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CMS Releases New Guidance on Skin-Grafted Pressure Ulcers

Posted on Sunday, October 30, 2016 1:40 PM

CMS has released new guidance regarding the coverage for a pressure ulcer with a skin graft and how changes it from a pressure ulcer to a surgical wound.

CMS explained this new guidance in response to Question No. 12, which was one of the 22 quarterly Q&As released October 19.

Prior guidance had instructed clinicians to continue counting the wound as a pressure ulcer even after the skin graft. With this change, all skin grafting of pressure ulcers is treated the same, says Ann Rambusch, president of Rambusch3 Consulting in Georgetown, Texas.

But it will cause a decrease in reimbursement. Now, all Stage 3 and 4 grafted ulcers will be non-reportable as pressure ulcers. Agencies will get points for the surgical wound but not as many as they currently get.

What’s worse is the impact on NRS reimbursement, Rambusch explains.

Starting January 1, skin-grafted pressure ulcer is a surgical wound. The wound that is not healing will earn 14 NRS points or $51.05 (CY 2016 rate). “That’s a huge loss, especially since these grafted wounds are very labor and supply expensive,” Rambusch says.

Additionally, these new guidelines from the Q&As will not be released until OASIS-C2 begins January 1. CMS plans to release an updated version of these documents by mid-November.

More on wounds from the Q&As
• Grafted burns are considered surgical wounds
• Don’t use Response “0” in M1320 (Status of the most problematic pressure ulcer)
• Pressure ulcers sutured closed are considered “unstageable”

Guidance on new OASIS-C2 items
• M1060 (Height and weight)
• GG0170C (Mobility)
• M2001 (Drug regimen review)

For the full article, please see the October 31, 2016 Home Health Line Edition.

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