OASIS Alert

If M0440 is "no," look again.

Question: What is the best way to answer M0440? Some of our nurses say other agencies they work for consider a mole or a scar a skin lesion. Thus the answer to M0440 would be "yes" for almost all patients. Other nurses say a skin lesion would include open wounds, new surgical incisions or a lesion that needs to be clinically monitored. Can you help me?

Answer: An accurate answer to M0440 will be "yes" 99 percent of the time, experts agree, because most patients have some sort of bruise, cut, rash, pustule or scar. The Centers for Medicare & Medicaid Services defines a lesion very broadly as an area of pathologically altered tissue. "All alterations in skin integrity are considered to be lesions except alterations that end in 'ostomy'... or peripheral IV sites," the OASIS Implementation Manual instructs. Even persistent redness without a break in the skin is considered a lesion, CMS says.

Some skin conditions CMS considers lesions include wheals, vesicles and pustules (primary lesions), or lesions that arise from these, such as crusts, scars and ulcerations (secondary lesions). Other lesions you might see are cuts, skin tears, burns, rashes, surgical incisions and sores. Patients often have areas of skin discoloration (macules and patches), changes in pigmentation or thickening epidermis (lichenification).

Don't overlook: Pin sites, surgical wounds with sutures or staples, central and PICC lines and implanted infusion or venous access devices also are lesions, CMS instructs. Although marking "yes" on this question only brings extra reimbursement when the patient's diagnosis is a burn or trauma code, overall OASIS accuracy still is essential in dealings with surveyors and intermediaries.

Note: Several good Web sites for increasing your understanding of different types of skin lesions include: wwwpediatrics.wisc.edu/education/derm/test.html and www.verpleegkunde.com/tekst/HandbookofSkinDiseases.pdf.