OASIS Alert

If you can't see it, you can't stage it in M1306.

Question: We have a new patient who entered our care with several pressure ulcers. One of those ulcers was closed using sutures. We aren't sure whether we should try to categorize it, if it would be considered the most problematic ulcer, or if it is unstageable since we cannot see the wound bed. How should we proceed?

Answer: Your first step is to determine whether the wound has been closed by direct suture or if you're actually looking at a surgical procedure such as skin advancement flap, rotation flap, or muscle flap. "Direct suture closure is extremely rare because it has a low success rate," according to the National Pressure Ulcer Advisory Panel. Though suture without a flap procedure is rare, you'd still tackle coding the wound the same way as any other pressure ulcer.

For instance, for M1306 (Does this patient have at least one unhealed Pressure Ulcer at Stage II or higher or designated as "unstageable"?) you'd select response "1" (Yes). Because the wound is sutured shut, the bed is obscured. Without being able to see the bed, you can't stage the wound, according to the Centers for Medicare & Medicaid Services in a clarification published date or number to locate? on the OASIS Certificate and Competency Board website.

You'd follow the same track for each of the other pressure ulcer items. You'll treat the direct-sutured wound the same as an ulcer covered with a dressing that cannot be removed. Here's what your staging should look like:

• M1308 (Current number of unhealed [non-epithelialized] pressure ulcers at each stage) -- Select row d.1 (Unstageable: known or likely but not stageableto due to non-removable dressing or device)
• M1310 (Pressure ulcer length) -- leave blank
• M1312 (Pressure ulcer width) -- leave blank
• M1314 (Pressure ulcer depth) -- leave blank
• M1320 (Status of the most problematic [observable] pressure ulcer) -- Select NA (No observable pressure ulcer)
• M1324 (Stage of most problematic [observable] pressure ulcer) -- Select NA (No observable pressure ulcer)

Resource: Read CMS's clarification at www.oasiscertificate.org.