February 4, 2011
Question: I have a patient with an old Stage 4 pressure ulcer on the buttock. The patient is coming from a nursing home, and the ulcer is “pretty much healed” down to a pin point. Now the patient is in home health. The nurse wants to call it an unstageable ulcer on the OASIS, and I said “once a stage 4 always a stage 4″ – at least for coding purposes?
Lisa says: There are three situations that make a pressure ulcer unstageable–1) eschar and slough, 2) dressing or device that cannot be removed, 3) deep tissue injury. A closing Stage 4 pressure ulcer should be marked as a fully granulating Stage 4. Once it is closed, it is marked as a newly epithelialized Stage 4 and will continue to be marked that way unless the pressure ulcer breaks down again. The pressure ulcer is coded as a Stage 4.
July 22, 2010
I’ll have some thoughts on these answers later, but just wanted everyone to know that CMS has released its quarterly Q&As to clarify OASIS issues.
Here are some highlights:
- Pressure ulcers (M1306, M1308, M1310, M1312, M1314, M1320, M1324): responses on sutured and grafted ulcers, as well as responding for resolved suspected DTI
- Measuring the depth of ulcers
- M1510 heart failure followup issues
- Other issues dealing with M102, M104, M1012
See the responses here.
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June 14, 2010
I receive a lot of questions on pressure ulcers, especially with all of the new OASIS specificity. One of the most common questions deals with eschar covering the wound.
This type of question has a common theme: If the wound is covered in soft/brown eschar on assessment (it had been documented as a Stage III ulcer), should it be coded as unstageable? And what about M1314, the pressure ulcer depth?
My answer is that a pressure ulcer with eschar can’t have depth; it’s 0 (zero) because it is covered. You can still measure the length and width, so M1310 and M1312 are straightforward.
Your healing status for M1320 is 3-Not Healing.
The answer to this question is NOT NA- No Observable Pressure Ulcer
Remember WOCN guidance on answering M1320 3 – Not healing:
o wound with ≥25% avascular tissue (eschar and/or slough) OR
o signs/symptoms of infection OR
o clean but non-granulating wound bed OR
o closed/hyperkeratotic wound edges OR
o persistent failure to improve despite appropriate comprehensive wound management
As for M1324, the answer is NA because the pressure ulcer cannot be staged because the wound bed is not visible.
Looking for the full WOCN guidance? We have it here.