Posts tagged ‘WOCN’

May 11, 2012

WOCN library helps walk us through wound issues

WOCN has moved its library to a new web address.

On this page you can find guidance for pressure ulcer staging, avoidable and unavoidable pressure ulcers, management of chronic wounds, guidance on ostomy and continence issues, and much more.

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.

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?

September 21, 2010

Correct pressure ulcer terminology will stop errors in M1320

Correct documentation, and wording in that documentation, are crucial to correct OASIS and coding. Pressure ulcers have very specific wordings, and using the incorrect phrase with a certain stage ulcer can result in rejection or validation errors as you electronically submit your records.

Let’s say this is your documentation:
M1308: a. Stage II, Number present: 2
M1320: 1- Fully Granulating
There is a note from the nurse that the ulcer is not “not healing,” so 03 on M1320 is ruled out by the agency.
Submitting this will result in a validation error on M1320. Why? Because Stage II pressure ulcers do not granulate. According to WOCN guidelines, if no granulation tissue is present, then the ulcer is not healing. If the RN is, indeed, seeing red beefy tissue (granulation) then the ulcer is likely to be at least a Stage III. OASIS does not allow any answer other than ‘not healing’ on Stage IIs.
Watch the WOCN website (linked on this blog) for definitions and pressure ulcer policy … and make sure to read your OASIS manual well for guidance!

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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.