Always code Stage 3 and 4 pressure ulcers

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.

4 Comments to “Always code Stage 3 and 4 pressure ulcers”

  1. This question is related to coding of depressiom. If the Nurse completing the OASIS assess that the patient is depressed during her SOC visit and the patient is on medications for depression, can depression be included as one of the diagnosis without a specific diagnosis from the ordering physician?

  2. Thanks for reconfirming this. I sometimes get people that don’t want me to code it.

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