ICD 10 Guidelines for Coding/ Reporting 2017: Pressure Ulcers evolving into another stage
IF a patient is admitted with a Stage 2 pressure ulcer, coccyx and then 10 days later it evolves into a Stage 3 -- by the new coding guidelines, we are to code both stages. Are we to code the Stage 3 pressure ulcer as POA or NOT POA. Will this then become a reportable PSI indicator if it evolves to a Stage 3?
Thanks
Diane
Dmmoore54@hotmail.com
Comments
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
Refer to page 112 of the 2017 ICD-10 Coding Guidelines (which would trump previously published Coding Clinics). It seems the objective of this new reporting requirement is to penalize facilities, under the HAC program, when a decubitus gets worse during an encounter.
"Assign "N" if at least one of the clinical concepts included in the code was not present on admission (e.g., COPD with acute exacerbation and the exacerbation was not present on admission; gastric ulcer that does not start bleeding until after admission; asthma patient develops status asthmaticus after admission)."Richard G. RN, CCS, CCDS
Richard,
I do not see any combination codes for pressure ulcers. For example if we have a pt who comes in with a stage 2 pressure ulcer of the left hip the code is L89.223, if that same ulcer progresses to a stage 3 during the encounter, the code is L89.223.
I agree that this is probably the intent of coding them both, but I haven't seen any official guidance stating that the first ulcer should be POA Y and the stage it progresses to be POA N. I am sure CMS will do some data collection for a year or so and then start issuing penalties.
Does someone have any concrete advice that supports the POA status of N for the progression of the ulcer? I have heard several webinars with leading industry experts and they seem to have differing opinions. Someone stated that their hospital had created a policy stating the 2nd ulcer would be POA N. I'd warn against until there's some concrete evidence (and there isn't in my opinion) issued by one of the cooperating parties. I understand guidance regarding combo codes but do not see any combo codes listed for pressure ulcers.
Thanks,
Jeff
After reading back over pressure ulcer coding I guess these codes are combo codes...I've just never thought of them that way as I would "Moderate persistent asthma with status asthmaticus".
So, since they are considered combo codes it would appear that it's correct to apply POA N to the progression of the wound. YIKES, that may spell trouble for some. I still wish that one of the cooperating parties would clear this up since there's a good bit of confusion surrounding the issue.
Thanks,
Jeff
What are other facilities interpretations? Are you going to be assigning POA N to the progression of the ulcer?
This question was directly asked of coding clinic and the response was as follows:
In ICD-10 CM, it would be appropriate to assign "Y" as the POA indicator to the pressure ulcer stage 3 (progression from stage 2 that was POA), since this code is referring to a pressure ulcer that was present on admission rather than a new ulcer.
Valerie
Thank you for the information.
Diane
Coding Clinic took any speculation out of the situation
4th Qtr 2016 pg 143 instructs you to assign POA "N" for the code associated with the progression of a pressure ulcer during the hospitalization.
Jeff
Jeff, have these guidelines been released? Where can I find a copy?
Thank you,
Jodi Thompson RN, BSN
I wanted to tag on to this discussion with another 2017 guideline question. It looks like BMI/obesity has some changes too?
under z68 it now states
"As with all other secondary diagnosis codes, the BMI codes should only be assigned when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses)." This is new. Do you take this to mean that we no longer can assume that ALL oberisty impacts care and we have to go back to querying the provider as to whether this is a dx that was 'evaluated, treated, monitored' or impacted care in some way?Katy
Looks like that might be ammunition for auditors to attempt to deny!
Jeff
Yes, the stage 3 would be classified as a HAC if not present on admission, therefore would not be an MCC. I just verified through 3M encoder.
- Richard
In the 2017 guidelines, under the categories of z codes (section I, C, 21) under Z68 it states "as with all other secondary diagnosis codes, the BMI codes should only be assigned when they meet the definition of a reportable diagnosis".
For what its worth, we are continuing to report the BMI if obesity, malnutrition, underweight, etc is documented in the record....