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Coding Pressure Ulcers in ICD-10-CM

Posted on Wednesday, October 18, 2017 9:09 PM

The rule concerning coding pressure ulcers in ICD-10-CM following a skin or muscle flap has left many of us scrambling for answers. We all know that a pressure ulcers treated with a skin or muscle graft/flap are considered surgical wounds for both coding and OASIS, but what do you do when these flaps/grafts fail? Do not make the mistake of coding these as non-healing surgical wounds. These are specific complications and must be captured using the appropriate codes. Use subcategory T86.- (Complications of transplanted organs and tissues) for failed grafts/flaps.

New pressure ulcers that appear in the spots of previously repaired pressure ulcers can be tricky to code. When a pressure ulcer treated by a skin graft fully heals but then breaks down again (due to pressure), the ulcer is whatever it was at its worst stage, according to CMS HHQRP Q&As presented in May 2017.

EXAMPLES

A patient with a stage IV pressure ulcer to the right hip. It was treated with a skin graft that fully healed but has now broken down due to pressure at the same site. The clinician documents it as a stage II pressure ulcer. This would be coded as a stage IV pressure ulcer following the above guidance.

Muscle flaps are different

A patient with a stage IV pressure ulcer to the right hip. It was treated with a muscle flap that fully healed but has now broken down due to pressure at the same site. The clinician documents it as a stage II pressure ulcer. This would be coded as a stage II pressure ulcer.

Proper documentation is essential to assure proper coding of these scenarios. Always query if documentation is unclear says Mary Deakle, BCHH-C, COS-C, Manager of Compliance and Education.

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