Home Health ICD-9/ICD-10 Alert

Know when to say 'yes' to M0440.

When you're tempted to answer "no" to M0440 for a patient who has had an I&D for an abscess, you're endangering the accuracy of your risk adjustment. 

While an abscess that was treated with an I&D isn't considered a surgical wound, it does qualify as a skin lesion. "Just about everything counts as a skin lesion," says Lisa Selman-Holman, JD, BSN, RN, CHCE, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX. "A mole counts as a skin lesion, so you wouldn't answer 'no' to M0440 (Does this patient have a Skin Lesion or an Open Wound?) if the patient has an abscess that has been cut open." 

Some agencies have chosen to answer "yes" to M0440 only when they are doing something about a wound or skin lesion, such as watching a rash, says Selman-Holman. But because M0440 is one of the OASIS questions that is calculated into the risk adjustment for outcomes, answering this question incorrectly will cause their risk adjustment to be flawed. 

"Routinely answering 'no' to M0440 may be impacting your outcome risk adjustment negatively, and that is true even if you are answering 'no' to the questions regarding surgical wounds, pressure ulcers and stasis ulcers," says Selman-Holman.
  
Risk adjustment is a statistical process used to identify and adjust for variation in patient outcomes that stem from differences in patient characteristics (risk factors) from one home health agency to the next.