OASIS Alert

Can you ace these 3 scenarios?

Just because your diagnosis codes in M0230 or M0240 include aftercare for a surgical treatment doesn't mean you can answer "yes" in wound questions M0482 through M0488.

Incorrect answers to OASIS wound questions frequently lead to downcoding, medical review, overpayments, underpayments and survey issues, experts warn. One area causing frequent confusion is determining what is considered a surgical wound, says clinical consultant Judy Adams with Charlotte, NC-based LarsonAllen.

Test Your Assessment Prowess

Especially confusing is deciding when surgical treatment creates a surgical wound, Adams tells Eli. Try your hand at the following scenarios Adams uses to illustrate some of the situations you may encounter.

Hint: Always ask yourself what caused the wound, she advises.
 
Scenario 1: The patient has multiple ulcers from an Unna boot that was left in place too long. One of the ulcers had to be surgically excised. The diagnosis code is V58.77 (Aftercare following surgery of the skin and subcutaneous tissue, NEC). Is this a surgical wound in M0482?

Answer: This is not a surgical wound because pressure caused it, Adams explains. It remains a pressure ulcer.

Scenario 2: The patient was hit by a swing and has a severe cut on her lower leg. The cut was surgically closed. The diagnosis code is V58.42 (Aftercare following surgery for injury and trauma). What kind of wound is this?

Answer: Because it resulted from trauma this is still a trauma wound, not a surgical wound, Adams says. The surgery didn't cause the wound but was a treatment for an existing trauma wound.

Scenario 3: The patient with a skin abscess has an incision and drainage procedure to drain the infection. The wound is no longer infected. The diagnosis code is V58.77 (Aftercare following surgery of the skin and subcutaneous tissue, NEC). Is this a surgical wound in M0482?

Answer: The wound is not a surgical wound for M0482, although it remains a skin lesion for M0440, Adams says.

Caution: If the patient had the I&D but the infection is still present, the diagnosis code would be for the abscess, rather than for the aftercare. But the wound would still not be surgical.

Surgical treatments can lead to surgical wounds. If an abscess is excised instead of drained, the resulting wound is surgical, Adams says. The treatment changed the basic nature of the wound.

If surgery replaces a pressure ulcer with a muscle flap, the site becomes a surgical wound. But if a pressure ulcer is just surgically debrided, it remains a pressure ulcer, the Centers for Medicare & Medicaid Services instructs in its OASIS questions and answers.

Note: For a detailed discussion of wound issues, order the tape or CD of Adams' teleconference "Prevent Wound Care Downcoding and Denials in Home Health" at http://codinginstitute.com/conference/tapes.cgi.