Posts tagged ‘ostomies’

January 5, 2011

Is debridement a surgical wound?

Question: If my patient had a debridement, can I mark 1 (Yes, patient has at least one (observable) surgical wound) in M1340?

Lisa says: No, debridement is not a surgical treatment, and CMS clearly states this in its M1340 specific instructions: Debridement or the placement of a skin graft does not create a surgical wound, as these are treatments performed to an existing wound. The wound would continue to be defined as the type of wound previously identified.

However, debridement is a place where OASIS and coding may not always match up. For example, you can code V58.77, Aftercare of surgery of the skin and subcutaneous tissue, NEC, in some cases. For example, for a patient with a debrided diabetic ulcer of the elbow, you can code V58.77 in M1020, and then code 250.80, 707.1x in M1024. The V58.77 code as primary indicates that the focus of care is a wound that is resolving without complications and considering the complexity and chronicity of diabetic ulcers, the V58.77 code is likely not the best choice.

IF V58.77 is used, remember that as a Diabetes case-mix diagnosis, 250.80 and 707.1x can go in both M1024 and M1022, if active. This is still active, of course, so code in M1022.

Just because M1340 isn’t applicable doesn’t mean that you should forget your OASIS … M1350 includes any wounds or skin lesions OTHER than the pressure ulcers, stasis ulcers, surgical wounds already addressed, and bowel ostomies, which are also addressed in another item. The answer ‘yes’ on M1350 means that the skin lesion or wound requires intervention and assessment.
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).

August 13, 2010

M0090, M1350, and M2004 questions answered

Here are answers to three recent questions that I have fielded on OASIS:

For M0090, we’ve heard that is the date that we  (RNs) complete the OASIS assessment, including getting frequency from PT, OT, ST, and response from MD if any abnormalities with meds are found … this occurs all in a five-day window. Others are teaching to put the M0o90 date as the date we (RNs) complete the assessments without info from others. How do we fill this item?

Lisa says: The assessing clinician has six days to complete the SOC assessment.  (Assessment is day zero + five days.) This time period includes collaboration with other clinicians, i.e., M2200, and waiting for the physician’s response for M2250. M0090 is the date the assessment is completed, and it is not complete until that info has been received.

If you address a wound under Wound 1 in M1350, do you answer as a ‘yes’? Or does this question only apply to the previous questions about ulcers. If you have a PICC line that you address later in the SOC, do you answer M1350 as ‘yes’?

Lisa says: M1350 includes any wounds or skin lesions OTHER than the pressure ulcers, stasis ulcers, surgical wounds already addressed, and bowel ostomies, which are also addressed in another item. The answer ‘yes’ on M1350 means that the skin lesion or wound requires intervention and assessment. PICC lines that require intervention ARE included.

Let’s say that the SOC and DC OASIS are all that were completed when answering M2004. You answered it as ‘no’ on the SOC because you did not receive a response from the MD in 24 hours, you have addressed all issues, and no new issues have appeared. Do you answer this as ‘NA’ or ‘no’ if the MD did not respond in the 24 hours from the SOC OASIS?
Lisa says: If the physician does not respond within one calendar day (which can be longer than 24 hours, given the way CMS has defined it) the answer has to be ‘no’ on M2004. If there were no issues identified, then ‘NA’ would be the correct answer. Keep alert to news on this, as some recent CMS guidance could muddy this answer.

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