| Course | HS292 Billing and Coding Practicum |
|---|---|
| Unit | Unit 10 |
| Paper type | Practicum case report |
| Length | About 1,160 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Associate of Applied Science in Health Science |
| Updated | October 2026 |
Free sample paper for HS292 Unit 10
Left in Triage, Right Everywhere Else: A Unit 10 Practicum Case Report Coding a Dog Bite to the Hand as a Log of Numbered Decisions
[Student Name]
Purdue University Global
HS292: Billing and Coding Practicum
Unit 10 Practicum Case Report
[Instructor Name]
[Date]
The patient, encounter and lengths are composite, and codes are shown as bracketed placeholders where documentation leaves them open; the coding guidelines, procedure code set, vaccine recommendations and query guidance cited are real.
Case Summary
A 38-year-old man came to the emergency department about two hours after his neighbor's dog bit the back of his hand while he was helping carry groceries into the neighbor's house. The dog is current on rabies vaccination, according to the neighbor's records. The physician irrigated and explored the wound, found no tendon involvement or foreign body and closed a [length] laceration with simple interrupted sutures. A tetanus, diphtheria and acellular pertussis booster was given because his last tetanus dose was more than ten years earlier. An oral antibiotic was prescribed, and he was discharged with wound care instructions. The summary interprets nothing; the facts below are taken as the record states them.
Abstraction
Injury: bite wound, dorsum of hand. Source: physician history and examination.
Side: left in the triage note; right in the physician's history, examination and procedure note. Source: triage note and physician note.
Mechanism and place: bitten by a dog inside a neighbor's home while carrying groceries. Source: physician history.
Procedure: irrigation, exploration and simple repair, length [length]. Source: procedure note.
Vaccine: Tdap booster, intramuscular, administered by nursing. Source: medication administration record.
Visit: emergency department evaluation and management on the same day as the repair. Source: physician note.
Decision Log
Decision 1. Question: what is the injury? Answer: open bite of the hand, initial encounter [code pending laterality]. Documentation: "puncture and laceration from dog bite, dorsum of hand." Rule: the injury chapter classifies bites by site as open wounds of the bite type, and the seventh character for initial encounter applies while the patient is receiving active treatment (National Center for Health Statistics, 2025).
Decision 2. Question: which hand? Answer: unresolved; query drafted. Documentation: triage charted left; physician history, examination and procedure note all say right. Rule: when documentation from clinicians conflicts, the coder asks the attending provider rather than choosing the side mentioned most often.
Three mentions of right against one of left is a count, not a clarification, and a code built on a count would be the coder's decision rather than the physician's.
Decision 3. Question: how did it happen? Answer: bitten by dog, initial encounter [W54.0XXA]. Documentation: "bitten by neighbor's dog." Rule: external cause codes are reported for the length of treatment when the injury results from an external cause, and the cause code carries the same encounter character as the injury.
Decision 4. Question: where did it happen? Answer: place of occurrence code for a private residence that is not the patient's own [code from the residence category]. Documentation: "inside the neighbor's house." Rule: the place code is reported once, at the initial encounter.
Decision 5. Question: what was he doing? Answer: activity code for carrying a load [code from the activity category]; external cause status code for leisure or other non-work activity [code]. Documentation: "helping carry groceries." Rule: activity and status codes are reported once, at the initial encounter, when the record supports them.
Decision 6. Question: what was done to the wound? Answer: simple repair of a superficial wound of the extremities, length [length] [code from the simple repair range by length]. Documentation: "irrigated, explored, closed with simple interrupted sutures, [length] cm." Rule: repair codes are chosen by type and total length, and irrigation and wound exploration that does not require enlargement or other procedures are included in the repair (American Medical Association, 2025).
Decision 7. Question: what was given? Answer: Tdap vaccine for patients seven years and older [90715], with the first vaccine administration code for an injection [90471]. Documentation: medication administration record. Rule: the vaccine product and its administration are reported separately. Clinical support: a booster is recommended after a dirty wound when more than five years have passed since the last tetanus-containing dose (Havers et al., 2020); the note records more than ten.
Decision 8. Question: is the visit itself reported? Answer: emergency department evaluation and management at the level the documentation supports [code], with the modifier for a significant, separately identifiable service. Documentation: history, examination, decision about tetanus status and antibiotic choice beyond the repair. Rule: when a minor procedure is performed, the evaluation that leads to it is part of the procedure, so a separate visit code needs documented work beyond that evaluation, here the tetanus decision and antibiotic choice.
Why the Log Runs in This Order
The decisions follow the order a coder meets the questions in the record: what happened to the patient, how it happened, what was done and what was given, and finally whether the visit itself is reported. That order mirrors the structure of the code sets. Injury codes come first because they determine which external cause codes apply and carry the encounter character the others must match. Procedure and vaccine codes follow, and the visit code comes last because whether it is separately reportable depends on everything the physician did besides the repair. Ordering the log this way also makes the unresolved entry easy to find. It sits second, right where it blocks the injury code, so a reviewer sees at once which part of the claim is waiting on the query and which parts are ready.
The Drafted Query
To: attending physician. Patient: [identifier]. Date of service: [date].
Clinical indicators: triage note at [time] documents "dog bite, left hand." Physician history, examination and procedure note document "right dorsal hand," "right hand wound" and "laceration repair, right dorsum."
Question: Please clarify the side of the injury in the record. Response options: right hand, left hand, other, unable to determine.
The options are drawn from the record and include other and unable to determine, which published query guidance expects so that a multiple-choice query does not steer the provider (American Health Information Management Association & Association of Clinical Documentation Integrity Specialists, 2022).
What the Case Showed
The report contains eight decisions, and seven are resolved from the record. The eighth, the side, would have been easy to resolve by assumption. The case shows that a complete report is not one in which every code is final, but one in which every code can be retraced to a sentence in the record, and every open question is routed to the person who can answer it.
Limits
The repair code cannot be finalized until the length is confirmed in the final note, and the evaluation and management level depends on the full documentation, which this summary condenses. Payer rules on modifier use and external cause reporting vary, and a real claim would be checked against the payer's policy as well as the guidelines.
References
American Health Information Management Association & Association of Clinical Documentation Integrity Specialists. (2022). Guidelines for achieving a compliant query practice (2022 update). American Health Information Management Association.
American Medical Association. (2025). CPT 2026 professional edition. American Medical Association.
Havers, F. P., Moro, P. L., Hunter, P., Hariri, S., & Bernstein, H. (2020). Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: Updated recommendations of the Advisory Committee on Immunization Practices, United States, 2019. MMWR. Morbidity and Mortality Weekly Report, 69(3), 77-83. https://doi.org/10.15585/mmwr.mm6903a5
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 HS 292 Unit 10 instructions
The final unit commonly asks for a case report that codes one encounter completely and documents the reasoning. Expect about five pages. Instructors look for a neutral case summary, abstracted facts tied to their sources and a decision log in which each code can be retraced to the record and the rule applied. Many sections reward handling unresolved documentation properly, with a query rather than an assumption. External cause, procedure, vaccine and visit codes may all be expected, depending on your section. Codes should be confirmed against the code set year your section names, with placeholders where documentation is incomplete. Citing the guidelines, the procedure code set, query guidance and any clinical recommendation relied on strengthens the report.
Inside the HS292 Unit 10 example
The report opens with a case summary that interprets nothing and an abstraction listing each fact with its source. The decision log follows, with each entry giving the question, answer, documentation and rule. The highlighted sentence explains why three mentions of right do not outweigh one of left. External cause, place, activity and status codes follow, then the repair with irrigation and exploration included, the Tdap vaccine supported by immunization guidance and the visit with its modifier. A section explains the log's order. The drafted query lists indicators from both notes and four options. Closing sections summarize what the case showed and note limits such as the unconfirmed repair length.
HS292 Unit 10 rubric: what earns full points
Practicum case reports are marked on completeness of coding, traceability of each decision, correct handling of unresolved documentation, accuracy of rules applied and organization. Traceability usually carries the largest share, because a report a supervisor cannot retrace is of little use in practice. Completeness rewards covering diagnosis, external cause, procedure, vaccine and visit where the record supports them. Handling the laterality conflict with a compliant query, rather than a guess, earns significant credit. Rules should be cited accurately. A summary that does not interpret, an abstraction tied to sources and a clearly ordered log help the grader. Reports that list final codes without the reasoning behind them usually score below reports that show every step.
HS292 Unit 10 help from the desk
The most frequent error is choosing a side by counting mentions or by assuming the physician is right, instead of querying. Another is omitting external cause codes or reporting place and activity codes at later encounters. Some reports code irrigation or wound exploration separately from a simple repair. Others forget the vaccine administration code or report the visit without documented work beyond the procedure. Summaries that interpret the case before abstraction can bias every later decision. If your section's case is different, perhaps a fall with a fracture or a burn with multiple sites, pass it along, and a decision log can be drafted in which every code traces to the record.
Get an HS292 Unit 10 example written to your instructions
A case report needs the case: the Unit 10 record or packet, identifiers masked; the report format your course expects; and the rubric. Each decision is logged against the documentation it rests on, and any conflict in the record gets a drafted query. It is delivered within 24-48h, and a first custom sample is not billed. 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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HS292 Unit 10 questions, answered
Why query when most of the record says right?
Because conflicting documentation is resolved by the provider, not by the coder counting mentions. The attending's entries usually govern, and the query will very likely confirm right, but the case report is graded on process as much as outcome. A drafted query shows the conflict was noticed and handled the way coding practice expects, and it costs the report nothing if the answer is the obvious one.
Does the case report include the emergency visit level?
Only if your instructions ask for it. Some sections include the evaluation and management level for the professional or facility side, and others keep the case to diagnoses and procedures. The sample stays with diagnoses, external causes, the repair and the immunization, and notes in its scope paragraph that the visit level was outside the assignment.
How does the case report relate to my practicum record?
They are separate documents with separate owners. Time records, attendance sheets, site paperwork and supervisor evaluations belong to the placement and to you, and nothing here is written for them. The case report is the written analysis that sits beside that record, built in the sample on a composite encounter so that no real site or patient appears in it.
Where can I find a free HS292 Unit 10 sample paper?
The complete Unit 10 practicum case report appears on this page, coding a dog bite visit as a log of numbered decisions.
What should a coder do when triage and physician notes disagree on the side?
Query the attending provider. Conflicting documentation between clinicians is resolved by the provider, not by the coder counting mentions or choosing one note.