Pressure Ulcer: Unstageable --> Stage 3 or 4
ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 (October 1, 2016 - September 30, 2017)
Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99)
a. Pressure ulcer stage codes
6. Patient admitted with pressure ulcer evolving into another stage during the admission
If a patient is admitted with a pressure ulcer at one stage and it progresses to a higher stage, two separate codes should be assigned: one code for the site and stage of the ulcer on admission and a second code for the same ulcer site and the highest stage reported during the stay.
My question is - if a PU is "Unstageable" on admission and later opens up to a stage-able status, do we code the second status? My understanding is that Unstageable pressure ulcers are deep but cannot be visualized to distinguish between Stage 3 or 4. The opening of the wound is not necessarily a progression to a higher stage, but coding Stage 3 or 4 after admission might appear as if it is a HAC.
How are other facilities handling this? Would you code the Stage 3 or 4 as POA (in which case, there would be no need for the Unstageable code)?
All ideas appreciated!