HI253 Unit 6 Sequencing Exercise Example

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

This HI253 Unit 6 sequencing exercise picks the principal diagnosis for five composite inpatient stays and names the rule behind each pick. Purdue Global HI 253 teaches BS in Health Information Management students that order on a claim is decided by Section II of the ICD-10-CM guidelines, not by which condition looked worst. The stays include pneumonia that replaced a fever on the admitting order, a lung disease flare and heart failure that equally qualify, chest pain followed by two contrasting diagnoses, probable diverticulitis at discharge and a gallbladder operation canceled when atrial fibrillation appeared on the morning of surgery. Every answer lists the principal code, the secondary codes and the conditions left off, and a closing section ties the order to how stays are grouped for payment and to published audits of principal diagnosis errors.

CourseHI253 Medical Coding I
UnitUnit 6
Paper typeSequencing exercise
LengthAbout 910 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 6

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The Condition That, After Study, Occasioned the Admission: A Unit 6 Sequencing Exercise Choosing the Principal Diagnosis for Five Composite Inpatient Stays and Naming the Section II Rule Behind Each Choice

[Student Name]

Purdue University Global

HI253: Medical Coding I

Unit 6 Sequencing Exercise

[Instructor Name]

[Date]

The admissions are composite; the code entries, guideline rules and sources cited are real and follow the FY 2026 ICD-10-CM.

What this part is doingEach answer quotes the rule that selected the principal diagnosis, because the rule, not the severity of the conditions, is what decides the order.
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The Definition Applied

The guidelines define the principal diagnosis as whichever condition, once the work-up is done, the evidence shows set this admission in motion. The phrase after study matters most: the working diagnosis on the face sheet or the admitting order does not bind the coder if the work-up found something else (National Center for Health Statistics, 2025). Secondary diagnoses are conditions that coexist at admission or develop later and that affect the stay through evaluation, treatment, testing, a longer stay or more nursing care. History that played no part in the stay is not coded.

Summary 1: Pneumonia With Two Monitored Chronic Conditions

A composite 66-year-old was admitted from the emergency department with fever and cough; the admitting order read fever, rule out pneumonia. A chest X-ray showed a right lower lobe infiltrate, the attending diagnosed pneumonia, organism not identified, and gave intravenous antibiotics for three days. Type 2 diabetes was managed with a temporary insulin sliding scale, and hypertension was continued on home medication with daily blood pressure checks. The history lists an appendectomy twenty years ago. Principal: J18.9, pneumonia, unspecified organism. Rule: Section II definition; after study, the pneumonia occasioned the admission. The admitting order's fever is a symptom of the established diagnosis and is not coded, and copying the face sheet would have been wrong. Secondary: E11.9 and I10, each monitored and treated. Not coded: the remote appendectomy, which affected nothing in this stay. The temporary sliding scale does not support Z79.4, which is reserved for long-term insulin use.

Summary 2: Two Conditions That Equally Qualify

A composite 74-year-old who lives with both chronic lung disease and diastolic heart failure came in too breathless to finish a sentence. The attending documented an acute exacerbation of the lung disease and acute on chronic diastolic heart failure, and treated both from the first day with steroids, nebulizers and intravenous diuretics. No hypertension is documented. Principal: either J44.1 or I50.33. Rule: Section II.C; when two or more interrelated conditions each potentially meet the definition, either may go first, provided nothing in why the patient came in, how they were treated or the tabular notes points to one of them. Here nothing tips the balance, so J44.1 was listed first and I50.33 second, and a note records that the reverse order would be equally correct. Not coded: a former smoking history was coded as Z87.891 because it bears on the lung disease; a childhood tonsillectomy was not. Two answers can be correct. The rule asks the coder to show that the record gave no reason to prefer one, not to pretend that one was obvious.

Summary 3: A Symptom Followed by Contrasting Diagnoses

A composite 51-year-old was admitted with chest pain. Troponin was negative on three draws and a stress test was inconclusive. The discharge summary reads chest pain, gastroesophageal reflux versus angina, and the patient leaves on a proton pump inhibitor with an outpatient cardiology appointment. Principal: R07.9, chest pain, unspecified. Rule: Section II.E; when a symptom is followed by contrasting or comparative diagnoses, the symptom code is sequenced first and the contrasting diagnoses are coded as additional diagnoses. Secondary: K21.9 and I20.9, both coded as if established, as the inpatient rules allow for uncertain diagnoses at discharge.

What this part is doingThe answer shows the symptom leading even though two diagnoses appear, which is the step most often reversed in this unit.
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Summary 4: A Probable Diagnosis at Discharge

A composite 58-year-old was admitted with left lower abdominal pain and fever. A CT scan showed thickening of the sigmoid colon without abscess or perforation. The attending's final note reads probable sigmoid diverticulitis, and the patient goes home on oral antibiotics with a plan for colonoscopy. Principal: K57.32, diverticulitis of the large intestine without perforation or abscess and without bleeding. Rule: Section II.H; in inpatient settings, a diagnosis documented as probable, suspected or likely at the time of discharge is coded as if it existed. The same wording in an outpatient record would be coded from its symptoms. Not coded separately: the abdominal pain and fever, which belong to the diagnosis.

What this part is doingNaming the outpatient contrast in one sentence shows the grader that the uncertain-diagnosis rule was applied knowingly to the inpatient setting.
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Summary 5: A Planned Operation That Did Not Happen

A composite 63-year-old was admitted for a planned laparoscopic cholecystectomy for chronic cholecystitis with gallstones. On the morning of surgery an electrocardiogram before induction showed atrial fibrillation not present at the preadmission visit; the operation was canceled and the patient was started on rate control and anticoagulation. Principal: K80.10, calculus of gallbladder with chronic cholecystitis without obstruction. Rule: the reason for admission remains the principal diagnosis when a planned procedure is not carried out. Secondary: Z53.09, procedure not carried out because of other contraindication, and I48.91, unspecified atrial fibrillation, which was treated during the stay.

Why Order Matters

The principal diagnosis drives the grouping of an inpatient stay for payment, and studies of hospital data find that the principal diagnosis is among the fields most often disputed between the original coding and a review (Burns et al., 2012). The rules above exist so that two coders reading the same record reach the same first line, and accuracy research shows how often, without such rules, they would not (O'Malley et al., 2005).

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References

Burns, E. M., Rigby, E., Mamidanna, R., Bottle, A., Aylin, P., Ziprin, P., & Faiz, O. D. (2012). Systematic review of discharge coding accuracy. Journal of Public Health, 34(1), 138-148. https://doi.org/10.1093/pubmed/fdr054

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

What the HI253 Unit 6 assignment asks for

In the sixth unit you are usually given several short discharge summaries, each listing three or four conditions, and asked to choose the principal diagnosis and justify it. The prompt expects you to use the definition in Section II, the condition established after study as chiefly responsible for the admission, and to cite the specific paragraph that applies when the case is unusual. Expect cases with two conditions that equally meet the definition, a symptom followed by contrasting diagnoses, an uncertain diagnosis documented at discharge and a planned procedure that did not take place. Many sections also want secondary diagnoses listed, each justified, plus a line on conditions that should not be coded at all. Citing this year's guideline edition in APA style is standard, and some instructors want codes as well as names.

Inside the HI253 Unit 6 example

The exercise opens with the definition and the meaning of after study, so later answers can point back to it. Each summary then follows a fixed layout: a short composite case, the principal diagnosis with its code, the rule that selected it, the secondary codes and a line on what was left out. The first case shows a confirmed pneumonia replacing the admitting symptom. The second carries a highlighted line on why two answers can both be correct. The third places the symptom first ahead of two contrasting diagnoses, and the fourth applies the inpatient rule for a probable diagnosis while naming the outpatient contrast. The fifth codes the reason for admission plus a status code for the canceled operation and the new arrhythmia. A closing section explains why order matters for grouping and audits.

Where the points sit in the HI253 Unit 6 rubric

The rubric in this unit nearly always rewards the principal diagnosis most heavily, case by case, with a further share for naming the correct Section II rule. Getting the right answer by the wrong rule usually earns partial credit only. Secondary diagnoses form the next block of points, and instructors check that each one meets the Section III test of affecting the stay rather than simply appearing in the history. Cases built around exceptions, such as the canceled operation and the equally qualifying pair, are often weighted more than the routine ones. Codes, when required, must be valid to the full character. Clear justification in complete sentences, a citation to the current guideline edition and tidy formatting complete the marks.

Common HI253 Unit 6 mistakes, and how to avoid them

Copying the admitting diagnosis as principal is the most frequent error, even after the work-up proves something else. Another is putting the most serious condition first because it sounds important, though seriousness is not the test. Students also misapply the uncertain diagnosis rule, coding a probable condition as confirmed on an outpatient record or leaving it as symptoms on an inpatient one. In the canceled surgery case, the reason for admission is often replaced by the new arrhythmia. Long lists of secondary diagnoses that include history with no bearing on the stay also cost points. We can sequence the summaries your section gave out, with the rule for each answer and the codes in order. Send the summaries, the edition and whether codes are required.

Get an HI253 Unit 6 example written to your instructions

Admission summaries for Unit 6 vary by section; attach the ones your course supplies, the instructions and the rubric. For each, the sample names a principal diagnosis, justifies it under Section II, and lists secondary diagnoses with their Section III reasons. Expect the exercise in 24-48h, and the first custom sample costs you 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 6 questions, answered

What if the admitting diagnosis turns out to be wrong?

The principal diagnosis is chosen after study, so the working diagnosis at admission does not bind it. If the work-up shows the presenting problem was caused by a different condition, that condition becomes principal. The sample's first summary includes a line about this, since answers that copy the admitting diagnosis from the face sheet are common and are marked wrong when the study changed the picture.

Is the principal diagnosis the same as the first-listed diagnosis?

The terms belong to different settings. Principal diagnosis applies to inpatient admissions and follows Section II. First-listed diagnosis is the outpatient term and follows Section IV, where uncertain diagnoses are not coded as confirmed and the reason for the visit sets the lead. Many Unit 6 sets use inpatient summaries only, but the distinction appears in grading comments often enough to state.

How many secondary diagnoses should an answer list?

As many as meet the Section III test and no more. A condition belongs on the list when the stay actually engaged it, through work-up, treatment, testing, added days or closer nursing attention. A long history that played no part in this admission adds nothing. The sample keeps an excluded list so the grader can see those decisions were made deliberately.

Where can I find a free HI253 Unit 6 sample paper?

This page has a full Unit 6 sequencing exercise with five composite stays, each giving the principal diagnosis, the Section II rule that chose it and the secondary codes kept or left out.

What happens to the principal diagnosis when a planned surgery is canceled?

The reason for the admission stays principal. A status code showing the procedure was not carried out is added, along with any condition, such as the atrial fibrillation in the sample, that was treated.