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.
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.