Posts tagged ‘pressure ulcer’

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.

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.

November 10, 2011

Comment on chronic wound issues

Public comment is open until Dec. 9 regarding chronic wounds. In the past, CMS has said that plasma products used for wound healing is not a reasonable and necessary treatment for the treatment of chronic non-healing wounds. (NCD 270.3)

CMS is now reconsidering NCD 270.3 to determine whether the policy should change regarding the use of autologous platelet rich gel in patients with chronic non-healing pressure ulcers, venous ulcers, and diabetic foot ulcers.

CMS has defined a chronic wound as one in which the healing process has failed to progress properly and the wound persists for longer than 30 days.

Read the full statement from CMS and make a public comment.

January 24, 2011

OASIS Q&As deal with pressure ulcers and surgical wounds

A new set of OASIS Q&As has been posted through the OCCB website.

M1020, M1022, M1024 do not get any mention, but there are several clarifications regarding wounds, and M1012 gets a nod, as well. Below are some highlights, and the link to the full set of Q&As.

Question 3: For M1012, Inpatient Procedure, can the same relevant procedure be listed twice if the procedure was done on two different dates in the inpatient facility?
Answer 3: Currently, there would be no reason or benefit to listing a procedure more than once.

Question 8: If you have two Stage IV pressure ulcers with intact skin in-between them and a tunnel that connects them underneath the wound surface, do you have one pressure ulcer or two?
Answer 8: If a patient develops two pressure ulcers that are separated by intact skin but have a tunnel which connects the two, they remain two pressure ulcers.

Question 9: When sutures are removed from surgical wounds healing by primary intention, how does it affect the healing status of the wound?
Answer 9: For the purposes of scoring the OASIS item, M1342, Status of the Most Problematic (Observable) Surgical Wound, openings in the skin, adjacent to the incision line, caused by the removal of a staple or suture, are not to be considered part of the surgical wound when determining the status of the surgical wound. The status of these sites would be included in the comprehensive assessment clinical documentation.
When determining the healing status of the incision, follow the WOCN Guidance on OASIS-C Integumentary Items, in addition to other relevant current CMS Q&As. The status of “not healing” would only be selected if the wound, excluding the status of the staple/suture site(s), meets the WOCN descriptors.

Other topics in the Q&As:

  • Influenza vaccine
  • M1300, risk of pressure ulcers
  • Explainer of “performing other ADLs” in M1400, dyspnea
  • UTIs
  • Impaired decision-making
  • M1840 and transferring … and lots more.

Looking for the Q&As?

October 29, 2010

V53.99 is not a wound VAC code

A treat today … no tricks. Another clarification on wound VAC coding …

I’ve posted several pressure ulcer/wound VAC answers lately (look in the archives of this blog, or click on the keywords at the bottom of this post!) Here’s another one that I hope gets us to better coding:

Question: May we use the aftercare code of V53.99 to capture the use of the VAC?
Lisa says: V53.99 is fitting and adjustment of other device and is very non-specific. There is no specific code for wound VACs. Also consider that most wounds that require a wound VAC are complicated wounds, so what does that mean about using a V code?

You DON’T use V codes for complicated codes.

The wound VAC is simply a wound dressing, so IF a V code is appropriate, use V58.30 or V58.31. If the wound is complicated, then just code the wound. I do not recommend the use of V53.99 for wound vacs.