OASIS Alert

Published on Sat Jan 23, 2010 PDF

Stage II pressure ulcers may heal, but for Stage III and Stage IV it's another story.

Don't miss: Stage II pressure ulcers that completely epithelialize are considered healed and are not referenced in either column in this item.

However, you will always report your patient's Stage III and Stage IV pressure ulcers -- even when they have closed, says Lisa Selman-Holman, JD, BSN, RN, HCSD, COS-C, consultant and principal of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas.

Stage III and Stage IV pressure ulcers are still counted as pressure ulcers because they have a high likelihood of breaking down again, says Judy Adams, RN, BSN, HCS-D, COS-C, president and CEO of Adams Home Care Consulting in Chapel Hill, N.C.

This is because these full thickness ulcers can be considered closed once they are fully granulated, but they will never fully heal. Continue to report these closed ulcers at their worst stage, unless they deteriorate, or are replaced by an advancement or muscle flap.

Never forget that closed Stage III and Stage IV pressure ulcers always require active intervention, including assessment and pressure ulcer risk interventions, Selman- Holman says. The tissues lost are replaced by granulation tissue, they are always at risk of breakdown and they should be addressed in the plan of care, she says.

Stage III or Stage IV pressure ulcers that were closed but reopen should be reported at their worst stage. But a pressure ulcer of any stage that is replaced by an advancement or muscle flap should no longer be marked as a pressure ulcer. After one of these surgical procedures, the ulcer is considered a surgical wound by OASIS guidelines. This is a point where OASIS guidance and diagnosis coding guidelines part, Selman-Holman says. Coding guidelines state that a pressure ulcer covered with a muscle graft is an unstageable pressure ulcer and would be coded by site and followed with 707.25 (Pressure ulcer, unstageable).

Tip: M1380 includes the term "non-epithelialized," but you will actually report both epithilialized and nonepithelialized Stage III and Stage IV pressure ulcers when completing this item.

Column 1 asks you to record the current number of unhealed Stage 2, Stage 3, Stage 4, and unstageable pressure ulcers -- in other words, list the number of pressure ulcers present today. Complete this column at start of care (SOC), resumption of care (ROC), followup (FU), and discharge (DC). At FU (RFA 6 - Recertification or RFA 5 " Other Followup) or DC, if a pressure ulcer was reported in column 1, you'll also complete column 2. Column 2 asks you to indicate the number of pressure ulcers listed in Column 1 that were present at the most recent SOC or ROC even if the stage has changed.

Hint: The number of pressure ulcers in Column 2 should never be greater than the number listed in Column 1.

Example: Your patient had a Stage III pressure ulcer on admission that has been assessed as a Stage IV at Recert. At SOC, you would report one Stage III pressure ulcer in Column 1, row b. Column 2 would be left blank. At Recert, you would report one Stage IV pressure ulcer in Column 1, row c. And one Stage IV pressure ulcer in Column 2, row c.