March 28, 2012
I don’t know why I’ve had people ask me lately if you can reverse pressure ulcer stages for Stage I and II ulcers, but you can’t, and CMS has clarified M1324 in a recent Q&A.
CMS also clarified an M1307 question dealing with a pressure ulcer that progressed from Stage I to Stage II during the episode:
Question: If the patient had a Stage I pressure ulcer at SOC that progressed to a Stage II, how do we answer M1307 at discharge?
CMS Answer: If a patient had a Stage I pressure ulcer at SOC/ROC and it advanced to a Stage II by discharge, Response “1-Was present at the most recent SOC/ROC assessment” would be appropriate due to the fact that the ulcer, caused by pressure, was present at the most recent SOC/ROC assessment, even though it was a Stage I at that time.
Looking for more CMS answers?
October 26, 2010
I’m thinking of creating a pressure ulcer page on the blog … I get so many questions on these wounds! At the end of this post, you’ll see some key words in green … if you want to find all posts that deal with stage II pressure ulcers, click on that link and you will have the archive!
Question: We have a patient being recertified. She has a stage II pressure ulcer and has been coded as such up to now. There is a discussion as to how to appropriately code with the placement of a wound VAC. Some are saying to code 891.1, complicated open wound, to account for the VAC. I’m thinking that I will continue to code the pressure ulcer to the ankle with a code for the stage. There is no documentation of the wound being infected, it’s just slow to heal and is now being treated with the VAC. I didn’t think there was a code we could use to capture the VAC.
Lisa says: You are correct! The wound is still a pressure ulcer, and there is no code for wound VAC. Coding the wound with an 800 code is incorrect and is considered upcoding. The nature of a pressure ulcer is chronic. The 800 codes are used for trauma wounds.
September 21, 2010
Correct documentation, and wording in that documentation, are crucial to correct OASIS and coding. Pressure ulcers have very specific wordings, and using the incorrect phrase with a certain stage ulcer can result in rejection or validation errors as you electronically submit your records.
Let’s say this is your documentation:
M1308: a. Stage II, Number present: 2
M1320: 1- Fully Granulating
There is a note from the nurse that the ulcer is not “not healing,” so 03 on M1320 is ruled out by the agency.
Submitting this will result in a validation error on M1320. Why? Because Stage II pressure ulcers do not granulate. According to WOCN guidelines, if no granulation tissue is present, then the ulcer is not healing. If the RN is, indeed, seeing red beefy tissue (granulation) then the ulcer is likely to be at least a Stage III. OASIS does not allow any answer other than ‘not healing’ on Stage IIs.
Watch the WOCN website (linked on this blog) for definitions and pressure ulcer policy … and make sure to read your OASIS manual well for guidance!
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September 14, 2010
Here is subject I field many, many questions on: the coding of stage 3 and 4 pressure ulcers.
Question: I recently read that closed pressure ulcers, regardless of stage, should not be coded. Is this true? I thought all Stage 3 & 4 closed pressure ulcers should still be coded.
Lisa says: Stage 3 and 4 pressure ulcers are never considered healed, but they can close. Because there is a strong risk that they will open again, they should be coded in a patient’s episode. If they are open ulcers, they would require much care, so they probably would be listed higher in your coding sequence, but the sequence will always depend on the seriousness of conditions, not just that these are difficult pressure ulcers. If they are closed pressure ulcers, you would probably code them lower, based on the time of care expended vs. the patient’s other needs.
Remember (and never forget) that closed stage 3s and 4s always require active intervention, including assessment and pressure ulcer risk interventions. The tissues lost are replaced by granulation tissue and they are always at risk. Because they should be addressed in the POC, they should be coded.
As for Stage 1 and 2 pressure ulcers: Code them when they are open. When they are closed and evidence of them is gone, they are considered healed, and they should not be coded.
In any case, watch the OASIS: There are nine items that deal with pressure ulcer assessment; be sure to watch all of them.
Looking for references on pressure ulcers? This is the WOCN’s position statement, which is considered official guidance.
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.