April 24, 2012
CMS recently stated that only wounds and lesions of the integumentary system are recorded in OASIS, not wound or lesions in mucosal membranes.
Those pressure ulcers are reported in the comprehensive assessment and documentation.
Want to see the clarification? Go to the April 2012 link.
January 24, 2011
A new set of OASIS Q&As has been posted through the OCCB website.
M1020, M1022, M1024 do not get any mention, but there are several clarifications regarding wounds, and M1012 gets a nod, as well. Below are some highlights, and the link to the full set of Q&As.
Question 3: For M1012, Inpatient Procedure, can the same relevant procedure be listed twice if the procedure was done on two different dates in the inpatient facility?
Answer 3: Currently, there would be no reason or benefit to listing a procedure more than once.
Question 8: If you have two Stage IV pressure ulcers with intact skin in-between them and a tunnel that connects them underneath the wound surface, do you have one pressure ulcer or two?
Answer 8: If a patient develops two pressure ulcers that are separated by intact skin but have a tunnel which connects the two, they remain two pressure ulcers.
Question 9: When sutures are removed from surgical wounds healing by primary intention, how does it affect the healing status of the wound?
Answer 9: For the purposes of scoring the OASIS item, M1342, Status of the Most Problematic (Observable) Surgical Wound, openings in the skin, adjacent to the incision line, caused by the removal of a staple or suture, are not to be considered part of the surgical wound when determining the status of the surgical wound. The status of these sites would be included in the comprehensive assessment clinical documentation.
When determining the healing status of the incision, follow the WOCN Guidance on OASIS-C Integumentary Items, in addition to other relevant current CMS Q&As. The status of “not healing” would only be selected if the wound, excluding the status of the staple/suture site(s), meets the WOCN descriptors.
Other topics in the Q&As:
- Influenza vaccine
- M1300, risk of pressure ulcers
- Explainer of “performing other ADLs” in M1400, dyspnea
- Impaired decision-making
- M1840 and transferring … and lots more.
Looking for the Q&As?
January 20, 2011
I often get questions about how to code a pressure ulcer that now has a muscle flap. Luckily, the coding guidelines are clear on this point (and many others regarding pressure ulcers) in its Chapter 12 guidelines:
2) Unstageable pressure ulcers
Assignment of code 707.25, Pressure ulcer, unstageable, should be based on the clinical documentation. Code 707.25 is used for pressure ulcers whose stage cannot be clinically determined (e.g., the ulcer is covered by eschar or has been treated with a skin or muscle graft) and pressure ulcers that are documented as deep tissue injury but not documented as due to trauma. This code should not be confused with code 707.20, Pressure ulcer, stage unspecified. Code 707.20 should be assigned when there is no documentation regarding the stage of the pressure ulcer.
As a quick aside: don’t routinely use 707.20. I would only consider using it when there is a pressure ulcer under a cast or other device where the stage cannot be determined and it doesn’t meet the definition of unstageable in the guideline.
You can code aftercare after a flap or skin graft. Remember on OASIS that the pressure ulcer covered with a muscle flap can be classified as a surgical wound in M1340 only. This is where the coding guidelines and the OASIS guidance take a whole different path. After the now-flapped pressure ulcer has been declared a surgical wound, the coding guidelines still consider the muscle flapped pressure ulcer an unstageable pressure ulcer. (Pressure ulcers with skin grafts are still pressure ulcers!)
Consider this scenario:
Your patient has a pressure ulcer on coccyx that was repaired with a muscle flap. Code the aftercare of surgery first: V58.77, then 707.03, 707.25 for the unstageable pressure ulcer on the coccyx.
You have a surgical wound in M1340 and no pressure ulcers in M1306.
January 4, 2011
How do you code a cardiac catheterization with a stent? Aftercare? V55?
A cardiac catheterization is not considered an ostomy, so do not use V55 codes. V55 codes are not used for temporary ostomies. i.e., openings, because V55 deals with permanent placements. Use V58.73 for aftercare of the circulatory surgery. A cardiac catheterization by cut down is considered a surgical wound so mark the surgical wound questions (M1340 and M1342) appropriately for status of healing on the OASIS. A cardiac catheterization by needle puncture is not a surgical wound so make sure to mark M1350 as yes. M1350 deals with a skin lesion or open wound that excludes ostomy or other wounds addressed in the M1300s of OASIS.
The instructions at M1350 state: Ostomies, other than bowel ostomies, (e.g., tracheostomy, thoracostomy, urostomy) ARE considered to be skin lesions or open wounds if clinical interventions (e.g., cleansing, dressing changes) are being provided by the home health agency during the home health care episode.
The other items that would be excluded from M1350: Pressure Ulcers or risk of pressure ulcers (M1300, M1302, M1306, M1307. M1308, M1310, M1312, M1314, M1320, M1322, M1324), stasis ulcers (M1330, M1332, M1334), surgical wounds (M1340, M1342).
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 18, 2010
Here is a pressure ulcer tool I created a while ago, and have now updated with OASIS and coding guidance.
My tool shows you OASIS and coding information broken down by stage (or if it is unstageable) of the pressure ulcer, whether it is closed, if there is a suspected DTI, or if the ulcer is with a skin graft or muscle flap.
The tools gives you OASIS guidance across M1306, M1307, M1308, M1310, M1312, M1314, M1320, M1322, M1324.
It also gives gives you the coding guidance for each situation.
Check out the pressure ulcer tool: pressure ulcersOASIS0610