Home Health Coding and OASIS Expert

Question: When there is eschar present in the wound, does that mean a pressure ulcer is a Stage IV? If you cannot see or palpate muscle tissue, tendon or bone but eschar is present but not covering the wound bed, how would I report the stage?

Answer: If slough or eschar cover the wound bed to the extent that you cannot visualize any Stage IV structures, you would report this pressure ulcer as Unstageable, according to the Response-Specific Instructions for OASIS-C1/ICD-9. Stage IV structures include bone, muscle, tendon, or joint capsule. Although the pressure ulcer is likely a Stage IV when eschar is present, the ulcer cannot be staged as a IV unless you can visualize Stage IV structures.

But if you can visualize any Stage IV structures, you shouldn’t report the pressure ulcer as Unstageable. In this case, it’s a Stage IV even if slough or eschar is present, the Centers for Medicare & Medicaid Services says in the updated item guidance.