Coding, Classification & Reimbursement

1.  Coding Pressure Ulcers

Posted 4 days ago
Hi all,

If a parient is admitted with a particular stage of a pressure ulcer but then it progresses to a higher stage ...would you code the higher stage or both? Also if a pressure ulcer is healed at the time of discharge,  I was under the impression that no code is assigned. However, I am now reading conflicting information. Thoughts?



2.  RE: Coding Pressure Ulcers

Posted 4 days ago
The topic of a pressure ulcer that progresses to a higher stage is covered in Coding Clinic.  The second part of your question is as well.  If you think of it this way.  You always code conditions that are present on admission that meet the conditions of a Secondary Diagnosis and a PU would always be coded as it does meet those conditions.  This topic is covered in Coding Clinic 2008 Q4 and in the new Official Coding Guidelines.
For EACH SITE,  you code the stage at the time of admission with a POA status Y.  For any stage that progresses to a higher stage, you would also code that stage and POA N, per Official Coding Guidelines, page ~51.  4th Qtr 2016 pg 143 instructs you to assign POA "N" for the code associated with the progression of a pressure ulcer during the hospitalization.  


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Marie Bourque-Namer
Adjunct Faculty MCCS/
Hendricks Regional Health/Harmony HealthCare (Solutions)
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3.  RE: Coding Pressure Ulcers

Posted 4 days ago
​Hello!

In the case of "healed" or "healing" pressure ulcers - If the pressure ulcer is healed at the time of admission, no code is assigned.  "For ulcers that were present on admission but healed at the time of discharge, assign the code for the site and stage of the pressure ulcer at the time of admission."  This is all covered in The Official Guidelines".

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Lawrence Barr
President
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4.  RE: Coding Pressure Ulcers

Posted 4 days ago
Thank you all for your help! I was a little confused based on what the ICD 10 book was informing. But I see now where I misunderstood.

Thanks again!!






5.  RE: Coding Pressure Ulcers

Posted 4 days ago
Dear Damaris,

You code the highest stage at time of discharge. I am not sure what to code if the pressure ulcer is healed at the time of discharge.

Jodi Miller, RHIT, CCS

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Jodi Miller, RHIT, CCS
Outpatient Coder/Abstractor
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6.  RE: Coding Pressure Ulcers

Posted 4 days ago
Hello,
Please take a look at the OCG (Official Coding Guidelines for ICD-10-CM FY 2018) in the category specific area Sect I. C.12.a. under Pressure ulcers -  This should help clear up any conflicting information.

5) Patients admitted with pressure ulcers documented as
healing
Pressure ulcers described as healing should be assigned the
appropriate pressure ulcer stage code based on the
documentation in the medical record. If the documentation does
not provide information about the stage of the healing pressure
ulcer, assign the appropriate code for unspecified stage.
If the documentation is unclear as to whether the patient has a
current (new) pressure ulcer or if the patient is being treated for
a healing pressure ulcer, query the provider.

For ulcers that were present on admission but healed at the time
of discharge, assign the code for the site and stage of the
pressure ulcer at the time of admission.

6) Patient admitted with pressure ulcer evolving into
another stage during the admission
If a patient is admitted to an inpatient hospital with a pressure
ulcer at one stage and it progresses to a higher stage, two
separate codes should be assigned: one code for the site and
stage of the ulcer on admission and a second code for the same
ulcer site and the highest stage reported during the stay.





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Cheryl Bowling,RHIT, CCS, CHC, CC-CDI
Client Compliance Partner
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7.  RE: Coding Pressure Ulcers

Posted 3 days ago
Damaris,

Here's your answers right from the official 2018 ICD-10-CM Guidelines (Pages 51-53):

12. Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99)
a. Pressure ulcer stage codes

5) Patients admitted with pressure ulcers documented as healing
Pressure ulcers described as healing should be assigned the appropriate pressure ulcer stage code based on the documentation in the medical record. If the documentation does not provide information about the stage of the healing pressure ulcer, assign the appropriate code for unspecified stage.
If the documentation is unclear as to whether the patient has a current (new) pressure ulcer or if the patient is being treated for a healing pressure ulcer, query the provider.

For ulcers that were present on admission but healed at the time of discharge, assign the code for the site and stage of the pressure ulcer at the time of admission.

6) Patient admitted with pressure ulcer evolving into another stage during the admission
If a patient is admitted to an inpatient hospital with a pressure ulcer at one stage and it progresses to a higher stage, two separate codes should be assigned: one code for the site and stage of the ulcer on admission and a second code for the same ulcer site and the highest stage reported during the stay.


Hope this clarifies! I just had both on test questions!

Jim

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James Schumer
CCS-P
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