Archive for February, 2011

February 25, 2011

Long questions with simple answers:

Question: Is a fresh colostomy (4 days post op) considered a surgical wound on the OASIS? If yes, how long can it be considered a surgical wound? Ostomies are not included under surgical wounds, but does that apply to a new colostomy?

Also, when is a surgical wound healing by primary intention considered fully granulated? Approximately 4 weeks (post op)? Once fully granulated, it must do so for 30 days before it can be considered newly epithelialized?

Lisa says: An ostomy is NEVER considered a surgical wound in OASIS.

A surgical wound healing by primary intention can only marked ‘not healing’ or ‘newly epithelialized’  The wound is considered ‘newly epithelialized’ from the moment the skin grows over (epithelialized) until 30 days have passed without complications.

February 16, 2011

Follow this rule on recertification dates

I receive a lot of questions about dates for recertifications … what day range can they be done in, and more … this is straight from the CMS Q&As, which are considered official guidance:

Q1. When is a recertification (follow-up) assessment due for a Medicare/Medicaid skilled care patient?

A1. A Medicare/Medicaid skilled-care adult patient who remains on service into a subsequent episode requires a follow-up comprehensive assessment (including OASIS items) during the last 5 days of each 60-day period (days 56-60, counting from the start of care date) until discharged.

I posted this link a few weeks ago, but I’ll put it here again. It s a terrific document to help guide you through tricky  timing sequences: http://www.cms.hhs.gov/OASIS/Downloads/OASISConsiderationsforPPS.pdf

February 4, 2011

3 reasons why your patient’s pressure ulcer is unstageable

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.