diff --git a/src/dataServices/dynamoDbBundleService.test.ts b/src/dataServices/dynamoDbBundleService.test.ts
index 87bcd1e..c17d91e 100644
--- a/src/dataServices/dynamoDbBundleService.test.ts
+++ b/src/dataServices/dynamoDbBundleService.test.ts
@@ -8,7 +8,7 @@ import * as AWSMock from 'aws-sdk-mock';
 
 import { QueryInput, TransactWriteItemsInput } from 'aws-sdk/clients/dynamodb';
 import AWS from 'aws-sdk';
-import { BundleResponse, BatchReadWriteRequest } from 'fhir-works-on-aws-interface';
+import { BundleResponse, BatchReadWriteRequest, TypeOperation } from 'fhir-works-on-aws-interface';
 import { DynamoDbBundleService } from './dynamoDbBundleService';
 import { DynamoDBConverter } from './dynamoDb';
 import { timeFromEpochInMsRegExp, utcTimeRegExp, uuidRegExp } from '../../testUtilities/regExpressions';
@@ -450,4 +450,55 @@ describe('atomicallyReadWriteResources', () => {
             await runUpdateTest(true);
         });
     });
+
+    describe('Update as Create Cases', () => {
+        const runTest = async (supportUpdateCreate: boolean, operation: TypeOperation, isLockSuccessful: boolean) => {
+            // READ items (Failure)
+            AWSMock.mock('DynamoDB', 'query', (params: QueryInput, callback: Function) => {
+                callback(null, { Items: [] });
+            });
+
+            const dynamoDb = new AWS.DynamoDB();
+            const bundleService = new DynamoDbBundleService(dynamoDb, supportUpdateCreate);
+
+            const batchRequest: BatchReadWriteRequest = {
+                operation,
+                resourceType: 'Patient',
+                id,
+                resource: `Patient/${id}`,
+            };
+            // @ts-ignore
+            const actualResponse = await bundleService.lockItems([batchRequest]);
+            if (isLockSuccessful) {
+                expect(actualResponse).toStrictEqual({
+                    lockedItems: [],
+                    successfulLock: true,
+                });
+            } else {
+                expect(actualResponse).toStrictEqual({
+                    errorMessage: `Failed to find resources: Patient/${id}`,
+                    errorType: 'USER_ERROR',
+                    lockedItems: [],
+                    successfulLock: false,
+                });
+            }
+        };
+
+        const testCases = [
+            // ['supportUpdateCreate', 'operation', 'isLockSuccessful'],
+            [true, 'create', true],
+            [true, 'update', true],
+            [true, 'read', false],
+            [false, 'create', true],
+            [false, 'update', false],
+            [false, 'read', false],
+        ];
+
+        // eslint-disable-next-line no-restricted-syntax
+        for (const [supportUpdateCreate, operation, isLockSuccessful] of testCases) {
+            test('lock update ', async () => {
+                await runTest(supportUpdateCreate as boolean, operation as TypeOperation, isLockSuccessful as boolean);
+            });
+        }
+    });
 });
diff --git a/src/dataServices/dynamoDbBundleService.ts b/src/dataServices/dynamoDbBundleService.ts
index a7df78e..07d3121 100644
--- a/src/dataServices/dynamoDbBundleService.ts
+++ b/src/dataServices/dynamoDbBundleService.ts
@@ -31,6 +31,8 @@ export class DynamoDbBundleService implements Bundle {
     private readonly ELAPSED_TIME_WARNING_MESSAGE =
         'Transaction time is greater than max allowed code execution time. Please reduce your bundle size by sending fewer Bundle entries.';
 
+    readonly updateCreateSupported: boolean;
+
     private dynamoDbHelper: DynamoDbHelper;
 
     private dynamoDb: DynamoDB;
@@ -40,9 +42,10 @@ export class DynamoDbBundleService implements Bundle {
     private static readonly dynamoDbMaxBatchSize = 25;
 
     // Allow Mocking DDB
-    constructor(dynamoDb: DynamoDB, maxExecutionTimeMs?: number) {
+    constructor(dynamoDb: DynamoDB, supportUpdateCreate: boolean = false, maxExecutionTimeMs?: number) {
         this.dynamoDbHelper = new DynamoDbHelper(dynamoDb);
         this.dynamoDb = dynamoDb;
+        this.updateCreateSupported = supportUpdateCreate;
         this.maxExecutionTimeMs = maxExecutionTimeMs || 26 * 1000;
     }
 
@@ -190,7 +193,11 @@ export class DynamoDbBundleService implements Bundle {
         const idItemsFailedToRead: string[] = [];
         for (let i = 0; i < itemResponses.length; i += 1) {
             const itemResponse = itemResponses[i];
-            if (itemResponse instanceof ResourceNotFoundError) {
+            // allow for update as create scenario
+            if (
+                itemResponse instanceof ResourceNotFoundError &&
+                !(itemsToLock[i].operation === 'update' && this.updateCreateSupported)
+            ) {
                 idItemsFailedToRead.push(`${itemsToLock[i].resourceType}/${itemsToLock[i].id}`);
             }
         }
diff --git a/src/dataServices/dynamoDbDataService.ts b/src/dataServices/dynamoDbDataService.ts
index f595da7..d8ec8f8 100644
--- a/src/dataServices/dynamoDbDataService.ts
+++ b/src/dataServices/dynamoDbDataService.ts
@@ -70,7 +70,7 @@ export class DynamoDbDataService implements Persistence, BulkDataAccess {
 
     constructor(dynamoDb: DynamoDB, supportUpdateCreate: boolean = false) {
         this.dynamoDbHelper = new DynamoDbHelper(dynamoDb);
-        this.transactionService = new DynamoDbBundleService(dynamoDb);
+        this.transactionService = new DynamoDbBundleService(dynamoDb, supportUpdateCreate);
         this.dynamoDb = dynamoDb;
         this.updateCreateSupported = supportUpdateCreate;
     }