OASIS Alert

Can you tackle these wound coding conundrums?

Surgical and open wound coding can be complicated at best and confusing at worst.

You can keep your wound coding know-how up to snuff with sample scenarios that help you stay on top of the game.

Here are a few examples:

Scenario 1: Your patient had a cut down procedure to perform endovascular abdominal aortic aneurysm repair. Does the resulting femoral sheath site qualify as a surgical wound?

Solution: When an incision or "cut down" is completed in order to perform a procedure via femoral sheath, the incision is not considered a surgical wound, according to the Centers for Medicare & Medicaid Services in the October 2010 set of OASIS questions and answers posted on the OASIS Certificate & Competency Board's Web site.

Tip: A femoral puncture site that was created without "cut down" is not a surgical wound on M1340. Scenario 2: Is the removal of a callus considered to be a surgical wound?

Solution: A callus that has been removed is not considered a surgical wound when scoring the OASIS item M1340, the OCCB reports. However, it may be reported in M1350 Wounds/Lesions if it is receiving intervention from the agency.

Scenario 3: A surgical incision was created to perform exploratory surgery. When closing the wound, the surgeon inserted a chest tube utilizing the opening created for the surgery. Can this closed incision with a chest tube be counted as a surgical wound when completing M1340?

Solution: The wound described in this scenario should be considered a thoracostomy and is not considered a surgical wound when completing the OASIS data set item M1340.

Question 4: Are gastrostomies and jejunostomies considered bowel ostomies for the purposes of M1350, Skin Lesion or Open Wound?

Solution: M1350 excludes bowel ostomies for elimination, such as a colostomy or an ileostomy. A jejunostomy or gastrostomy utilized for enteral nutrition is not considered a bowel ostomy for the purposes of OASIS data collection. Ostomies other than bowel ostomies for elimination (e.g., tracheostomies, thoracostomies, urostomies, jejunostomies, gastrostomies) are considered to be skin lesions or open wounds if clinical interventions (such as cleansing, dressing changes, and assessment) are being provided by the home health agency during the care episode, according to the December 2010 OASIS-C Guidance Manual updates.