OASIS Alert

Published on Thu Sep 27, 2012 PDF

Make sure you're using the correct 30-day count.

As if figuring out which wounds qualify as surgical wounds for M1340 -- Does this patient have a surgical wound? wasn't complicated enough, you'll also need to determine whether or not your patient's wound has become a scar to answer this item correctly. Make sure you're up-to-date on this distinction or risk accuracy and reimbursement.

Once surgical wounds become scars, they are no longer eligible for OASIS-C surgical wound data collection, says Rhonda Will, RN, BS, COS-C, HCS-D, with Northampton, Mass.-based Fazzi Associates. "The good thing is we do have a definition for a scar."

The incision becomes a scar about 30 days after complete reepithelialization with no signs and symptoms of complications, Will says. In other words, after about 30 days of looking "pretty pink," she says.

Take note: Be sure to document the first day the incision becomes "pretty pink," Will says. "Mark it on a calendar and then after 30 days use your clinical judgment to determine if scar status has been achieved," she advises

Mistake: Many clinicians are under the impression that the surgical wound becomes a scar 30 days after wounding, Will says. This isn't so.

You should consider the date of surgery only when you encounter a reepithelialized or "pretty pink" surgical wound and you are attempting to determine whether the wound is a scar or still healing within the first 30 days of reepithelialization, Will advises.

Difficult: Guidance from the Centers for Medicare & Medicaid Services does suggest that clinicians should contact the physician to determine the healing status of surgical wounds, but most physicians are not familiar with the WOCN definitions for healing status, Will says.

"Considering that most of our older surgical patients with multiple comorbidities do not achieve complete reepithelializtion as quickly as younger patients with fewer comorbidities, the clinician must evaluate the circumstances, think about the date of wounding, determine if healing was routine and not complicated and exercise clinical judgment to determine if enough time has elapsed that the patient could possibly be sporting a scar," Will says.

Bottom line: If you can document a scar, you can answer M1340 -- Does this patient have a surgical wound? with response 0 -- No, Will says.