Pressure Ulcer: Unstageable --> Stage 3 or 4

I know there has already been some great discussion re: Coding of Pressure Ulcers that progress to a higher stage during hospitalization. The latest directive is:

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!

Comments

  • 1) Code to the highest level of specificity
    2) For your particular case, code stage 3 or 4 and POA yes!
  • What a great question.  Yes, this new guideline muddies the water in this type of situation.  I think key here is that the pressure ulcer could not be staged UNTIL it "opened up" or was debrided (which often occurs) so it isn't necessary to reflect an evolution of the pressure ulcer because a pressure ulcer was present on admission.  As such, until additional guidance is offered through Coding Clinic, I would think people will continue as they have always done, report the applicable stage (once staging can be done) as POA.  Depending on the length of the admission, if the pressure ulcer evolves from a stage 3 to a stage 4, it could still be captured by the coded data.  Cheryl Ericson    
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