Posts tagged ‘epithelialized’

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 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.

September 28, 2010

Straight up surgical wound guidance

I get many questions on venous devices and whether they are current surgical wound … Here is CMS’s official guidance.

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.

Looking for the official guidance? Look at CMS’s OASIS Q&A, Category 4b, Q105.3.