Unstageable if appropriate documentation if the wound is filled with eschar and the dept cannot be determined. It should not be reported if the wound is debrided during the stay. Deep tissue injury gets reported as unstageable . POA of N or Unspecified will is bad, however some times N is the clinical truth so we must report it. POA of Yes or W (unable to determine) is good.
All of this is actually covered very well in the official coding guidelines for this year.
Thanks for the reply, however my question is... Is it safe practice to document " possibly stg III or stg IV poa" as it is most likely beneath the eschar, and can, at times open up w/out any debridement to reveal the true stage, and that stage would have been already documented POA as written as a suspected stg III or IV.
That is actually within the official guidelines. Once previously unstageable wounds dept is revealed, then it should be reported as POA.
•What code and POA indicator are assigned
for an unstageable ulcer but has the eschar removed to reveal a Stage III or IV
pressure ulcer?
•Assign a code for the site with the
highest stage with a POA-Y
•Example – Unstageable ulcer, right lower
back_> Stage 3 revealed (L89.133-Y Pressure ulcer of right lower back, stage 3)
•The code for unstageable should only be
used when it is not possible to stage the ulcer during the current admission.
CC 4th Q 2017 pg. 110
•“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.”
CC does not address the coding of a "possible" stage, however once the stage is revealed as you pointed out, the previously documented "possible" stage is irrelevant. The stage that is actually discovered once revealed is what gets reported.
I am not aware of any convention that lets you report an ulcer that is clearly unstageable and NEVER revealed during an admission to its possible stage. The reporting convention for that scenario requires unstageable be reported.
Thank-you for clarifying that. The documentation of suspected Stg III or IV is not codeable and IS NOT coded, that's understood. At my institution when and unstageable is poa suspected Stg III or IV is documented in quotes by Nursing only, this codes to unstageable poa. This type of "suspected documentation" acts as a safety net, if the true Stg is revealed during the stay it helps the clinician in NOT documenting Stg III NOT POA. The updated documentation would state Stg III POA, and be coded as such. This documentation is helpful in the clinical field and helps averting an erroneous HAC. Thanks
Unstageable if appropriate documentation if the wound is filled with eschar and the dept cannot be determined. It should not be reported if the wound is debrided during the stay. Deep tissue injury gets reported as unstageable . POA of N or Unspecified will is bad, however some times N is the clinical truth so we must report it. POA of Yes or W (unable to determine) is good.
All of this is actually covered very well in the official coding guidelines for this year.
I have run into a case where the surgeon stated that preoperatively the decubitus ulcer was a stage II and after surgery it was a stage III. So how does this affect the POA of the now stage III ulcer? It doesn't seem right that it becomes a HAC when it is due to the debridement. Do I question the validity of the stage II classification prior to OR?
There is a recent coding clinic to assist you with this issue. 4th Quarter 2017, page 109. this coidng clinic asks about how should POA be assigned related to an unstageable pressure (present on admission) that is debrided to discover a stage 3 pressure ulcer. The answer was to "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 issue is you are describing a pressure ulcer identified as a stage 3 on admission not unstageable. My clinical experience tells me that likley the base of the wound described as stage 3 on admission was not visible and with the cutting of the necrosis a stage 4 was visible. BUT- we don't have clear direction related to your scenario. We cannot easily apply this coding clinic to your situation. This would be a great question to submit to coding clinic. As what to do in your situation- I would query the provider. If the provider states that the wound bed was not visible on admission and with debridement there was a stage three present on admission you could code it as such.
Comments
Unstageable if appropriate documentation if the wound is filled with eschar and the dept cannot be determined. It should not be reported if the wound is debrided during the stay. Deep tissue injury gets reported as unstageable . POA of N or Unspecified will is bad, however some times N is the clinical truth so we must report it. POA of Yes or W (unable to determine) is good.
All of this is actually covered very well in the official coding guidelines for this year.
Thanks for the reply, however my question is... Is it safe practice to document " possibly stg III or stg IV poa" as it is most likely beneath the eschar, and can, at times open up w/out any debridement to reveal the true stage, and that stage would have been already documented POA as written as a suspected stg III or IV.
Thanks.
That is actually within the official guidelines. Once previously unstageable wounds dept is revealed, then it should be reported as POA.
The opening of the wound does not indicate a progression to a higher stage.
Agreed! That is what clinicians need to be educated on.Thanks for the conversation Alan.
I have run into a case where the surgeon stated that preoperatively the decubitus ulcer was a stage II and after surgery it was a stage III. So how does this affect the POA of the now stage III ulcer? It doesn't seem right that it becomes a HAC when it is due to the debridement. Do I question the validity of the stage II classification prior to OR?
Thank you for your help!
Lisa