Posts tagged ‘pressure ulcers’

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.

April 6, 2012

CMS finally has some OASIS-C training

CMS has posted its first OASIS C training module, which addresses medication items.

The agency says more sessions should come online soon, including: care planning and interventions; neuro/emotional/behavioral status items; and integumentary/pressure ulcer items.

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). 
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.

January 20, 2011

Coding guidelines direct you on unstageable pressure ulcer coding

I often get questions about how to code a pressure ulcer that now has a muscle flap. Luckily, the coding guidelines are clear on this point (and many others regarding pressure ulcers) in its Chapter 12 guidelines:

2) Unstageable pressure ulcers
Assignment of code 707.25, Pressure ulcer, unstageable, should be based on the clinical documentation. Code 707.25 is used for pressure ulcers whose stage cannot be clinically determined (e.g., the ulcer is covered by eschar or has been treated with a skin or muscle graft) and pressure ulcers that are documented as deep tissue injury but not documented as due to trauma. This code should not be confused with code 707.20, Pressure ulcer, stage unspecified. Code 707.20 should be assigned when there is no documentation regarding the stage of the pressure ulcer.

As a quick aside: don’t routinely use 707.20. I would only consider using it when there is a pressure ulcer under a cast or other device where the stage cannot be determined and it doesn’t meet the definition of unstageable in the guideline.

You can code aftercare after a flap or skin graft. Remember on OASIS that the pressure ulcer covered with a muscle flap can be classified as a surgical wound in M1340 only. This is where the coding guidelines and the OASIS guidance take a whole different path. After the now-flapped pressure ulcer has been declared a surgical wound, the coding guidelines still consider the muscle flapped pressure ulcer an unstageable pressure ulcer. (Pressure ulcers with skin grafts are still pressure ulcers!)

Consider this scenario:

Your patient has a pressure ulcer on coccyx that was repaired with a muscle flap. Code the aftercare of surgery first: V58.77, then 707.03, 707.25 for the unstageable pressure ulcer on the coccyx.
You have a surgical wound in M1340 and no pressure ulcers in M1306.