Home Health & Hospice Week

Better pressure ulcer scoring could mean more money for your patient.

Pressure ulcer staging for OASIS has long been a trouble spot, but now home health agencies have more help on the matter.

The National Pressure Ulcer Advisory Panel has issued revised pressure ulcer stages, definitions and descriptions. That's important because the Centers for Medicare & Medicaid Services refers to NPUAP guidance in instructing agencies how to fill out the OASIS items on pressure ulcers (M0445, M0450 and M0460).

CMS links "correct responses to the OASIS pressure ulcer questions to the NPUAP guidance and interpretation," explains consultant Judy Adams with LarsonAllen based in Charlotte, NC. "As the NPUAP information is updated or changes, HHAs will still be expected to follow that guidance."

More details in the NPUAP guidance for the four stages of pressure ulcers means clinicians may be able to stage them more accurately, Adams expects. "The more accurate HHA staff are about staging pressure ulcers, potentially the better their case mix reimbursement may be," she tells Eli.

Scoring: An agency receives 17 more case mix points for a patient who has two or more stage 3 or 4 pressure ulcers in M0450. And it receives 15 points for a patient whose most problematic ulcer is stage 1 or 2, versus 36 points if it's stage 3 or 4 in M0460.

More detailed guidance also may lead to better consistency between clinicians filling out OASIS, Adams hopes.

Guidance Neglects Unstageable Problem

The NPUAP guidance doesn't squarely address one common complaint about pressure ulcer scoring--scoring the wound as unstageable if eschar obscures it.

"Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined," the NPUAP guidance says.

Protest: Under the prohibition against reverse-staging pressure ulcers in CMS' OASIS Manual, if you know it was stage 4 before the eschar, it has to be stage 4 after, industry veterans complain.

And if eschar covers just part of the wound, but you can see the bone in the rest of it, you should be able to stage it accordingly, they add.

But agencies seem stuck with those rules. NPUAP's guidance reinforces CMS' previous instructions on unstageable wounds, Adams believes.

Note: To receive a copy of the NPUAP pressure ulcer guidance, email Rebecca Johnson at rebeccaj@eliresearch.com with "Pressure Ulcer Guidance" in the subject line.