Home Health & Hospice Week

Retrain clinicians quickly on this important wound clarification. If you don't keep up with new "clarifications," you'll be answering M0488 wrong, and collecting money you'll have to send back. In the latest quarterly set of OASIS questions and answers posted in July on the OASIS Certificate & Competency Board's Web site, the Centers for Medicare & Medicaid Services re-tracted its previous guidance about what a scab means when answering OASIS item M0488 (Status of most problematic [observable] surgical wound). Old way: CMS responded to previous M0488 questions about scabs by reminding clinicians to rely on the Wound, Ostomy and Conti-nence Nurses Society document WOCN Guidance on OASIS Skin and Wound. Using this document's Glossary clarifies that a scab equates to avascular tissue, which equates to necrotic tissue, CMS said. And in a wound healing by primary intention (the typical surgical wound), any amount of "incisional necrosis" is considered "not healing," CMS reasoned. Therefore, the surgical incision with a scab would be defined as "3 - Not Healing" for M0488, CMS said. New way: In its July 15 Q&As, in question 12, CMS says its answer "represents a retraction of previous guidance that indicated a scab was considered avascular or necrotic tissue, and therefore an indicator of a non-healing surgical wound." Now CMS concludes: "A scab is a crust of dried blood and serum and should not be equated to either avascular or necrotic tissue when applying the WOCN guidelines. Therefore while the presence of a scab does indicate that full epithelialization has not occurred in the scabbed area, the presence of a scab does not meet the WOCN criteria for reporting the wound status as 'not healing.'" This new CMS guidance will supersede prior guidance found in CMS OASIS Q&As Category 4, Questions 112.1, 112.2, and 112.3, CMS notes. What this means for you: This change will affect both reimbursement and outcomes, says consultant Judy Adams with Charlotte, NC-based Lar-sonAllen. Good news: This new way of classifying a surgical wound with a scab will decrease adverse events and improve outcomes, Adams expects. "Under the old guidance, many agencies were ending up with 'non-healing' wounds at discharge, when in fact the wound was healing," she says. This made it look like the wound had deteriorated under the agency's care. And when the agency admitted the patient with a early/partially granulating wound after surgery, but discharged the patient with a non-healing wound because of a small scab, this triggered an adverse event, even though the wound actually was improving, she says. Bad news: The presence of a scab used to result in the wound being classified as not healing, which garners more case mix points for the home health resource group and [...]