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.
October 3, 2010
As we start our new code year, we’re always scrambling for education on codes, but what about other subjects, like PPS fundamentals or OASIS best practices or coding and filling out OASIS information on those pressure ulcers?
It’s time for new education in the new year, and I’m offering these in the month of October, in addition to my live education around the country.
PPS Fundamentals, Monday, October 11
Understand the fundamentals of PPS that are essential to agency operations for administrators, quality personnel and coders. This includes information on:
- How the HHRG is obtained.
- Explain the case mix variable table.
- Identifying how to bill non-routine supplies.
- Explaining the role of diagnosis coding and OASIS answers to the financial health of a home health agency.
12pm -1:45pm CST
OASIS C Best Practices, Monday, October 18
What is a “best practice”? And what does it mean to your agency? The first quality reports have been released from OASIS C. How did CMS derive the information and how can your agency do better next time? In this education, we will:
- Define best practice.
- Discuss best practices involved in pain assessment, falls risk, depression screening and others.
- Identify the correct method for answering OASIS data items regarding best practices.
12pm -1:45pm CST
Pressure ulcers, coding and OASIS-C, Monday, October 25
Coding pressure ulcers and responding to OASIS data items regarding pressure ulcers are some of the most difficult areas of home health practice. Lisa will lead your staff through the latest guidance on answering OASIS-C regarding pressure ulcers and contrast that with coding guidance. Lisa will:
- Describe how to answer OASIS and code for pressure ulcers with skin grafts.
- Describe how to answer OASIS and code for pressure ulcers with muscle flaps.
- Describe how to answer OASIS and code for pressure ulcers that “heal.”
12pm -1:45pm CST
Want more information?
July 26, 2010
I always get questions during and after education seminars. Here are a few dealing with one of our favorite home health questions: pressure ulcers
Is a reddened coccyx with a few scabbed areas considered a Stage 2 because of the scabs?
Lisa says: A Stage 1 has intact skin. The presence of scabs would be considered more than Stage 1; however, it cannot be staged if the wound bed is not visible.
If we have a Stage 3 that is closed and would be a Stage 3 on admit and discharge, do we put zeros for MO1310 1312 and 1314 to reflect that it is closed.
Lisa says: A closed Stage 3 is never fully healed, so will continue to be called a Stage 3 at each time point unless it breaks down and becomes a Stage 4. The correct response to M1310,1312 and 1314 is 000.
If a patient went in hospital for shoulder surgery and was kept in observation and left just shy of 24 hours, would the admission MO1000 be NA ?
Lisa says: This patient would still be marked ‘Hospital’ as M1000 is not related to the criteria for a transfer assessment. The item simply asks from which facility was the patient discharged. (A transfer assessment is not required.) Note: Before you mark ‘Hospital,’ make sure this patient was not considered outpatient, e.g., had outpatient surgery.
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
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.