Home Health & Hospice Week

Coding for ulcers is never easy, but a recent clarification from the Centers for Medicare & Medicaid helps lay to rest one common question. Can you describe a healed stasis ulcer as newly epithelialized?

The answer is no, according to the OASIS C Guidance Manual, updated in December 2010. The latest version of the manual includes the following new information at M1334 (Status of Most Problematic [Observable] Stasis Ulcer): "Once a stasis ulcer has completely epithelialized, it is considered healed and should not be reported as a current stasis ulcer. The response option 'Newly epithelialized' should not be selected for a healed stasis ulcer, as a completely epithelialized (healed) stasis ulcer is not reported as a stasis ulcer on OASIS."

This clarification clears up a matter that has caused confusion since OASIS C went into effect, says OASIS expert Trish Twombly, director of coding with Foundation Management Services in Denton, Texas.

Not all of CMS's updates provide clear-cut guidance, however. A new bullet at M1324 (Stage of Most Problematic Unhealed [Observable] Pressure Ulcer) seems to contradict ICD-9 coding instruction, Twombly points out.

The new response-specific instructions at M1324 advise "Until suspected deep tissue injury (DTI) evolves and opens, the stage will be considered 'NA,' as the wound bed cannot be visualized."

But the official ICD-9 coding guidelines advise you to assign code 707.25 (Pressure ulcer, unstageable) for "pressure ulcers that are documented as deep tissue injury but not documented as due to trauma." "There is a new conflict there," Twombly says.