HI255 Unit 10 Surgical Case Portfolio Example

Course	HI255 Medical Coding II
Unit	Unit 10
Paper type	Surgical case portfolio
Length	About 940 words, 6 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 HI255 Unit 10

One Operation, Three Lists: A Unit 10 Surgical Case Portfolio Coding a Perforated Sigmoid Diverticulitis Admission Where a Laparoscopy Became an Open Hartmann Procedure, With an Agreement Matrix Pairing Every Procedure to Its Diagnosis

[Student Name]

Purdue University Global

HI255: Medical Coding II

Unit 10 Surgical Case Portfolio

[Instructor Name]

[Date]

The patient and the record are composite; the code values, guideline numbers and sources cited are real and follow the FY 2026 ICD-10-CM and ICD-10-PCS and the 2026 CPT book.

What this part is doingThe case summary comes first because every later code points back to a document named in it.

Case Summary

A composite 66-year-old man arrived with two days of left lower abdominal pain, fever and a white count of 18,200. CT showed sigmoid diverticulitis with a perforation and a 5 cm pelvic abscess (history and physical, page 2). He had hypertension treated with lisinopril and had quit smoking nine years earlier. On day 2 the surgeon began laparoscopically, found dense inflammation that made the anatomy unsafe to work through the ports, and converted to a lower midline incision (operative report, page 6). The sigmoid colon was removed entirely, the rectal stump was closed, an end colostomy was brought out from the descending colon, and the pelvis was washed out. Pathology confirmed perforated diverticulitis with abscess and no malignancy (page 11). He went home on day 7 with the stoma working (discharge summary, page 14). Practice guidelines support an operation with a stoma in this setting when the abscess and contamination make a joined bowel unsafe (Hall et al., 2020).

Diagnosis List

1. K57.20, diverticulitis of the large intestine with perforation and abscess, without bleeding. Principal, because it occasioned the admission after study (National Center for Health Statistics, 2025). The abscess and perforation are both captured in the combination code.

2. I10, essential hypertension, treated during the stay.

3. Z53.31, laparoscopic surgical procedure converted to open procedure. The guidelines direct this status code when a laparoscopic approach is changed to open.

4. Z87.891, personal history of nicotine dependence.

A colostomy status code is not added, because the colostomy was created during this admission rather than present as a status the patient arrived with. The perforation, the abscess and the diverticulitis are one diagnosis code, not three. The pathology confirms what the combination code already says.

Facility Procedure List

1. 0WJG4ZZ, inspection of the peritoneal cavity, percutaneous endoscopic approach. Guideline B3.2d directs that an intended procedure attempted by one approach and converted to another is coded as an inspection by the abandoned approach and the completed procedure by the final one (Centers for Medicare & Medicaid Services, 2025).

2. 0DTN0ZZ, resection of the sigmoid colon, open approach. All of the sigmoid, a body part with its own value, was removed.

3. 0D1M0Z4, bypass of the descending colon to the skin, open approach. The end colostomy reroutes the bowel's contents to the abdominal wall, which is the objective of Bypass.

Not coded: the washout of the pelvis and the closure of the rectal stump, both steps needed to complete the resection; and division of adhesions done only to reach the colon.

What this part is doingListing what was left off the facility side, with the reason, answers the question a grader is most likely to ask about the washout.

Professional Procedure List

1. The CPT code for a partial colectomy with an end colostomy and closure of the distal segment, the Hartmann type procedure (American Medical Association, 2025).

The laparoscopic attempt is not reported on the surgeon's claim. Once a scope case turns into an open one, CPT practice reports the open procedure alone, and the diagnostic look through the scope is part of the surgical work. The washout and stump closure are included in the descriptor.

Why the Lists Differ

The facility side reports each distinct objective the surgeons achieved, plus the abandoned approach, because ICD-10-PCS is built to describe exactly what was done to which body part. The professional side reports the service the surgeon is paid for, and CPT bundles the steps of a named operation into one descriptor. Neither list is more complete than the other. They answer different questions for different payers.

Agreement Matrix

1. 0WJG4ZZ is paired with K57.20 and Z53.31. Link: operative report, page 6, conversion sentence.

2. 0DTN0ZZ is paired with K57.20. Link: operative report, page 6, and pathology, page 11.

3. 0D1M0Z4 is paired with K57.20. Link: operative report, page 7, stoma sentence.

4. The professional Hartmann line is paired with K57.20. Link: operative report, pages 6 and 7.

Every procedure has a diagnosis partner. I10 and Z87.891 have no procedure partner, which is expected for conditions managed medically.

What this part is doingA matrix with no orphan procedure lines is the check most likely to catch a missed diagnosis before the claim goes out.

What the Documentation Had to Show

Three sentences in the record carried most of the weight. The conversion sentence on page 6 had to say why the surgeon changed approach and at what point, because without it the inspection code and the status code would have nothing to stand on. The resection sentence had to name the extent of colon removed, since a partial sigmoid removal would have changed the root operation to Excision. The stoma sentence on page 7 had to name the segment brought to the skin, because the body part value of the bypass comes from it. A portfolio that cites these pages lets a reviewer confirm each code in a few minutes, which is the practical reason the course asks for document links on every line.

The Hardest Decision

The hardest decision was whether the colostomy deserved its own facility code. It looks like part of the Hartmann operation, and on the professional side it is. On the facility side, though, the colostomy achieves a separate objective, rerouting the bowel to the skin, that the resection does not describe. Leaving it off would make the record say the colon was removed and nothing else changed, which is not what happened to this patient.

References

American Medical Association. (2025). CPT 2026 professional edition. American Medical 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.

Hall, J., Hardiman, K., Lee, S., Lightner, A., Stocchi, L., Paquette, I. M., Steele, S. R., & Feingold, D. L. (2020). The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Diseases of the Colon & Rectum, 63(6), 728-747. https://doi.org/10.1097/DCR.0000000000001679

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

Reading the HI 255 Unit 10 instructions

The final unit usually hands you a full surgical admission, often a history, operative report, pathology and discharge summary, and asks for a coded portfolio. You are expected to produce the diagnosis codes with the principal sequenced correctly, the facility procedure codes built in ICD-10-PCS and the professional procedure codes in CPT, each with a short rationale. Many prompts require an agreement matrix or crosswalk that pairs every procedure with a diagnosis and the document that links them. Expect a complication of approach, such as a conversion, and at least one step that is integral on one side and separately coded on the other. A brief closing reflection on a hard decision is common. Cite both guideline sets, the CPT book and a clinical source if you explain the surgical choice.

How this HI255 Unit 10 example is built

The portfolio starts with a case summary that names the page behind every key fact. The diagnosis list follows with sequencing reasons and a note on the status code left off. A highlighted line explains that perforation, abscess and diverticulitis share one combination code. The facility list gives the inspection under the conversion guideline, the sigmoid resection and the colostomy as a bypass, then names the steps left uncoded. The professional list reports the Hartmann procedure alone and explains why the laparoscopic attempt and the washout are not added. A short section explains why the two lists differ. The agreement matrix pairs each line with its diagnosis and page. A section names the three documentation sentences the codes depend on, and the portfolio ends on the colostomy decision.

Where the points sit in the HI255 Unit 10 rubric

Portfolios are usually graded section by section. The diagnosis list earns points for the principal diagnosis and complete secondaries, including status codes used correctly. The facility procedure list is often the largest block, checked character by character, with the conversion guideline a frequent focus. The professional list is graded on choosing one CPT service and not adding the bundled steps. The matrix earns its own credit when every procedure has a diagnosis partner and a document link. Reasoning paragraphs and the closing reflection carry a smaller but real share, because the course wants judgment shown, not only codes. Citation of both guideline sets and the CPT book, together with clean layout, completes the rubric. Missing the inspection code on a converted case is one of the most common deductions.

Common HI255 Unit 10 mistakes, and how to avoid them

The costliest error in converted cases is coding only the open procedure on the facility side and leaving out the inspection by the abandoned approach. Students also report the laparoscopy on the surgeon's claim beside the open operation. On diagnoses, some list perforation and abscess as separate codes, or add a colostomy status code for a stoma created during the stay. The colostomy itself is sometimes missed on the facility list or wrongly reported on the professional one. Matrices with procedures that have no diagnosis partner signal that something was skipped. We can code your admission for both sides, build the matrix and write the reflection your instructor asks for. Share every page of the record, the edition of each code set and any template for the portfolio.

Get an HI255 Unit 10 example written to your instructions

For a portfolio built on your own Unit 10 surgical record, send that record with identifiers removed, the instructions, any portfolio template and the rubric. Name the code sets your course expects on the professional side. The three code lists, the agreement matrix and a rationale for each section follow in 24-48h. No payment is taken for a first custom sample. 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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HI255 Unit 10 questions, answered

Why do the facility and professional code lists differ?

They use different code sets for different purposes. Inpatient facility procedures are coded in the procedure classification built character by character, while the surgeon's services are reported with the professional code set and its bundling rules. The same operation can therefore produce more lines on one side than the other, and the portfolio explains each difference rather than forcing the lists to match line for line.

Is the pathology report used for procedure coding?

The procedure codes rest on the operative report, which describes what the surgeon did. The pathology report confirms what was removed and often supplies the diagnosis that justifies the procedure, which is why the matrix cites it. Where the operative report and pathology disagree about something that affects a code, the portfolio names the conflict and treats it as a query rather than choosing one silently.

Where can I find a free HI255 Unit 10 sample paper?

The finished Unit 10 surgical case portfolio is on this page: a laparoscopy converted to an open Hartmann procedure coded for facility and surgeon, with an agreement matrix.

What codes does a laparoscopy that becomes an open operation need?

As two codes: an inspection using the percutaneous endoscopic approach for the abandoned attempt, and the completed procedure using the open approach. Z53.31 records the conversion on the diagnosis side.

Is the colostomy coded separately from the colon resection?

On the facility side, yes, as a bypass of the descending colon to the skin. On the surgeon's claim, the Hartmann procedure descriptor already includes the colostomy.