new pressure ulcer reporting

I'm curious about other's discussions regarding reporting of two different pressure ulcer stages if the pressure ulcer evolves through the admission. It seem odd to me if they are encouraging both stages to be coded, that the deeper stage that develops would qualify for (Y)POA status?  I think the advisement I have heard is that the only coding clinic saying that it was poa still applies... ?  I would think the entire reason to allow for both codes would be to NOT allow for POA and have it be an HAC/ non-allowable MCC (if it's the impact maker)... any thoughts? 

Comments

  • My CDI Pocket Guide for 2016 says  "If a patient is admitted with a pressure ulcer at one stage and it progresses to a higher stage, assign the code for the highest stage reported for that site. In this case, assign POA indicator= "Y" (Yes) for both the stage and location, since it was  present on admission despite the progression. " I would think that would still apply to 2017 then.
  • prior to 2017 only the highest stage was reported ... 2017 they are both reported. Chapter 13 6th bullet point:

    https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2017-ICD-10-CM-Guidelines.pdf

  • I've listened to two webinars & the speakers gave differing advice. One said POA Y to both codes & the other stated POA Y for first code & POA N for the progression of the ulcer. Definitely think we need some official advice.
  • The policy at our institution is to code the earlier stage as YES - POA, and the more advanced stage as NO.- Not POA.
  • Based on the following coding clinic, it appears that Y would be the correct choice for both codes since the ulcer was POA, it just progressed during the stay.

    Coding Clinic 2008 Q4 "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."

    Would love to hear other's thoughts.

    Jeff

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