Home Health ICD-9/ICD-10 Alert

Reader Question:

Don't Close the Door on Ulcer Coding

Published on Fri Jan 20, 2012

Question: I know that OASIS item guidelines require us to report closed stage III and IV pressure ulcers, but should we also list diagnosis codes for these wounds?

Montana Subscriber

Answer: Yes, you should list a diagnosis code for stage III and IV pressure ulcers, even if they are closed. Because there is a strong risk that stage 3 and 4 pressure ulcers will open again, they may be considered closed, but they are never considered healed.

Why: OASIS C guidelines hold that stage III and IV pressure ulcers heal through a process of contraction, granulation, and epithelialization, and can never be considered "fully healed,"

When coding for pressure ulcers, you'll need to list a code for the location and a second code that describes the stage. For instance, if your patient has a closed stage IV pressure ulcer of the coccyx, you would list:

707.03 (Pressure ulcer; coccyx) and

707.24 (Pressure ulcer stage IV).

Tip: If the documentation shows that your patient had a stage I or II pressure ulcer that was healed on admission, you don't need to list a code for it.

OASIS C instructions for stage I and stage II pressure ulcers note that these ulcers heal by epithelialization and once healed should no longer be reported.