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!
Comments
2) For your particular case, code stage 3 or 4 and POA yes!
"If a patient is admitted with an unstageable pressure ulcer, and the eschar is removed to reveal the stage of the ulcer, assign the code for the ulcer site with the highest stage reported during the stay with a POA indicator of "Y". Do not assign a code for unstageable pressure ulcer, as the true stage of an unstageable ulcer cannot be determined until the slough/eschar is removed. The opening of the wound does not indicate a progression to a higher stage. The code for unstageable pressure ulcer should only be assigned when it is not possible to stage the ulcer during the current encounter"