Home Health ICD-9/ICD-10 Alert

Question: Your November issue includes the following: "Coding vs. OASIS: An ulcer covered by eschar loses the opportunity for HHRG points but still earns NRS points, Selman-Holman points out. A pressure ulcer covered by a skin graft is still documented on OASIS according to stage but should be coded as unstageable (707.25). A pressure ulcer treated with a muscle graft is no longer a pressure ulcer by OASIS standards but is coded as unstageable (707.25)."

When a pressure ulcer is treated with a muscle graft, it no longer is classified as a pressure ulcer (it becomes a surgical wound); therefore, M0445 on the OASIS gets a NO answer, then it bypasses M0450 where it counts the staged ulcers, and M0460 -- the most problematic ulcer. It is my understanding that only pressure ulcers are staged (not the surgical nor other types). Please correct me if I'm wrong.

Pennsylvania Subscriber

Answer: When a pressure ulcer is treated with a muscle graft, it is no longer considered a pressure ulcer according to OASIS, so you would answer M0445 "No" and bypass M0450 and the other pressure ulcer M0 items.

The pressure ulcer treated with a muscle graft is marked "Yes" on M0482 and subsequent OASIS M0 items are marked according to number and the most problematic surgical wounds. Documentation on the assessment should indicate that the muscle graft was done to treat a pressure ulcer.

The codes entered into M0230 and/or M0240 would include the 707.0x (Pressure ulcer) code for the location of the pressure ulcer and 707.25 (Pressure ulcer, unstageable) for unstageable. Remember to mark the OASIS according to OASIS guidelines, but choose ICD-9 codes according to coding guidelines. In this case the guidelines are not consistent with one another.