OASIS Alert

Check out these 8 items you must be able to answer.

Are you sure you know the difference between an arterial and a venous insufficiency ulcer? The wrong answer could cost you $600.
 
M0468 asks if the patient has a stasis ulcer - one caused by inadequate venous circulation. If you say no, the skip pattern sends you to M0482. If you say yes, the follow-up questions in M0470 and M0476 can lead to 14 to 22 additional points in the patient's clinical domain.

But you must know how to recognize a stasis ulcer to answer these questions correctly.

Do this: Test your assessment prowess by identifying whether each statement below is associated with a venous insufficiency or arterial ulcer:

1. The ulcer is characteristically painful and usually located on distal portion of lower extremity (may be over ankle or bony areas of foot).

2. Foot on affected extremity may show coolness to touch, diminished or absent pedal pulses.

3. May be associated with venous hypertension due to one or a combination of factors, such as obesity, deep vein thrombosis, malignancy, inactivity or paralysis.

4. Open lesion of the skin and subcutaneous tissue on lower leg - usually pretibial area of lower leg or above medial ankle.

5. Pain may increase when foot is in a dependent position (when the patient is sitting with feet on the floor).

6. Pain may decrease when foot is dependent (hanging down) and increase when elevated.

7. Ulcer may have a moist, granulating wound bed and may be superficial with minimal to copious serous drainage unless infected.

8. Wound bed is frequently dry and pale with minimal or no exudate.

Answers: 1 arterial; 2 arterial; 3 venous insufficiency; 4 venous insufficiency; 5 venous insufficiency; 6 arterial; 7 venous insufficiency; 8 arterial.

Editor's Note: The above test was developed by Eli Healthcare with answers based on definitions of ulcers in a Centers for Medicare & Medicaid Services revised survey guidance. The guidance is at www.cms.hhs.gov/manuals/pm_trans/R4SOM.pdf.