is often where full marks are decided. The Excludes1 exception is a favorite grading item because many students drop a documented condition that should stay. Instructors also check that etiology codes come before manifestation codes and that the with link is applied without waiting for the provider to state a cause. Smaller shares cover the location of the note, a reference to the current guidelines and clean formatting. A set that gives codes with no explanation tends to earn about half the available points even if every code is correct.

HI253 Unit 3 help from the desk

Students most often treat Excludes1 and Excludes2 as the same instruction, which leads to dropping a code that should be reported. The second common slip is reversing a code first pair and placing the manifestation ahead of the disease. Some miss the with convention and list diabetes and neuropathy as two unrelated codes. Others apply Excludes1 even when the physician wrote that the conditions are unrelated, which is the exception the guidelines carve out. Answers also lose credit when they name a convention without saying where it is printed. We can complete a Unit 3 set from the pairs your instructor assigned, with the note, its location, its meaning and the result for each. Send the conditions as written, the edition required and any template, and point out pairs your text treats differently.

Get an HI253 Unit 3 example written to your instructions

Send the convention pairs or case excerpts from your Unit 3 assignment, together with the instructions and rubric, and note the code set year the course uses. Every pair comes back with its tabular note quoted, the convention named and the consequence stated. It is back in 24-48h, and a first custom sample is free. 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 3 questions, answered

Is a use additional code note the reverse of code first?

In effect, yes: they are the same instruction seen from opposite ends. A code first note appears at the manifestation and tells the coder the underlying condition goes ahead of it. A use additional code note appears at the etiology and tells the coder a second code should follow. The sample shows both notes on one pair so the reader sees that they agree.

How does the with convention change coding?

It presumes a causal relationship between two conditions linked by with in the Alphabetic Index or an instructional note, even when the provider has not written that one caused the other. The link is set aside only when the documentation states the conditions are unrelated. Missing it usually produces two separate codes where the classification expected a combined or linked assignment.

What does a code also note require?

It signals that two codes may be needed to describe the condition fully, without fixing which one comes first. Sequencing then depends on the circumstances of the encounter. The sample does not include a code also pair, but many Unit 3 sets do, and the right answer names both codes and explains the order from the record rather than from the note.

Where can I find a free HI253 Unit 3 sample paper?

The complete Unit 3 convention application is on this page, with six pairs worked through Excludes1, its unrelated exception, Excludes2, code first, use additional code and the with presumption.

Can both codes be reported under an Excludes1 note?

Only in the exception. If the provider documents that the two conditions are unrelated, as in Pair 2 of the sample, both codes stand; otherwise the note means only one of them is reported.