| Course | HI255 Medical Coding II |
|---|---|
| Unit | Unit 7 |
| Paper type | Bundling review |
| Length | About 890 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 7
Nine Lines Billed, Four Survive: A Unit 7 Bundling Review of One Total Thyroidectomy Episode Tested Against the Global Surgical Package, Correct Coding Edits and the Descriptors' Own Words
[Student Name]
Purdue University Global
HI255: Medical Coding II
Unit 7 Bundling Review
[Instructor Name]
[Date]
The surgical episode, dates and claim lines are composite; the global surgery rules, policy documents and sources cited are real.
Three Sources of Bundling
The review uses three tests. The first is the global surgical package: for a major operation, Medicare pays one fee that covers a visit within a day before the operation, the usual work during the operation and routine care for 90 days afterward, including treatment of complications that do not need a return to the operating room (Medicare Learning Network, 2024). The second is the national correct coding edits and their policy manual, which list pairs of codes that are not reported together and explain why (Centers for Medicare & Medicaid Services, 2025). The third is the code descriptors themselves, which often state what an operation includes.
The Episode in Brief
A composite 47-year-old woman with a multinodular goiter compressing her trachea saw an otolaryngologist on day minus one, when surgery was recommended and scheduled for the next morning. A total thyroidectomy was performed on day 0. The surgeon also removed a small, unrelated skin lesion from the left side of the neck under the same anesthetic, documented separately. She went home on day 1. On day 12 she called with tingling around the mouth and was seen in the office, where her calcium was low and oral calcium was started. On day 40 she returned with ear pain unrelated to the surgery.
Line by Line
1. Day minus 1, office visit where the surgeon and patient chose to operate. Keep, with modifier 57. The note records the decision and the plan to operate the next day, which takes this visit out of the package.
2. Day 0, total thyroidectomy. Keep. The primary line.
3. Day 0, intraoperative nerve monitoring billed by the operating surgeon. Remove. The policy manual treats monitoring performed by the surgeon doing the operation as part of the operation.
4. Day 0, local anesthetic injected by the surgeon. Remove. Anesthesia given by the operating surgeon is part of the package.
5. Day 0, layered closure of the neck incision. Remove. Closure of the incision a surgeon made is part of the operation it closes.
6. Day 0, excision of a 0.8 cm benign lesion from the left neck skin, outside the operative field. Keep, with modifier XS. The note describes a separate site and a separate pathology specimen.
7. Day 1, hospital visit before discharge. Remove. Routine postoperative care in the global period.
8. Day 12, office visit for low calcium with oral replacement. Remove. Postoperative hypocalcemia is a known complication of total thyroidectomy (Orloff et al., 2018), and under Medicare rules a complication managed without a return to the operating room stays inside the package.
9. Day 40, office visit for ear pain diagnosed as otitis externa. Keep, with modifier 24. The problem is unrelated to the surgery and its diagnosis says so.
Five of the nine lines describe real work. They are removed not because they did not happen but because the payment for the operation already covers them.
Corrected Claim
The four lines that survive, in submission order: the total thyroidectomy; the neck skin lesion excision with XS; the decision for surgery visit with 57; the day 40 visit with 24. Each kept line carries its modifier and is paired with a diagnosis that supports it: the goiter for the operation and the decision visit, the benign skin neoplasm for the lesion and otitis externa for the late visit.
Two Close Calls
The day 12 visit was the hardest to remove. The patient had a real complication, and many commercial payers pay for complication care inside the global period. Medicare does not when no return to the operating room is needed, and the review follows the Medicare rule because the scenario names a Medicare patient. A review for a different payer would check that payer's policy before deciding. The lesion excision was the hardest to keep. Lines that are added on an operative day draw attention, and modifier XS is one of the most audited modifiers. It stays because the record supports it: a different site outside the incision, a separate description and a separate specimen. Without those three facts, keeping the line would be unbundling by another route.
Why the Review Matters
The order of the table is part of the method. Reading the lines by date shows the package as a span of time with a visible start and end, so a visit on day 40 can be weighed against day 90 at a glance, and a decision visit the day before can be told apart from the routine check the morning of surgery. A claim sent with all nine lines would have asked to be paid twice for five pieces of work. Payers find these duplications through edits and audits, and the result is denial at best and a repayment demand at worst. Reviewing the episode in date order also makes the package boundaries visible: the visit before the decision, the operation and the 90 days that follow it.
References
Centers for Medicare & Medicaid Services. (2025). National Correct Coding Initiative policy manual for Medicare services. U.S. Department of Health and Human Services.
Medicare Learning Network. (2024). Global surgery booklet (MLN907166). Centers for Medicare & Medicaid Services.
Orloff, L. A., Wiseman, S. M., Bernet, V. J., Fahey, T. J., Shaha, A. R., Shindo, M. L., Snyder, S. K., Stack, B. C., Sunwoo, J. B., & Wang, M. B. (2018). American Thyroid Association statement on postoperative hypoparathyroidism: Diagnosis, prevention, and management in adults. Thyroid, 28(7), 830-841. https://doi.org/10.1089/thy.2017.0309
The Purdue Global HI255 Unit 7 instructions
The seventh unit commonly gives a surgical episode with a list of billed services and asks which belong on the claim. You are expected to apply the global surgical package, including its preoperative and postoperative periods, the procedure-to-procedure edits and the descriptor language that defines what an operation includes. Each line needs a verdict and a reason, and kept lines usually need a modifier plus the record line behind it. A good number of prompts also want for the corrected claim in submission order. Some sections specify the payer, which matters because commercial plans may treat postoperative complications differently from Medicare. Expect at least one line that is real work but bundled, and one that looks bundled but is not. Cite the policy manual and a Medicare global surgery source in APA style.
How the HI 255 Unit 7 example is put together
The review opens by defining its three tests. A short summary of the episode follows, from the decision visit to the day 40 complaint. The nine lines are then set out in date order, each with its date, verdict and one-sentence reason. A highlighted line observes that five of the nine lines describe real work that is still covered by the surgical payment. The corrected claim lists the four survivors with their modifiers and the diagnosis that supports each. A section on two close calls explains why the day 12 hypocalcemia visit was removed under the Medicare rule, citing the thyroid association's statement on postoperative hypoparathyroidism, and why the skin excision was kept on the strength of three documented facts. A brief closing section explains what a nine-line claim would have cost.
Reading the HI255 Unit 7 grading rubric
Bundling reviews are usually graded line by line, with points for the right verdict and further points for naming the rule. A removed line with no reason earns little, and a kept line with no modifier or documentation is often marked as unbundling. The global period lines carry weight because they test whether the student knows the package covers routine postoperative care and, under Medicare, complications without a return to surgery. Modifiers 57 and 24 are frequent grading points. The corrected claim is checked for completeness and order. Instructors give credit for discussing close calls, since they show judgment rather than memorization. Citations to the correct coding manual and a Medicare global surgery source, plus clear formatting, account for the remaining marks in most sections of this course.
HI255 Unit 7 help: mistakes that cost points
Students most often keep the intraoperative and postoperative lines because the work clearly happened, which is the definition of unbundling. A second mistake is removing the decision for surgery visit without checking whether the decision was made there. Others remove every visit in the global period, including one for an unrelated problem that should be kept with modifier 24. Complications are another trap: commercial and Medicare rules differ, and reviews that ignore the payer may be marked wrong. Kept lines without a quoted sentence from the record are treated as unsupported. We can review the episode in your assignment line by line and build the corrected claim. Send the episode, the billed lines with dates, the payer named in the scenario and your instructor's format.
Get an HI255 Unit 7 example written to your instructions
Send the billed lines or encounter record your Unit 7 case supplies, with the instructions and rubric plus a note on the payer conventions your course applies. The review returns with a verdict and cited rule for every line and a corrected claim beneath, in 24-48h. First custom samples come free of charge. 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.
More HI255 papers and BS in Health Information Management samples
- HI255 Unit 1: Discussion Post
- HI255 Unit 2: Operative Report Analysis
- HI255 Unit 3: Root Operation Exercise
- HI255 Unit 4: Approach and Device Drill
- HI255 Unit 5: Procedure Coding Set
- HI255 Unit 6: Modifier Justification
- HI255 Unit 8: Evaluation and Management Case
- HI255 Unit 9: Seminar Reflection
- HI255 Unit 10: Surgical Case Portfolio
- HI253 Unit 7: Physician Query Letter
- HI230 Unit 7: Records Audit
- HI215 Unit 7: Remittance Advice Review
- HI150 Unit 7: Chart Tracking Report
HI255 Unit 7 questions, answered
What is a procedure-to-procedure edit?
It is a pair of codes that should not normally be reported together for the same patient on the same date by the same provider, because one includes the other or because the two are mutually exclusive. Some pairs allow a modifier when the services were genuinely separate, and others never do. The review cites the edit type for each removed line rather than quoting edit tables directly.
What does the global surgical package include?
For a major procedure it typically includes preoperative visits after the decision to operate, beginning the day before surgery, the operation with its routine components, and ordinary postoperative care during the global period. The visit where the decision is made, and care for an unrelated problem, fall outside it when documented. Package details vary by procedure and payer, and the sample names the convention used.
Is unbundling always intentional?
No. Much of it comes from coding every documented step as if it were a separate service, which feels thorough and is simply wrong. The course treats it as a compliance matter regardless of intent, because the claim overstates what was performed. Reviews that explain the rule behind each removed line help prevent the same error on the next report, which is the practical point of this unit.
Where can I find a free HI255 Unit 7 sample paper?
The full Unit 7 bundling review is on this page: nine lines from a thyroidectomy episode tested against the global package and correct coding edits, with four kept.
Is a postoperative complication visit billed separately in the global period?
Under Medicare, not if the complication is treated without a return to the operating room. The sample removes a day 12 visit for low calcium for that reason. Other payers may differ.