Deep Tissue Injury

dvitalone1dvitalone1
in Clinical & Coding

I'm am looking for some guidance. Wound RN documents deep tissue injury of coccyx. MD does not mention anything about this or any other skin abnormalities in notes. Coder sent a query to MD validating this and asking for stage which MD responds stage 4!!!  OUCH!! I have researched NPUAP site. How do we code a deep tissue injury? pressure ulcer unspecified stage? Would you send a query to MD asking for stage since DTI is considered a stage?

Comments

  • rwillcuttrwillcutt
    It should be coded as an unstageable pressure ulcer.   I would not have queried for the stage until exposed.  The biggest issue is making sure that onced exposed, the pressure ulcer is documented as POA.  
  • gspataforegspatafore
    An unstageable pressure ulcer is a reportable condition, since a deep tissue injury is clinically different and not reportable, how are facilities handling this with their quality departments?
  • jmccorkl@stanfordhealthcare.orgjmccorkl@stanfordhealthcare.org
    I would have queried only for acknowledgement of the presence of a wound on coccyx and POA status.  A DTI is unstageable until/if/when it opens. I agree with rwillcutt above that it is important to be clear about POA if it was not stageable in the beginning.  
    References:
    Coding Clinic, Third Quarter 2016: Page 38
    Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2017: Page 109
    Jeanne McCorkle BSN, RN, CCDS
  • afrady@blr.comafrady@blr.com
    edited February 2018
    An unstageable pressure ulcer is a reportable condition, since a deep tissue injury is clinically different and not reportable, how are facilities handling this with their quality departments?

    Not according to coding clinic:

    A deep tissue injury is coded as an unstageable pressure ulcer. In ICD-10-CM, there is an existing index entry under deep tissue injury: Injury deep tissue meaning pressure ulcer – see Ulcer pressure, unstageable, by site

    Pressure Injury


    Full entry below:

    Coding Clinic, Third Quarter 2016: Page 38

    Coding advice or code assignments contained in this issue effective with discharges September 23, 2016.

    Question:

    Please advise how to code pressure injury in ICD-10-CM. There is no entry in the alphabetic index for pressure injury. In April 2016, the National Pressure Ulcer Advisory Panel (NPUAP) announced a change in terminology from "pressure ulcer" to "pressure injury" and also updated the stages of pressure injury. The change in terminology more accurately describes pressure injuries to both intact and ulcerated skin. In the previous staging system Stage 1 and Deep Tissue Injury described injured intact skin, while the other stages described open ulcers. This led to confusion because the definitions for each of the stages referred to the injuries as "pressure ulcers." In light of the NPUAP redefining pressure ulcers as pressure injury, can coders assume that a documented "staged pressure injury" is assigned to the corresponding decubitus/pressure ulcer codes? Will new index entries be created for "pressure injury" with the new code update?

    Answer:

    This is a change in terminology rather than a change in definition of pressure ulcer. For the term, "pressure injury" meaning pressure ulcer, code as a pressure ulcer by the site and stage or unstageable as appropriate. The stages of pressure injury used in the NPUAP's updated terminology correspond to the pressure ulcer stages in ICD-10-CM. Therefore, code a nontraumatic pressure injury the same as a pressure ulcer by site with stages one through four and unstageable. Pressure injury, stage 1-4 would be coded as pressure ulcer, stage 1-4. A deep tissue injury is coded as an unstageable pressure ulcer. In ICD-10-CM, there is an existing index entry under deep tissue injury:

    Injury

    deep tissue

    meaning pressure ulcer – see Ulcer

    pressure, unstageable, by site

    ICD-10-CM/PCS Coding Clinic. AHA CODING CLINIC® FOR ICD-10-CM/PCS 2018 is copyrighted by the American Hospital Association (“AHA”), Chicago, Illinois. Except as permitted by this Customer Agreement, no portion of AHA CODING CLINIC® FOR ICD-10-CM/PCS may be reproduced, sorted in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of the AHA.

    Forgive the all caps, when I do a direct copy and paste the sizing gets out of control and there is little I can do to re-size here.  Not meant as a yell, just too lazy to retype all that.
  • afrady@blr.comafrady@blr.com
    An unstageable pressure ulcer is a reportable condition, since a deep tissue injury is clinically different and not reportable, how are facilities handling this with their quality departments?


    Also not according to official coding guidelines:

    "Code 707.25 is used for pressure ulcers whose stage cannot be clinically determined (e.g., the ulcer is covered by eschar or has been treated with a skin or muscle graft) and pressure ulcers that are documented as deep tissue injury but not documented as due to trauma"

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