pressure ulcers
I am noticing that many of our severe pressure ulcers are "unstageable" according to the WCON. Many of these are severe decubes that take many resources. Currently we have a morbidly obese patient with many wounds, the worst being her coccyx. This is an "unstageable" wound. So far, general surg has been consulted on this wound (no dictation yet) and in rounds they were discussing consulting plastics, so clearly this is resource intensive and not a minor wound. This wound was POA.
Do you come accross this at your hospital? If so, do you ask the WCON to document a probable stage considering it will likely be III-IV? Or do you just let this go since the WCON is stating is is unstagable. Is there another way to capture these resources that I am missing?
Thanks,
Katy
Do you come accross this at your hospital? If so, do you ask the WCON to document a probable stage considering it will likely be III-IV? Or do you just let this go since the WCON is stating is is unstagable. Is there another way to capture these resources that I am missing?
Thanks,
Katy
Comments
Robert
Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
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Sandy Beatty
1. How would you code out Incontinence associated dermatitis? 692.9 - Contact dermatitis/eczema due to unspecified cause or cause not listed
2. Do you code skin tears? If so, How? Hate skin tears! If documented by physician, code to injury (superficial or open) depending on the documentation.
3. What about 'shearing' injuries? If documented by the physician code to Superficial Injury (abrasion/friction burn).
4. What do you recommend in instances where we had a wound that was staged at some point in the admission but is later 'unstageable'?. For ex: Patient admitted with a stage II pressure ulcer. During a prolonged admission it progresses to a stage IV. Then later, eschar develops and it is stated to be 'unstageable'. Do you code a stage IV pressure ulcer (MCC, SOI/ROM 3/2) or an unstageable pressure ulcer (NCC, SOI/ROM 1/1)? Code to deepest level documented.
5. Whose documentation do you accept for staging? I realize we can take documentation from physicians, WCON's, Physical Therapy, etc. But do you also accept staging from bedside nurses? Use staging documented by nurse's since they are verified by wound care nurse.
I would appreciate others' comments/ideas on how they code these conditions.
Sharon Salinas, CCS
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
ssalinas@barlow2000.org