Home Health & Hospice Week

Hint:  Be precise in medical record documentation and on the OASIS.

Wound care adds to your agency's episode costs, so to get the reimbursement you earned, answer OASIS ulcer questions accurately. Unless you can distinguish between the types of skin ulcerations your patient has, you won't be able to answer M0445 through M0476 correctly. And these questions can add from 14 to 36 points to the clinical severity portion of a patient's home health resource group score--plus $200 to $2,000 to the episode reimbursement amount. Know Your Ulcer Types Use these pointers to identify wound types so you correctly answer the related M0 questions:

1. Pressure ulcer. OASIS item M0445 defines a pressure ulcer as any lesion caused by unrelieved pressure resulting in tissue hypoxia and damage of the underlying tissue. Look for skin breakdown over bony prominences, says Donna Collins, the director of nursing for Little Flower Manor in Wilkes-Barre, PA.

Watch for: "Patients may also have skin breakdown on the back of their heads--especially if they lay too long on an operating room or procedure table in the hospital," adds Clare Hendrick, a geriatric nurse practitioner and consultant in San Clemente, CA. "You might also find ulcers on earlobes."

Reminder: A debrided ulcer is still a pressure ulcer, but if the ulcer is repaired with a skin flap, it becomes a surgical wound, says Collins.

Experts warn: Don't overlook skin breakdown caused by friction and shear, which can cause pressure ulcers. For example, an abrasion that the clinician knows was caused by a shearing force or friction--such as when a patient transfers or slides down in the chair--should be coded as a pressure ulcer, says Rena Shephard, president of RRS Healthcare Consulting in San Diego.

2. Stasis ulcer. M0468 defines a stasis ulcer as one caused by inadequate venous circulation in the area affected (usually lower legs). This lesion is often associated with stasis dermatitis.

To help identify a venous stasis ulcer, "look for a brownish deposit around the wound," suggests Laura Bolton, a wound-care expert and researcher in Metuchen, NJ. "Or if the patient has highly pigmented skin, look for a darker area around the wound," she says.

What it looks like: The ulcer may have a moist, granulating wound bed, be superficial   and have minimal to copious serous drainage unless infected. If the physician diagnoses the ulcer as a "diabetic ulcer," it would be considered a wound in M0440 but would not be counted as a pressure ulcer or stasis ulcer, the Centers for Medicare & Medicaid Services says in its OASIS questions and answers. Rule Out Other Types Of Ulcers Although only pressure and stasis ulcers have proven useful for outcome measures and risk factor adjustments, it's "extremely important" to document other types [...]