OASIS Alert

Remember: Scabs no longer indicate a non-healing wound.

All home health agencies must know the difference between a surgical wound and a lesion -- or risk inaccurate outcomes and lower payment.

A wound is fully healed and not reportable as a current surgical wound four weeks after complete epithelialization and there are no signs or symptoms of infection, according to the Wound Ostomy and Continence Nurses Society (WOCN). The Centers for Medicare & Medicaid Services accepts this definition and uses it to determine how to code M0482.

Coding decision: If your patient's incision is clean, dry and completely closed without any signs of infection, you should not report it as a wound for M0482. The scar left from that wound should be reported as lesion for M0440, according to a July 2008 clarification on the OASIS Certificate and Comp-etency Board (OCCB).

However, if an incision is still healing, it should be coded as a surgical wound, explains wound care consultant Patti Johnston with Woodlands, TX-based Healthcare Qual-ity Solutions. Signs that an incision is still healing include partial epithelialization, a non-granulating wound bed, incisional separation and signs or symptoms of infection, among others.

Caution: Previously, WOCN considered the presence of a scab as an indicator of a non-healing surgical wound. The group has retracted that guidance, which means the presence of a scab is not enough to report a wound as not healing (see OASIS Alert Vol. 9, No. 8 for more information).