Posts tagged ‘stage 1 pressure ulcers’

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?

September 14, 2010

Always code Stage 3 and 4 pressure ulcers

Here is subject I field many, many questions on: the coding of stage 3 and 4 pressure ulcers.

Question: I recently read that closed pressure ulcers, regardless of stage, should not be coded. Is this true? I thought all Stage 3 & 4 closed pressure ulcers should still be coded.

Lisa says: Stage 3 and 4 pressure ulcers are never considered healed, but they can close. Because there is a strong risk that they will open again, they should be coded in a patient’s episode. If they are open ulcers, they would require much care, so they probably would be listed higher in your coding sequence, but the sequence will always depend on the seriousness of conditions, not just that these are difficult pressure ulcers. If they are closed pressure ulcers, you would probably code them lower, based on the time of care expended vs. the patient’s other needs.

Remember (and never forget) that closed stage 3s and 4s always require active intervention, including assessment and pressure ulcer risk interventions. The tissues lost are replaced by granulation tissue and they are always at risk. Because they should be addressed in the POC, they should be coded.

As for Stage 1 and 2 pressure ulcers: Code them when they are open. When they are closed and evidence of them is gone, they are considered healed, and they should not be coded.

In any case, watch the OASIS: There are nine items that deal with pressure ulcer assessment; be sure to watch all of them.

Looking for references on pressure ulcers? This is the WOCN’s position statement, which is considered official guidance.

July 26, 2010

Pressure ulcer answers!

I always get questions during and after education seminars. Here are a few dealing with one of our favorite home health questions: pressure ulcers

Is a reddened coccyx with a few scabbed areas considered a Stage 2 because of the scabs?

Lisa says:  A Stage 1 has intact skin. The presence of scabs would be considered more than Stage 1; however, it cannot be staged if the wound bed is not visible.

If we have a Stage 3 that is closed and would be a Stage 3 on admit and discharge, do we put zeros for MO1310 1312 and 1314 to reflect that it is closed.

Lisa says: A closed Stage 3 is never fully healed, so will continue to be called a Stage 3 at each time point unless it breaks down and becomes a Stage 4. The correct response to M1310,1312 and 1314 is 000.

If a patient went in hospital for shoulder surgery and was kept in observation and left just shy of 24 hours, would the admission MO1000 be NA ?

Lisa says: This patient would still be marked ‘Hospital’ as M1000 is not related to the criteria for a transfer assessment. The item simply asks from which facility was the patient discharged. (A transfer assessment  is not required.) Note: Before you mark ‘Hospital,’ make sure this patient was not considered outpatient, e.g., had outpatient surgery.