Choose 996.52 for non-healing muscle flap. When is a pressure ulcer no longer a pressure ulcer? When it becomes a surgical wound. Remember: Not every surgical procedure on a pressure ulcer changes it into a surgical wound. When a muscle flap surgically replaces a pressure ulcer, the pressure ulcer disappears and becomes a surgical wound. But when a pressure ulcer is surgically debrided or covered with a skin graft, it remains a pressure ulcer and doesn't become a surgical wound, the Centers for Medicare & Medicaid Services explains in its OASIS Q&As. The skin graft donor site, however, is a surgical wound. Trap: Mistakes in pressure ulcer coding will be a red flag for intermediaries because of the reimbursement involved, motivating them to comb through your OASIS documents and medical records, experts say. Errors could prove very costly. Handy tool: Use this visual aid to help your clinicians get the pressure ulcer riddle correct every time, suggests Selman-Holman. Source: Lisa Selman-Holman, Selman-Holman & Associates, Denton, TX
Clinicians are often confused about when a surgical procedure creates a surgical wound, says clinical consultant Judy Adams, RN, BSN, HCS-D, with Charlotte, NC-based LarsonAllen. The first step is to ask what caused the wound, she advises.
Keep in mind that if a muscle flap -- now a surgical wound -- doesn't heal, it becomes a non-healing surgical wound and has a specific code. And if it heals but later breaks down again, it is a new pressure ulcer and is coded as such, explains Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX.