Pressure ulcer staging

katysuegood@gmail.com

It is my understanding that when you have a pressure ulcer that is POA but evolves during the admission (ex: stage 2 to stage 3) that both the codes, the one for the location AND the one for the stage, associated with the decube are POA (Y). I currently have a coder who is maintaining that the location code will be POA (Y) but the stage is POA (N).
Is this correct? I can't seem to find my reference....

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

evanspx@sutterhealth.org

On my pad - there is a reference - I think in Guidelines, and your scenario is correct. (Coder is not correct).

Paul

katysuegood@gmail.com

Thanks Paul.
All I see in the guidelines is the guideline to code to the highest level if it is evolving.

I think she is getting confused by the POA guidance that states that if there is a combo code or if the code captures both an acute and chronic condition and one part developed during the admission, then you should assign POA (N).


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

vanessa.falkoff

Hi,

I found this helpful for my coders.

HOLES IN THE SKIN: Thought Processes in Face of HAC for Pressure Ulcers
By Robert S. Gold, MD

http://www.cditalk.com/content/216-HOLES-IN-THE-SKIN-Thought-Processes-in-Face-of-HAC-for-Pressure-Ulcers



Vanessa Falkoff RN
Clinical Documentation Coordinator
University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322

Compassion * Accountability * Respect * Integrity

fishdl@shands.ufl.edu

Stage II Pressure Progressing to Stage III

Coding Clinic 1Q2009 -
Question:
Coding Clinic Fourth Quarter 2008, page 194 stated that a stage II pressure ulcer, which was present on admission, and progresses to become a stage III pressure ulcer during the stay is reported as "Yes" for the present on admission (POA) indicator. However, the POA indicator is reported for conditions present at the time of inpatient admission. It appears inconsistent to report a Stage III pressure ulcer as present on admission since the pressure ulcer gradually deteriorated during the hospital stay. Could Coding Clinic please clarify this issue for coders and clinical teams that rely on this guidance?
Answer:
In terms of coding and POA reporting, a pressure ulcer is only coded and reported once at the highest stage. The information published in Coding Clinic Fourth Quarter 2008, page 194, instructing to report a Stage II pressure ulcer that progresses to a Stage III as present on admission is correct. The pressure ulcer was present on admission; therefore, the POA should be yes. This advice is consistent with the National Quality Forum (NQF) endorsed measures. The NQF established a standardized set of serious reportable events also called never events. The list of serious reportable events excludes the progression of a pressure ulcer from stage II to Stage III, if stage II was recognized upon admission.

Coding Clinic 4Q2008 -
Question:
A patient is admitted to the hospital with a stage II pressure ulcer of the heel. During the hospitalization, the pressure ulcer worsens and becomes a stage III. Based on the new Official Coding Guidelines, we would be assigning the code for the highest stage for that site. What would be the correct POA indicator assignment for the stage III code?
Answer:
Assign "Y" to the pressure ulcer stage III code since this code is referring to a pressure ulcer that was present on admission rather than a new ulcer.

Hope this helps,
Donna Fisher, CCS, CCDS
CDI Coordinator
fishdl@shands.ufl.edu

wendy.clesi

There is a more recent Coding Clinic that has created confusion regarding POA assignment of two different pressure ulcers (one present on admission and the other developed after admission). Both ulcers were documented as having the same stage. The coding clinic suggested applying a POA indicator of "N" to the stage. In this particular case, I feel like the question being posed was not answered fully. Coding Clinic 1Q, 2009 provides more clear guidance.

katysuegood@gmail.com

Thanks Donna! Thanks exactly what I needed. I don't know why I wasn't ending up in the right place when I was searching the coding clinics.

Thank you!

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

katysuegood@gmail.com

Yes, she sent me that one too.


POA indicator for stage 4 pressure ulcer of different sites

Coding Clinic, Second Quarter 2010 Pages: 17-18 Effective with discharges: July 7, 2010
Question:
A patient on admission has a pressure ulcer of her ankle due to a previously placed internal fixation device. Over several days, it was noted that the ulcer further deteriorated to stage 4. Later in the stay the patient developed another pressure ulcer in the sacrum, which was treated with excisional debridement and wound vac. Because of the patient's debilitated state, the sacral ulcer progressed to stage 4. The POA indicators for the sacral decubitus and stage 4 are "N". However, the POA indicators for the stage 4 ankle ulcer are both "Y". Since each decubitus and the corresponding stages would be reported separately, how is the POA indicator captured for stage 4 pressure ulcers of different sites? Would it be appropriate to assign code 707.24, Pressure ulcer stage IV, twice and report both "Y" and "N"?
Answer:
Report the POA indicator "N" for the ulcer stage. There is no ideal answer for this situation; however, due to the constraints of the classification, this is the most appropriate approach. The Official Guidelines for Coding and Reporting indicate that ICD-9-CM diagnosis codes may not be reported twice on the same admission. This problem will be addressed with ICD-10-CM, since information about the site and stage is included in a single code.
(c) Copyright 1984-2013, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.





But my read of that is that this is ONLY referring to if you have two ulcers of the same stage but one was POA (Y) and the other was POA(N). You can only use the staging code once so one ulcers stage will not be coded. In that case, they are suggesting to code the POA(N) one and not the other which makes sense to me. But this doesn't change that an evolving pressure ulcer is POA(Y) if the ulcer, at any stage, was present on admission.



Thanks everyone!



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