Coding of Kennedy Terminal Ulcers

kerryseekircherkerryseekircher
edited May 2016 in CDI Talk Archive
Does anyone have insight they can share regarding the coding of Kennedy Terminal Ulcers (KTU)? I am reviewing a patient that was admitted and expired about a week later. She has a documented hospital acquired pressure ulcer. The wound care manager wants the doctor to clarify that this was a KTU. She does not feel that it should be coded to a pressure ulcer if stated as such.
I have done some research and understand that this diagnosis is used with pressure ulcers in terminal patients (as sometimes they are unavoidable regardless of the best nursing care), however I do not see any coding clinics or guidelines on this topic.
Thanks,
Kerry

Comments

  • cstukenbergcstukenberg
    edited May 2016
    Maybe others have more insight on this but I do not see that the KTU is recognized as a different diagnosis to be coded. I did not see it in the ICD 10 info either from a brief look.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, October 23, 2013 8:02 AM
    To: Stukenberg, Colleen M.
    Subject: [cdi_talk] Coding of Kennedy Terminal Ulcers

    Does anyone have insight they can share regarding the coding of Kennedy Terminal Ulcers (KTU)? I am reviewing a patient that was admitted and expired about a week later. She has a documented hospital acquired pressure ulcer. The wound care manager wants the doctor to clarify that this was a KTU. She does not feel that it should be coded to a pressure ulcer if stated as such.
    I have done some research and understand that this diagnosis is used with pressure ulcers in terminal patients (as sometimes they are unavoidable regardless of the best nursing care), however I do not see any coding clinics or guidelines on this topic.
    Thanks,
    Kerry
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I agree. It sounds like the ulcer is still related to 'pressure', correct? If it was related to something else (ex: stasis) then you may be able to avoid the HAC but if its related to pressure, I believe this is where it will lie. These things happen sometimes even with the best care. I would just ensure that the comorbidities that put this Patient at a high risk for this (Malnutrition? Func quad? Chronic disease?) are well documented.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • kerryseekircherkerryseekircher
    edited May 2016
    Thank you both for your advice! I agree-it is definitely an ulcer caused by pressure. I just wanted to make sure before provided feedback to the coding supervisor and the wound care manager.
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    It may be relevant also to recall that a stage II progressing to a stage IV due to unavoidable consequences of pathophysiology is reported with a POA of YES. There can be implications for quality, HAC, compliance, and so forth.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • paxnerospaxneros
    edited May 2016
    I do not know of any other distinguishing codes in ICD 9 regarding Kennedy Ulcers other than what are already there to describe all Ulcers.

    Norma T. Brunson, RHIA,CDIP,CCS,CDIP
  • kerryseekircherkerryseekircher
    edited May 2016
    Thanks Paul. In this case, the patient did not have a pressure ulcer on admission, so it will be a HAC.
    Kerry
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    I agree, and find no reference for Kennedy Ulcers – lacking any other documentation, one would not be able to code these are pressure ulcers.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • cstukenbergcstukenberg
    edited May 2016
    I assume you checked the nurses notes closely for any skin issues on admit and the ER record if there was one?
  • dr_dexterdcosta@yahoo.comdr_dexterdcosta@yahoo.com
    edited May 2016
    I believe there was a question sent to Coding Clinic and they clarified that the KTU can be coded as Pressure Ulcer. One of the CDI coders at NCAL KP had requested a answer from them and got a response.
    Dexter Dcosta
  • mark.domineseymark.dominesey
    edited May 2016
    There are all kinds of information out in the interwebs about KTU. Here are a few good links:

    http://www.jeffreymlevinemd.com/unavoidable-kennedy-ulcer-in-long-term-care-hospitals/
    http://www.ncbi.nlm.nih.gov/pubmed/19797802
    http://www.kennedyterminalulcer.com/

    It seems that CMS will recognize the inevitability of these ulcers in the dying patient for 2014 and not count them against hospital’s quality rankings.

    POA or not, these should be tracked closely to help delineate true HACs versus unavoidable complications of the dying patient.

    Right now, there are no ICD-10 codes specific to this. The quality agencies will likely create a protocol around the types of codes reported to determine if a patient is included. Maybe the hospice code? Or a death code?, or, better, give us some ICD-10 codes for this particular type of ulcer and exclude those codes from the numerator.

    Kindest Regards,

    Mark
  • kerryseekircherkerryseekircher
    edited May 2016
    Thank you for sharing all of these links!
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Mark,
    I see the article stating that these are excluded from quality reporting for LTACH’s. Will they also be excluded from Acute-care Hospitals? If so, do you have that reference or did I miss it.

    Thanks!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
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