Posts tagged ‘M1308’

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.

November 23, 2011

M1308, the question that keeps on giving …

Several questions in CMS’s 3rd quarter Q&As deal with pressure ulcers and M1308.

The highlights (in my words, not CMS’s!):

  • Should a muscle flap be reported in M1308 as a current pressure ulcer? No. It is a surgical wound (as are skin advancement flap, or rotational flap)
  • If the pressure ulcer has a skin graft, how is it treated? Not as a surgical wound but as unstageable until it heals, then Stage III or IV.
  • How do you report a Stage III that is closing to the point of a pinpoint? As a Stage III …

Find CMS’s full answers here.

July 16, 2011

Read on … this patient has something for everyone

Question:  This gentleman has six pressure ulcers total, 2 of which are unstageable and 4 of which are a stage 4.  I have coded each pressure ulcer by location and stage already and the primary diagnosis as aftercare following surgery because he had surgical debridement of these while in the hospital prior to admission onto services. I feel that is correct, but you may think differently.
He was diagnosed with severe osteo while in the hospital and also had debridement of the bone as well as the wounds. He is on po levaquin now in the home and was discharged with dx of osteo, so I am assuming that the surgical debridement and IV antibiotics while in the hospital did not rectify it all.  So, I am not sure how to add the dx it into the sequence of the pressure ulcers, maybe secondary, but not quite sure on that.

educating and providing care to this as well.  So, I know that I need to add “colostomy status (v44.3)” and “attn to colostomy, (v55.3)” in the sequence. Our primary focus in the home of course is the wounds, but the colostomy is very important as well, so do I sequence it under the wounds? The wounds just take up so much in the coding scenario that I do not want the colostomy to get missed or I put it too far down in the “line up”.

I am still unclear how to code for supplies on this and we will be providing to him his colostomy supplies.

He is a paraplegic (344.1), so of course I will code that and he also was diagnosed sarcodosis (136.5?) leukocytosis (288.60) and malnutrition (236.9?).

Lisa says: Because you have several stage 4s code the locations and then add the 707.24 for stage 4. I would then code the paraplegia. The V code for attention to colostomy can be used as the 6th diagnosis if you feel strongly that it needs to be coded in the top six. NEVER code the status and attention to codes for the same ostomy at the same time. 
Add the other codes in any order keeping in mind that the other two ulcers are coded as unstageable. 
I would not code aftercare in this situation at all. You are not really providing aftercare. 
Other general reminders: the same code cannot be used more than once so there is no way to code two ulcers at the same site nor is there any way to code bilateral ulcers. 
Non routine supply points in this case are obtained from how M1630 (bowel ostomy), M1308 and M1324 (pressure ulcers) are answered, not on the codes. This scenario is getting a LOT of NRS points so ensure that the appropriate revenue codes and charges are added to your final bill and your HIPPS code ends in a letter (provided supplies). 
October 3, 2010

New code year … new chance for education!

As we start our new code year, we’re always scrambling for education on codes, but what about other subjects, like PPS fundamentals or OASIS best practices or coding and filling out OASIS information on those pressure ulcers?

It’s time for new education in the new year, and I’m offering these in the month of October, in addition to my live education around the country.

PPS Fundamentals, Monday, October 11
Understand the fundamentals of PPS that are essential to agency operations for administrators, quality personnel and coders. This includes information on:

  • How the HHRG is obtained.
  • Explain the case mix variable table.
  • Identifying how to bill non-routine supplies.
  • Explaining the role of diagnosis coding and OASIS answers to the financial health of a home health agency.

12pm -1:45pm CST

OASIS C Best Practices, Monday, October 18
What is a “best practice”? And what does it mean to your agency? The first quality reports have been released from OASIS C. How did CMS derive the information and how can your agency do better next time? In this education, we will:

  • Define best practice.
  • Discuss best practices involved in pain assessment, falls risk, depression screening and others.
  • Identify the correct method for answering OASIS data items regarding best practices.

12pm -1:45pm CST

Pressure ulcers, coding and OASIS-C, Monday, October 25
Coding pressure ulcers and responding to OASIS data items regarding pressure ulcers are some of the most difficult areas of home health practice. Lisa will lead your staff through the latest guidance on answering OASIS-C regarding pressure ulcers and contrast that with coding guidance. Lisa will:

  • Describe how to answer OASIS and code for pressure ulcers with skin grafts.
  • Describe how to answer OASIS and code for pressure ulcers with muscle flaps.
  • Describe how to answer OASIS and code for pressure ulcers that “heal.”

12pm -1:45pm CST

Want more information?