Home Health ICD-9/ICD-10 Alert

Published on Fri Jan 12, 2007 PDF

Choose 996.52 for non-healing muscle flap.

When is a pressure ulcer no longer a pressure ulcer? When it becomes a surgical wound.

Clinicians are often confused about when a surgical procedure creates a surgical wound, says clinical consultant Judy Adams, RN, BSN, HCS-D, with Charlotte, NC-based LarsonAllen. The first step is to ask what caused the wound, she advises.

Remember: Not every surgical procedure on a pressure ulcer changes it into a surgical wound. When a muscle flap surgically replaces a pressure ulcer, the pressure ulcer disappears and becomes a surgical wound. But when a pressure ulcer is surgically debrided or covered with a skin graft, it remains a pressure ulcer and doesn't become a surgical wound, the Centers for Medicare & Medicaid Services explains in its OASIS Q&As. The skin graft donor site, however, is a surgical wound.

Trap: Mistakes in pressure ulcer coding will be a red flag for intermediaries because of the reimbursement involved, motivating them to comb through your OASIS documents and medical records, experts say. Errors could prove very costly.

Keep in mind that if a muscle flap -- now a surgical wound -- doesn't heal, it becomes a non-healing surgical wound and has a specific code. And if it heals but later breaks down again, it is a new pressure ulcer and is coded as such, explains Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX.

Handy tool: Use this visual aid to help your clinicians get the pressure ulcer riddle correct every time, suggests Selman-Holman.

Source: Lisa Selman-Holman, Selman-Holman & Associates, Denton, TX