Coding, Classification & Reimbursement

1.  Pressure ulcer stage stage

Posted 10 days ago
​Hi Everyone,

Can you guys please give me your opinion on the latest coding clinic 4th Q 2017 about unstageable pressure ulcer. So, according to the latest coding clinic if the pt. comes in with an unstageable pressure ulcer and the eschar is removed to reveal the true stage of the ulcer(e.g.. 3). In that case, stage 3 pressure ulcer is coded to POA-Y, I understand that.

What is the pt. comes in with an unstageable pressure ulcer and the stage was revealed as stage 3 after the eschar was removed; but a week or two later they're documenting stage 4, wouldn't it go back to the older coding clinic as stage 3-POA-Y and stage 4, POA-N. Or would you assume that it's the same stage that they couldn't tell the exact stage after the eschar was removed and the stage 4 would be still POA-Y, since the unstageable pressure ulcer coding clinic states that "assign the code for the ulcer site with the highest stage reported during the stay with a POA indicator of "Y". I'm thinking in a case like this I would query the physician to ask if the stage 4 was POA or not, agree?

Please let me know your thoughts
Thanks,
Magdala


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Magdala Andre
Coding Educator
Capital Health System
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2.  RE: Pressure ulcer stage stage

Posted 9 days ago
​I would code as stage 3 POA Y and the stage 4 POA N.

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Chrystel Barron
Coding Education Instructor
Cleveland Clinic Health System
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3.  RE: Pressure ulcer stage stage

Posted 9 days ago
​Hello!

Please see Official Guideline I.C.12.a.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.

On reading the cited Coding Clinic, it appears the advice given contradicts an Official Guideline.  Coding Clinics must adhere to The Official Guidelines.  I would assign 2 codes with Stage 3 POA Y and Stage 4 POA N.  I would cite the Official Guideline as my rationale.  I think a query to AHA would be more important than a query to the provider.



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Lawrence Barr
President
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4.  RE: Pressure ulcer stage stage

Posted 9 days ago
​I was thinking the same thing. I agree, Coding Clinics should to verify, but in the mean time it makes sense to use two codes in a case like this one POA-Y and the higher stage POA-N.

Magdala
Thank very much,

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Magdala Andre
Coding Educator
Capital Health System
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