Coding Tip from Sparkle Sparks: ICD-9-CM Coding vs. OASIS Instructions for the Description of Pressure Ulcers

Check out the free coding tip below discussing ICD-9-CM Coding vs. OASIS Instructions for the Description of Pressure Ulcers, provided by OASIS Answers’ Sparkle Sparks, PT, MPT, COS-C.

Join Sparkle for The Art of ICD-9 Coding workshops in Orlando next week — March 22nd (Beginning)23rd (Intermediate) and24th (Advanced).

ICD-9-CM Coding vs. OASIS Instructions for the Description of Pressure Ulcers

Have you ever noticed that sometimes a lesion is identified in the integumentary section of the OASIS, yet it is either not coded in the diagnostic section, or the coding seems to conflict with the wound or ulcer described in the integumentary section?  While it’s true that a “leopard doesn’t change its spots” the CMS instructions for the completion of the OASIS were developed with input from both the National Pressure Ulcer Advisory Panel and the Wound, Ostomy and Continence Nurses Society.  However, for instructions related to diagnostic coding CMS bases their guidance on the Official Guidelines for Coding & Reporting.  The Guidelines are updated annually and are a collaborative effort between the Four Cooperating Parties of the ICD-9-CM.  They are comprised of representatives from the American Hospital Association, the American Health Information Management Association, the Centers for Medicare & Medicaid Services, and the National Center for Health Statistics, which is a division of The Centers for Disease Control.

While it is true that the same wound cannot be described / scored as a pressure ulcer in the integumentary section of the OASIS and reported as a diabetic ulcer in the relevant coding section M items, you may find it odd that we could identify closed stage III & stage IV pressure ulcers as “current pressure ulcers” in the relevant integumentary M items on the OASIS (per OASIS instructions), yet we would not assign ICD-9 codes to them (per coding guidelines).  In section I.C.12.a.7) the guidelines instruct that, “no code is assigned if the documentation states that the pressure ulcer is completely healed.”  In the guidelines they do not use the term “closed”, only healed, but the intent is that only pressure ulcers that are “healing” (section I.C.12.a.8) or “evolving” (section I.C.12.a.9) should be coded.

2 Responses to “Coding Tip from Sparkle Sparks: ICD-9-CM Coding vs. OASIS Instructions for the Description of Pressure Ulcers”

  1. Doris Pinkerton Says:

    now I am confused – a stage 4 is always a stage 4 – even if it is fully granulated – it is never healed – it always has the capacity to reopen as the granulated material is never the same as the original tissues. so we would have to say stage 4 in oasis – then do we code as Dx even if not open? or not?

    • hcafadmin Says:

      Everything Doris has said is true regarding the guidance for how we are to score a pressure ulcer on the OASIS. However, that guidance is NOT consistent with the coding instructions. That was the point of that article. If you refer to the Chapter-Specific Guidelines for instructions on how to code pressure ulcers they state “no code is assigned if the documentation states that the pressure ulcer is completely healed.” (Remember, they use the word “healed” but the correct terminology for a stage 3 or 4 pressure ulcers would be “closed.”)

      So, the “take home message” is that we will continue to score pressure ulcers in the integumentary section on the OASIS per the instructions in the OASIS Guidance Manual in Chapter 3. OASIS instructions are consistent with guidance from the National Pressure Ulcer Advisory Panel & the WOCN that states that a “”closed” pressure ulcer is still considered a current pressure ulcer because they never heal and are always at an increased risk of reopening.

      However we must assign ICD-9 codes by the instructions in the Coding Guidelines. So a closed stage 4 would be scored as a current pressure the on OASIS in the appropriate items but would NOT be coded per the ICD-9 guidance in Section I. C. Chapter-Specific Guidelines, 12. a. Pressure ulcer stage codes 7) “Patients admitted with pressure ulcers documented as healed.”

      Sparkle Sparks, PT, MPT, COS-C
      Senior Associate Consultant
      OASIS Answers, Inc.

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