Posts tagged ‘CMS Q&As’

December 1, 2012

If wound margins meet on pressure ulcers, do you have 1 ulcer or 2?

A clarification from CMS regarding M1308:

Question: Upon admission, our patient had 2 distinct pressure ulcers in close proximity. Over the course of the episode the ulcers deteriorate and no longer have any separating tissue. Do we now call this 1 pressure ulcer at the worst stage?
Answer from CMS: If the patient had one pressure ulcer and then later developed another pressure ulcer, and eventually the wound margins met, it would be counted as two ulcers, as long as it remains possible to differentiate one ulcer from another based on wound margins. Depending on the timing and progression, it may be difficult for the clinician to know that a current ulcer was once two ulcers, and/or where one ulcer ends and another begins for assessment/reporting purposes. It would be up the assessing clinician to determine the number of pressure ulcers in situations where multiple ulcers
may have merged together.

More CMS Q&As.

April 24, 2012

Mucosal membranes are not reported in OASIS

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 9, 2010

Place diagnoses in M1010 when treatment goes beyond standard medications

CMS has given guidance on when to list inpatient diagnoses, M1010, and the agency specifically answers the question of whether giving medicines is “active treatment.”

Question:

If a patient is hospitalized (or in a SNF) and is given his/her routine medications BUT some of those medications are for diagnoses that are not the reason for the hospitalization, are the diagnoses for which the routine meds are given considered as being “treated” during the stay. For example: the patient is admitted to the hospital for surgery. While in the hospital, he is given his routine medication for HTN, atrial fib, GERD, etc. Should those dx be listed at M1010?

CMS answer:

When completing M1010, Inpatient Diagnoses, only include the diagnoses actively treated during the inpatient facility stay within the past 14 days, not all the diagnoses the patient may have. “Actively treated” should be defined as receiving something more than the regularly scheduled medications and treatments necessary to maintain or treat an existing condition. In the scenario you provided, Hypertension would not be included in M1010 if the patient only received their maintenance dose of antihypertensive.

Here is the site reference to the April 2010 Q&As.

September 13, 2010

Dialysis shunts are surgical wounds

CMS has been answering questions regarding dialysis shunts and surgical wound rules. In short, the dialysis shunt is a surgical wound, but the 30 day rule does not apply. It is considered a surgical wound as long as it is in place. Read below for the official information:

Question: M1342 Surgical Wound –implanted venous device: I am confused by one of the CMS OASIS Q&As. The answer to Q105.3 states that an implanted venous device is considered a surgical wound until it has been epithelialized completed for 30 days at which time it becomes a scar. The next sentence of the answer says that the site is considered a surgical wound as long as the device is in place. Can you clarify this?

Answer from CMS: An implanted venous access device is considered a current surgical wound as long as it is implanted in the patient’s body.

When first implanted, the incision is the surgical wound. The assessing clinician will follow the 12/09 WOCN guidance to determine the healing status of the incision. Once it is fully epithelialized, the site due to the implanted device will remain a current surgical wound with a status of “Newly epithelialized” for as long as it is present in the patient’s body, unless it later develops complications. This guidance clarifies and supersedes CMS OASIS Q&A Category 4b, Q105.3.

Click here to do some searches on this question and others.