| Course | HCR 201 Medical Billing and Coding (HCR/201) |
|---|---|
| Week | 2 |
| Paper type | Diagnosis coding exercise |
| Length | about 863 words, 3 double-spaced pages plus title page and references |
| Format | APA 7 student paper |
| School | University of Phoenix |
| Program | BS in Health Administration |
| Updated | September 2026 |
Free sample paper for HCR 201 Week 2
Five Family Medicine Visits, Coded With ICD-10-CM: Combination Codes, Symptoms Instead of Suspicions, External Causes and the Guideline Behind Each Choice
[Student Name]
University of Phoenix
HCR/201: Medical Billing and Coding
Week 2 Assignment
[Instructor Name]
[Date]
The patients and visit notes are composites written for a model coding exercise; codes and guidelines come from the FY 2026 code set and official guidelines listed.
How an ICD-10-CM Code Is Built
ICD-10-CM codes have three to seven characters. The first three form the category, such as E11 for type 2 diabetes; characters after the decimal add detail about cause, site, severity or complication. Injury codes often require a seventh character for the encounter type, with the letter X as a placeholder when earlier positions are empty. The official guidelines direct coders to locate a term in the Alphabetic Index and then verify it in the Tabular List, where instructional notes can change the answer (National Center for Health Statistics, 2025).
Case One: Diabetes and Kidney Disease Follow-Up
Documentation: 64-year-old man seen for diabetes follow-up. Type 2 diabetes; chronic kidney disease stage 3a, due to diabetes. Hypertension, controlled. Uses insulin daily.
Codes: E11.22, I12.9, N18.31, Z79.4.
Reasoning: The index entry for diabetes, type 2, with chronic kidney disease leads to E11.22, a combination code. Under that code, a tabular note asks for a second code naming how advanced the kidney disease is, here N18.31. Hypertension and chronic kidney disease are also treated as related unless the physician says otherwise, so hypertension with kidney disease is coded I12.9 rather than I10 unless the physician states the conditions are unrelated. Z79.4 reports long-term insulin use. E11.22 is listed first because diabetes was the reason for the visit, and the stage code follows the codes it describes.
Case Two: Sore Throat With a Positive Test
Documentation: 9-year-old girl with sore throat and fever for two days. Rapid strep test positive. Diagnosis: streptococcal pharyngitis.
Code: J02.0.
Reasoning: The confirmed diagnosis replaces the symptoms; fever and sore throat are integral to strep throat and are not coded separately. Had the test been negative and the physician documented acute pharyngitis without a cause, the code would be J02.9.
Case Three: Cough and Suspected Pneumonia
Documentation: 45-year-old woman with cough for four days and fever of 101.6. Suspected pneumonia; chest X-ray ordered.
Codes: R05.1, R50.9.
Reasoning: In outpatient settings, diagnoses documented as suspected, probable or rule out are not coded; the coder reports the documented signs and symptoms to the highest degree of certainty. Acute cough and fever are coded. If the X-ray confirms pneumonia at a later visit, pneumonia will be coded then. Coding the suspicion would put a diagnosis in her record that no test has confirmed.
Case Four: A Fall on Icy Steps
Documentation: 71-year-old woman slipped on icy front steps of her house while walking to get the mail. Closed Colles fracture of the right wrist, first visit for this injury.
Codes: S52.531A, W00.1XXA, Y92.018, Y93.01.
Reasoning: S52.531A reports a Colles fracture of the right radius, initial encounter for closed fracture; the seventh character A marks active treatment. External cause codes describe how, where and during what activity the injury occurred: a fall from stairs and steps due to ice and snow, at another place in a single-family house and while walking. The placeholder X characters in W00.1XXA fill positions five and six so the seventh character sits in the right place.
Case Five: An Annual Physical With a New Finding
Documentation: 52-year-old man for annual examination. Fasting glucose 112, A1c 6.1%. Assessment: prediabetes, counseled on diet and exercise. Influenza vaccine given.
Codes: Z00.01, R73.03, Z23.
Reasoning: Because the examination found an abnormal result, the encounter code is Z00.01, examination with abnormal findings, rather than Z00.00. Prediabetes is coded as the finding, and Z23 reports the immunization encounter.
Why the Code Set Is Required
Physician practices do not choose their diagnosis code set. Under the rule that adopted it for HIPAA transactions (U.S. Department of Health and Human Services, 2009), ICD-10-CM became the required standard for reporting diagnoses on claims from October 2015, replacing ICD-9-CM, whose codes had run out of room for new conditions and lacked detail such as laterality. The greater specificity is why a coder must now say which wrist was broken and whether this is the first visit for it.
Common Errors
The practice's coding audit last quarter found the same errors that appear in these cases: coding hypertension as I10 when kidney disease was present, coding suspected diagnoses, omitting the kidney disease stage and leaving off the seventh character on injury codes, which causes an automatic rejection.
Why Accuracy Matters Beyond Payment
Diagnosis codes are used for research, quality measurement and public health. O'Malley et al. (2005) reviewed the sources of error in ICD coding, from the patient's description of symptoms to the physician's documentation to the coder's choice, and warned that errors at each step reduce the accuracy of data used for policy and research. A coder is the last step where some of those errors can be caught.
Conclusion
The five visits show the core skills of diagnostic coding: building codes to full specificity, using combination codes and presumed relationships, coding symptoms rather than suspicions in outpatient care, completing injury codes with seventh characters and external causes and choosing the right encounter code. Each choice rests on a guideline, and each code must be verified in the tabular list before it reaches a claim.
References
National Center for Health Statistics. (2025). ICD-10-CM official guidelines for coding and reporting FY 2026. https://www.cms.gov/files/document/fy-2026-icd-10-cm-coding-guidelines.pdf
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(5, Pt. 2), 1620-1639. https://doi.org/10.1111/j.1475-6773.2005.00444.x
U.S. Department of Health and Human Services. (2009). HIPAA administrative simplification: Modifications to medical data code set standards to adopt ICD-10-CM and ICD-10-PCS. Federal Register, 74, 3328. https://www.federalregister.gov/d/E9-743
What the HCR 201 Week 2 instructions ask
HCR 201 Week 2 typically introduces diagnostic coding with ICD-10-CM. Students may be asked to explain the structure of diagnosis codes, the Alphabetic Index and Tabular List, coding conventions such as includes and excludes notes and combination codes and the official guidelines for outpatient coding. Many sections include coding scenarios or a worksheet in which students assign codes to documentation and explain their choices. Some versions ask how diagnosis codes support medical necessity on claims. Strong answers look up every code in the index and verify it in the tabular list, apply the outpatient rule on uncertain diagnoses, use combination and seventh-character codes correctly and cite the guideline behind each decision.
How this HCR 201 Week 2 example is built
The exercise begins with how an ICD-10-CM code is built, from category to seventh character, and the rule that no code is assigned from the index alone. Five visits follow, each in the same format: a documentation excerpt, the codes assigned, the lookup path and the guideline that decided the choice. The diabetes visit shows the presumed link for diabetes and kidney disease and the separate presumption for hypertension. The strep visit shows how a test result changes the code. The pneumonia visit shows why suspected diagnoses are not coded in outpatient care. The fall shows injury and external cause codes. The physical shows how an abnormal finding changes the encounter code.
HCR 201 Week 2 grading rubric: where the points go
The diagnosis coding week is usually graded on accuracy and on the reasoning behind each code. Instructors check that codes are complete to the highest level of specificity, that combination codes and seventh characters are used correctly, that the outpatient rule for uncertain diagnoses is followed and that sequencing reflects the reason for the visit. Points go to explaining the lookup path and citing the official guideline, not only listing codes. Where the prompt asks, connecting diagnosis codes to medical necessity on claims earns credit. Clear presentation and APA citation of the code set and guidelines complete the grade. Answers that list codes without explanation, or that code suspected conditions as confirmed, lose points.
HCR 201 Week 2 help: mistakes to avoid
The most frequent error in HCR 201 Week 2 is coding from the Alphabetic Index without checking the Tabular List, which misses notes, extra characters and excludes rules. Always verify. Another is coding suspected, probable or rule-out diagnoses in outpatient visits; code the symptoms instead. Students also miss combination codes, such as diabetes with kidney disease, and the separate code for the stage of kidney disease. Remember seventh characters for injuries and placeholder X characters. Sequence the reason for the visit first. Add external cause codes for injuries when your setting reports them. Finally, explain your reasoning for each code, since the reasoning is what the exercise tests.
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- HCR 201 Week 4: Procedure Coding With HCPCS
- HCR 201 Week 5: Codes in the Billing Cycle
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HCR 201 Week 2 questions, answered
What does HCR/201 Week 2 usually ask for?
Many sections introduce ICD-10-CM diagnosis coding, asking students to explain code structure, index and tabular list use and guidelines, and to code short scenarios with explanations.
Where can I find a free HCR 201 Week 2 sample paper?
All five coded visits, with lookup paths and guidelines, appear on this page free to read, plus margin notes on each decision. We can code a first worksheet of your own scenarios at no charge.
Can you code a suspected diagnosis in an outpatient visit?
No. Outpatient guidelines say not to code diagnoses documented as probable, suspected, questionable or rule out; code the signs, symptoms or findings instead.
What is a combination code in ICD-10-CM?
A single code that classifies two diagnoses, a diagnosis with a complication or a diagnosis with a manifestation, such as E11.22, which captures type 2 diabetes and the kidney disease it caused in one code.
What does the seventh character mean in injury codes?
It identifies the encounter type, such as A for initial encounter, D for subsequent encounter and S for sequela, and placeholder X characters fill empty positions before it.
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