MDS Alert

Here are the F tag and RUG realities.

What you code on the MDS is what you get in the QM/QI and payment realms, which is certainly true for staging pressure ulcers in Section M.

For instance, you could trigger the postacute pressure ulcer QM/QI if you don't stage a pressure ulcer accurately on the 5-day and 14-day MDSs, says Jane Belt, RN, MSN, a consultant with Plante & Moran Clinical Group in Columbus, OH. And that will get surveyors potentially digging deeper to see if your facility has systemic shortfalls in assessing and coding pressure ulcers. If you understage what's really a stage 3 pressure ulcer, a resident may end up in a lower-paying RUG, which means the facility will have less money for wound care. While a single stage 2 pressure ulcer with two or more treatments won't RUG a resident into Special Care, one stage 3 or 4 ulcer with two treatments coded in Section M will. And many shallow stage 3 pressure ulcers are actually reported as stage 2, in the experience of Mary Arnold Long, MSN, RN, CRRN, CWOCN, APRN-BC, CLNC, a wound care specialist in Mason, OH. (For tips on how to differentiate between a stage 2 and stage 3 pressure ulcer, see the SPECIAL FOCUS article in this issue.)