Wiki Pressure ulcer stage diagnosis

[hildapgarciav]

**Posted on another thread, but trying to get as much input as possible**

We are being told by our medical providers that a pressure ulcer will always be reported at it's initial severity for the duration of the wound, even if consistent care is being performed and wound is healing to a lesser stage. We believe per coding guidelines that the wound staging should be updated according to its current stage at the time of the encounter.

EX 01/01/20xx Pt presents with stage 4 sacral pressure ulcer

After continuous treatment, on 03/01/20xx wound now presents as a stage 2 sacral pressure ulcer.

Providers believe that as of 03/01/20xx they should still code it as stage 4, that the wound will always be a stage 4 ulcer until it fully heals, or worsens.
we as coders believe that at this point in time, for DOS 03/01/20xx it should be coded as stage 2.

What are your thoughts on this scenario? Any guidance on how we can bridge this knowledge gap with our providers and overcome the pushback that we get on this subject? Unless we are in the wrong, I would love to understand more.

Please see attached the guidelines we have found.

Thanks a million!

 

[LisaAlonso23]

Please refer to the ICD-10 guidelines.

 

[thomas7331]

I think I responded to your previous post, but it sounds like there is some misunderstanding going on here between coders and providers, so I'll add to what I posted before.

It's important to keep in mind that assignment of a diagnosis and assignment of code are two different things - this needs to be clear in the minds of both coders and physicians. Coders aren't qualified to tell a provider how to diagnose or stage an ulcer and should not be telling the provider how they should or should not do this. Coder may only instruct on how to correctly assign the code based on what the provider has diagnosed. It's entirely up to the provider to determine the stage of the pressure ulcer and document that in the record of the encounter. Once documented, then the code is assigned to accurately report what was documented. There's no cross-over of duties here and this should be quite cut and dry: 1) a coder can't tell a provider what they should or shouldn't document as the correct stage; but 2) the code must reflect what the provider documented at that encounter and nothing else. So if at a given encounter the provider documents the stage of the wound to be what the initial stage was, then that's the code that has to be assigned. If the provider documents the stage of the wound to be a different stage based on where it is in the healing process, then that's the stage that has to be reflected in the code.

I'd just add too that the guidelines you've attached can be confusing because when they're talking about coding for an ulcer that has changed stage, it's in reference to a wound that changes stage during an encounter (in this case they're likely speaking about an extended inpatient stay where the ulcer stage might change over the course of a single encounter). But if you're coding for outpatient/office encounters, you're only coding based on the current encounter and not referencing documentation from previous encounters for purposes of code assignment.

Hope maybe this helps to clarify your situation.