Pressure ulcer queries

holly.bird@imail.org

At my facility we have been told to query any time there is documentation of an ulcer, whether or not it is pressure, venous, diabetic ect. This is new for us as in the past if i have no clinical indicators of a pressure ulcer, other than the word ulcer I would not query. Also I  thought that pressure ulcers stage 1 and 2 were exluded as HAC whether poa or not. Is this true? I see no rationale for this type of query. For example even if a pt presents w a pu stage 1 or 2 not stated as poa, and it progresses to a 3 or 4 , the hospital buys it. Whether it was stated poa in that scenario wouldnt matter. Now an unstageable pu would need to be clarified for poa status in case of a debridement revealing the stage. Querying for a 3 or 4 stage would be appropriate to try to get on admit if the clinical indicators and treatment are there correct. We have just been writing many queries clarifying for stage 1/2 documented as on admit by the provider, resulting ina lot of query fatigue . What rationale am i missing querying for stage 1 and 2 pu on admit? 

morris-jeff@CooperHealth.edu

CDI is tasked with helping portray the clinical truth, not just with what alters reimbursement. If the patient has indicators of a stage 1 or 2 with treatment you should seek to clarify this. Stage 1 and 2 are risk adjustment diagnoses in many models and also increase SOI/ROM in many cases....so, they would show that your patient is sicker and/or debilitated upon admission to your facility. 

So, even if you are paid on an MSDRG payment model, you’d want to ensure accurate SOI/ROM to portray how sick the patient is and the resources they consume. Also, you’d want those risk adjustment diagnoses, especially if the patient dies. 

Im not in front of my computer right now, but are stage 1 and 2’s HCC’s? If so, another argument to capture. 

Seems like queries could be reduced by some MD education and collaboration with wound care for staging. 

Hope this makes sense and helps. 

Jeff 

katysuegood@gmail.com

Many of the VBP metrics rely on risk adjustment which includes ulcers of all stages. They need to be captured prior to index admissions so capture of all ulcers on all encounters is valuable.

Katy

holly.bird@imail.org

Agreed with portraying a true clinical picture for the pt and thank you for commenting. I do believe that an on afmit status does make a difference in the soi rom world, although i think maybe even a pu not staged qualifies as an hcc. I just have been reviewing queries for my staff, one today where the wound nurse was documenting a venous stasis ulcer, and so the CDI queried asking the physician to document the type location and stage if applicable of the ulcer in his notes. Maybe the query could have been worded differently because the type was stated  query development opportunity..ugh physician education, whats that? Haha lol. Work in progress always. Tks!