| Course | HI255 Medical Coding II |
|---|---|
| Unit | Unit 4 |
| Paper type | Approach and device drill |
| Length | About 850 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 4
How It Got In and What Stayed Behind: A Unit 4 Approach and Device Drill Coding the Fifth and Sixth Characters of Seven Procedures, Including a Hand-Assisted Colectomy and a Drain That Is Not a Device
[Student Name]
Purdue University Global
HI255: Medical Coding II
Unit 4 Approach and Device Drill
[Instructor Name]
[Date]
The procedures are composite; the approach and device values, guideline numbers and sources cited are real and follow the FY 2026 ICD-10-PCS.
Key to the Values Used
ICD-10-PCS defines each approach by how the site was reached (Centers for Medicare & Medicaid Services, 2025). Open: the surgeon cuts through skin or mucosa and whatever lies beneath until the site is laid bare. Percutaneous: instruments pass through a puncture or small cut in the skin or mucosa and on to the site, without laying it bare. Percutaneous Endoscopic: that same small entry, with a scope carrying the view. Via Natural or Artificial Opening Endoscopic: a scope enters by the mouth, urethra, anus, a stoma or another opening and the instruments follow it. External: work done on the skin or mucosa itself, or done to deeper parts by force applied from outside. A device is coded in the sixth character only if it remains in the body after the procedure is complete (guideline B6.1a).
The Seven Rows
1. Ultrasound-guided needle aspiration of a fluid collection in the right thigh, with no catheter left.
Approach: Percutaneous. Evidence: the needle was passed through the skin under imaging. Device: No Device, since nothing remained.
2. Hand-assisted laparoscopic left colectomy.
Approach: Open. Evidence: the surgeon placed a hand port through a seven centimeter incision and worked with one hand inside the abdomen alongside the laparoscopic instruments. Device: No Device.
3. Cystoscopy with removal of a bladder stone.
Approach: Via Natural or Artificial Opening Endoscopic. Evidence: the scope was passed through the urethra. Device: No Device.
4. Shave removal of a raised lesion from the skin of the back.
Approach: External. Evidence: the lesion was shaved flush with the skin surface. Device: No Device.
5. Plating of a displaced right distal radius fracture after open reduction.
Approach: Open. Evidence: the fracture was exposed through a volar incision. Device: Internal Fixation Device. Evidence: a locking plate and seven screws were secured to the bone and left in place.
6. Open excision of a pilonidal sinus with a temporary drain brought out through the skin and removed in clinic a week later.
Approach: Open. Device: No Device. Evidence: the drain is a temporary postoperative wound drain.
7. Insertion of a totally implantable venous access port in the right chest wall, catheter tip at the cavoatrial junction.
Approach: Open for the port pocket. Device: the totally implantable vascular access device value. Evidence: the port and its catheter remain in place for months of chemotherapy. Rows 5, 6 and 7 sit together on purpose. One device stays for good, one stays for a week, and one is placed for months. Only the week-long drain is left out.
Flagged Row 2: Why Hand-Assisted Is Open
Surgeons describe a hand-assisted colectomy as laparoscopic, and the operative report's title usually says so. The classification disagrees. Guideline B5.2a states that procedures performed with the open approach and percutaneous endoscopic assistance, or with hand-assisted laparoscopy, are coded to the Open approach. The reasoning follows from the definition: the hand port is an incision large enough to expose the site to the surgeon's hand, which is what Open means. Studies comparing hand-assisted with standard laparoscopic colectomy treat it as a hybrid with a longer incision, which supports the classification's choice (Marcello et al., 2008). Coders who copy the title will choose Percutaneous Endoscopic and be wrong.
Flagged Row 6: Why the Drain Is Not a Device
The drain in row 6 was still in the patient when the operation ended, so a reader of guideline B6.1a alone might code it. Guideline B6.1b settles the question. It names sutures, ligatures, radiological markers and short-term wound drains as part of doing the procedure, and none of them is coded as a device. The drain's purpose was to let the wound settle, and its removal a week later is not coded either. If the surgeon had placed a drain to treat a collection, the root operation would change to Drainage, and the drain would become a drainage device for that procedure.
Two Rows That Needed Care for a Different Reason
Row 4 surprises students who assume every procedure crosses the skin. A shave removal works on the skin itself, so the approach is External. Row 7 needs the device value and the body part read together: the port sits in the subcutaneous tissue of the chest, and the device value names the kind of access device rather than its brand. Neither row is hard once the definition is open on the desk. Both rows reward the same habit as the flagged ones, which is reading the definition before the procedure name. Reviews of procedure coding errors find approach and device characters among the positions most often changed on audit (Cheng et al., 2009).
References
Centers for Medicare & Medicaid Services. (2025). ICD-10-PCS official guidelines for coding and reporting 2026. U.S. Department of Health and Human Services.
Cheng, P., Gilchrist, A., Robinson, K. M., & Paul, L. (2009). The risk and consequences of clinical miscoding due to inadequate medical documentation: A case study of the impact on health services funding. Health Information Management Journal, 38(1), 35-46. https://doi.org/10.1177/183335830903800105
Marcello, P. W., Fleshman, J. W., Milsom, J. W., Read, T. E., Arnell, T. D., Birnbaum, E. H., Feingold, D. L., Lee, S. W., Mutch, M. G., Sonoda, T., Yan, Y., & Whelan, R. L. (2008). Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: A multicenter, prospective, randomized trial. Diseases of the Colon & Rectum, 51(6), 818-826. https://doi.org/10.1007/s10350-008-9269-6
The Purdue Global HI255 Unit 4 instructions
Unit 4 typically gives a short set of procedures and asks for the approach and device values with a reason for each. You are expected to use the classification's definitions of the approaches, Open, Percutaneous, Percutaneous Endoscopic, Via Natural or Artificial Opening, the endoscopic version of it, and External, and to apply the device guidelines that decide whether anything left behind is coded. Most sets include at least one hand-assisted or converted case and one temporary item such as a drain or a marker. Some prompts ask for a table with columns for the evidence; others accept short paragraphs. Instructors usually expect the guideline numbers cited where they decide an answer, such as the hand-assisted rule or the list of items that are not devices. A sentence of explanation per row is the norm.
How the HI 255 Unit 4 example is put together
A key defines each approach value in plain language and states the rule that a device is coded only if it remains after the procedure. The seven rows follow, each naming the approach, the device and the sentence from the report that decides them. Rows 5, 6 and 7 are grouped and carry a highlighted line, because one device stays permanently, one stays a week and one stays for months, and only the short-term drain is excluded. A section on the hand-assisted colectomy quotes the guideline and cites a randomized trial describing the hybrid technique. A second section explains why the temporary drain is integral rather than a device and what would change if a drain had been placed to treat a collection. The drill closes with notes on the External shave removal and the port's device value.
Reading the HI255 Unit 4 grading rubric
Approach and device drills are usually graded row by row, with equal points for each character and extra credit for the evidence quoted. The flagged rows tend to carry more weight because they separate students who read the guidelines from those who rely on surgical vocabulary. Coding the hand-assisted case as Percutaneous Endoscopic is the deduction instructors expect most often. The device column is checked for both directions of error: a retained plate coded as No Device, and a temporary drain coded as a device. Citations of the guideline numbers earn their own small share in many sections. A key or definitions list is not always required, but it often earns credit for clarity. Formatting, consistency and an APA reference to the PCS guidelines complete the grading.
HI255 Unit 4 help: mistakes that cost points
The biggest trap is the hand-assisted laparoscopic case, which nearly everyone codes as laparoscopic until they read the guideline. A second is treating anything still in the patient at the end of surgery as a device, including drains and sutures. Students also miss the External approach for skin procedures, assuming every surgery crosses the skin. On fixation, some forget the device altogether because the root operation is Reposition. Approach values for scopes passed through the urethra or mouth are confused with percutaneous endoscopic work. Rows with no quoted evidence lose credit even when the value is right. If your drill uses different procedures, we can answer each row with the definition and the report sentence behind it. Send the procedures, the format and your edition of the guidelines.
Get an HI255 Unit 4 example written to your instructions
Upload the Unit 4 drill items or the reports your section provides, plus the instructions and rubric. Every item returns with approach and device values, each tied to the sentence that supports it, and the guideline cited wherever the answer runs against intuition. Answers arrive in 24-48h, with the first custom sample free of any fee. 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 4 questions, answered
How do Percutaneous and Percutaneous Endoscopic differ?
Both reach the site by puncture or a small incision rather than by exposing it. Percutaneous Endoscopic adds a scope to see the site, as in laparoscopy or arthroscopy. Percutaneous alone uses instruments without direct visualization, such as a needle placed under imaging guidance. The drill includes one of each so the difference is carried by the report's description of how the site was seen.
When is a device coded if it is removed later?
A device is coded when it remains after the procedure is completed, even if a later procedure will take it out. Devices placed and removed within the same operation are not coded as devices. Removal of a retained device in a later encounter is a procedure of its own, with its own root operation, which many Unit 4 sets include as a paired item.
Does the approach change for procedures converted from laparoscopic to open?
The classification treats the conversion as two procedures: an inspection using the laparoscopic approach and the completed procedure using the open approach. No converted case appears in this drill, but many sets carry one, and the expected answer shows both codes with the report sentence that marks the point of conversion.
Where can I find a free HI255 Unit 4 sample paper?
This page holds the complete Unit 4 approach and device drill, seven procedures answered for approach and device with the deciding sentence for each and two flagged rows.
Is a temporary wound drain coded as a device?
No. Even if the drain is still in place when the operation ends, the guidelines list temporary postoperative wound drains as integral, so the device character does not record it.