Home Health ICD-9/ICD-10 Alert

Question: We are providing wound care for a new patient with multiple pressure ulcers. He has a stage IV pressure ulcer on his coccyx, three stage I pressure ulcers on his upper back and a closed stage III pressure ulcer on his ankle. The stage IV pressure ulcer was recently debrided. Skilled nursing is seeing the patient to perform wound care. The patient is also incontinent of urine and bowel. How should we code for this patient?

-- New Hampshire Subscriber

Answer: Code for this patient as follows, says Tricia A. Twombly, BSN, RN, HCS-D, CHCE, senior education consultant and director of coding with Foundation Management Services in Denton, Texas:

• M1020a: 707.03 (Pressure ulcer; coccyx);
• M1022b: 707.24 (Pressure ulcer stage IV);
• M1022c: 707.02 (Pressure ulcer; upper back);
• M1022d: 707.21 (Pressure ulcer stage I);
• M1022e: 707.06 (Pressure ulcer; ankle);
• M1022f: 707.23 (Pressure ulcer stage III);

Other pertinent diagnoses: 788.30 (Urinary incontinence; unspecified), 787.6 (Incontinence of feces).

The focus of your care for this patient is wound care, so you'll code for his pressure ulcers first, sequencing the one which requires the most care first, Twombly says. When coding for pressure ulcers, remember to pair the 707.0x location code with the 707.2x stage code for each ulcer.

Your patient has a closed stage III pressure ulcer on his ankle. While past guidance instructed home health coders not to code for healed pressure ulcers, 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," Twombly says. They can, however, be considered closed and should continue to be reported.

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.

Your patient's incontinence may impact the care you provide, so it's appropriate to include the codes for these conditions as well.