PSI 3 Pressure Ulcer

There is ongoing discussion in my organization regarding the assignment of Stage 3 or 4 pressure ulcers.

Scenario:  Patient admitted with a deep tissue injury, which was present on admission.  DTI progresses to be able to be staged as a stage 3 or 4 pressure ulcer. We are currently coding the DTI as POA Yes and the pressure ulcer as POA of No, based on coding guidelines regarding staged ulcers progressing to other stages during the stay. However, wound care states the pressure ulcer was likely POA, just not able to be staged until the DTI had progression to a ulcer.

I have reached out to others and an external auditing company and a query is recommended to determine POA status of the PU.  Does anyone know how a POA of "W" impacts the PSI?  We have put in place to query the provider in these instances and I can see them responding with clinically undetermined.

Is anyone doing something on this topic in their organization?


  • We have this same question at our facility especially with our COVID patients. I was hoping someone would have provided some insight on this. It is very confusing when they start as a DTI then evolve to a stage 3 or 4. I can't seem to find clear guidance on this. I will continue to research and hopefully someone can provide some insight.

  • Did this 1st Quarter 2021 Coding Clinic help any?

    Evolving deep tissue injury   

       ICD-10-CM/PCS Coding Clinic, First Quarter ICD-10 2021 Page: 24 Effective with discharges: March 10, 2021


     A patient presents with a sacral deep tissue injury (DTI), and undergoes surgical debridement. Following excisional debridement, the provider documents "Stage 4 pressure ulcer of the sacrum." Should guideline I.C.12.a.7, be interpreted to mean that only one code (L89.--6) is assigned for the DTI, whether the stage is later revealed or not? What is the correct ICD-10- CM code assignment and present on admission (POA) indicator, for this case?




    Assign code L89.154, Pressure ulcer of sacral region, stage 4, to capture the stage 4 pressure ulcer revealed following debridement of the DTI, with the POA indicator "Y".

  • A POA of "W" means the provider was unable to determine. However, it does count as a POA of yes and will not impact the quality scores or PSI 3.

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