Self inflicted skin wounds

robert.hodges2robert.hodges2
edited May 2016 in CDI Talk Archive
I had a provider ask me today about a patient that picks their skin to the point where ulcers and infection have formed. A phychiatrist used the term "fictitious ulcers" (which is a non-codable term). The areas are described as infected and need antibiotics.

My thoughts are: Superficial injury with infection, or Open wounds with Cellultiis (depending on the severity of the injury and infection of course), and self mutilation to describe the behavior.

Any thoughts on this?

Thanks in advance.

Robert

Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov

VA Core Values: Integrity, Commitment, Advocacy, Respect, Excellence (“I CARE”)
VA Core Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile, Integrated

"We are dealing with Veterans, not procedures; With their problems, not ours." --General Omar Bradley

Comments

  • angelisa.romanelloangelisa.romanello
    edited May 2016
    Robert,
    I agree with the coding of the behavior as self mutilation. I have had a patient with that diagnosis.....we have a wound care team here and they looked at the wounds and described them as open wounds with cellulitis....... so I queried the physician to see if he agreed. If they are infected, I would think the resources would be more than superficial injury.
    Hope that helps.
    Lisa


    Lisa Romanello,RN,BSN,FNS,CCDS
    Manager, Clinical Documentation Improvement Specialist
    CJW Medical Center
    Quality and Compliance
    804-228-6527
  • robert.hodges2robert.hodges2
    edited May 2016
    Thanks Lisa. I’m curious though if the attending can make that diagnosis or if I need a psychiatrist to. Especially since it’s an involuntary behavior.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov

    VA Core Values: Integrity, Commitment, Advocacy, Respect, Excellence (“I CARE”)

    VA Core Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile, Integrated



    "We are dealing with Veterans, not procedures; With their problems, not ours." --General Omar Bradley
  • angelisa.romanelloangelisa.romanello
    edited May 2016
    Robert,
    A very interesting question. We have some hospitalists here who will go out a limb and make that diagnosis and some who will not. HCA has a very firm policy on the desire for the attending to document the information. We are very lucky here to have a psych hospital attached to our medical facility.
    Lisa


    Lisa Romanello,RN,BSN,FNS,CCDS
    Manager, Clinical Documentation Improvement Specialist
    CJW Medical Center
    Quality and Compliance
    804-228-6527
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