Kennedy Ulcer

LarissaStein

Hello,

We are discussing Kennedy ulcers at our facility and would like to know if others have seen this and how they are addressing it.  Are they being coded as pressure injury's or as non-pressure ulcers?  Are you sending queries to determine if an ulcer is a Kennedy ulcer, pressure injury, etc. when identified after admission, during the dying process?

I have provided some links below, including one from ACDIS which didn't indicate the source that said to not code them as pressure injury's.  We have heard that these will be addressed in an upcoming coding clinic.  It sounds like this guidance will state to code a Kennedy ulcer as a pressure injury, but it may only pertain to LTCH's.

Any additional information you have would be helpful, thanks!

https://acdis.org/articles/qa-coding-kennedy-ulcers

http://jmlevinemd.com/unavoidable-kennedy-ulcer-in-long-term-care-hospitals/ 

Larissa Stein, RHIT, CCS, CCDS
CDI Quality Liaison

sondra.hess@outlook.com

I also had this concern regarding Kennedy Terminal Ulcers. The literature all regards them as pressure ulcers, but there was not (and still isn't) an Index entry for that term. So I sent a question to AHA. The response from Coding Clinic that I eventually received and shared with my HIM leadership was that these ulcers should be coded as due to pressure. It will be nice to see it as official guidance.

Sondra Hess, CCS, CRC

sondra.hess@outlook.com

Here is what they said back in 2012.......

"A Kennedy Terminal Ulcer is a rapidly developing pressure sore that occurs in premorbid patients. Assign specific codes for the stage and location of the pressure ulcer, when Kennedy Terminal Ulcer is documented.  If the documentation is unclear as to the stage and/or location of the ulcer, query the physician for clarification of the Kennedy Terminal Ulcer."

Sondra Hess, CCS, CRC

lprescott1

I have previously submitted a question to AHA Coding Clinic on this subject.  I attached information about Kennedy Ulcers and their etiology and asked if these must be coded as pressure ulcers. I did get an answer that instructed me to code as a pressure ulcer, but I have not seen any formal publishing of this direction. I would suggest others submit the same question and perhaps if they are further educated they will see this type of ulcer as very different. It is important to understand when coding clinic replies to an individual that is does not mean an approved directive to the "masses". 

LarissaStein

Thank you for the feedback, this is very helpful!  I wish there was a separate code to identify this type of pressure injury, it's unfortunate that this impacts quality reporting.

afrady@blr.com

One of the problems here is the insipid nature of the development of a pressure injury.  In many cases the underlying ischemic injury has either already occurred or is in process of time the admission.  I believe ulcers assigned to present on admission of less than four days in the hospital are suspect.  Even when poor care is given during a longer admission the ulcer might not be visible until after discharge, giving the hospital a free pass.  Only CMS would imply that a homeless patient who has been sleeping on the side walk, malnourished and was admitted to a hospital and proceeded to be warmed, cleaned, given food and placed on a therapeutic bed who subsequently developed a noticeable pressure injury 48 hours later was the fault of the hospital.    I agree with Laurie, everyone should write in about these issues.  Specifically, the KTU situation, which is NOT “avoidable” in many cases. 

LarissaStein

We will be bringing this up to the Coding Clinic Editorial Advisory Board and hopefully get a response.  It would be very helpful to have a separate code for Kennedy Ulcers.