Posts tagged ‘M1324’

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.

March 28, 2012

Don’t reverse those pressure ulcers!

I don’t know why I’ve had people ask me lately if you can reverse pressure ulcer stages for Stage I and II ulcers, but you can’t, and CMS has clarified M1324  in a recent Q&A.

CMS also clarified an M1307 question dealing with a pressure ulcer that progressed from Stage I to Stage II during the episode:

Question: If the patient had a Stage I pressure ulcer at SOC that progressed to a Stage II, how do we answer M1307 at discharge?
CMS Answer: If a patient had a Stage I pressure ulcer at SOC/ROC and it advanced to a Stage II by discharge, Response “1-Was present at the most recent SOC/ROC assessment” would be appropriate due to the fact that the ulcer, caused by pressure, was present at the most recent SOC/ROC assessment, even though it was a Stage I at that time.

Looking for more CMS answers?

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). 
January 4, 2011

V58.73 is the code for cardiac catheterization with a stent

How do you code a cardiac catheterization with a stent? Aftercare? V55?

A cardiac catheterization is not considered an ostomy, so do not use V55 codes. V55 codes are not used for temporary ostomies. i.e., openings, because V55 deals with permanent placements. Use V58.73 for aftercare of the circulatory surgery. A cardiac catheterization by cut down is considered a surgical wound so mark the surgical wound questions (M1340 and M1342) appropriately for status of healing on the OASIS. A cardiac catheterization by needle puncture is not a surgical wound so make sure to mark M1350 as yes. M1350 deals with a skin lesion or open wound that excludes ostomy or other wounds addressed in the M1300s of OASIS.

The instructions at M1350 state: Ostomies, other than bowel ostomies, (e.g., tracheostomy, thoracostomy, urostomy) ARE considered to be skin lesions or open wounds if clinical interventions (e.g., cleansing, dressing changes) are being provided by the home health agency during the home health care episode.

The other items that would be excluded from M1350: Pressure Ulcers or risk of pressure ulcers (M1300, M1302, M1306, M1307. M1308, M1310, M1312, M1314, M1320, M1322, M1324), stasis ulcers (M1330, M1332, M1334), surgical wounds (M1340, M1342).

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?