Tip of the week: Understand clinical descriptions of pressure ulcer stages
HIM Connection, June 10, 2008
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Pressure ulcers, a condition that CMS designates as preventable, occupy center stage in hospital pay for performance (P4P). After October 1, any stage 3 or 4 hospital-acquired pressure ulcer not designated as POA will not incur additional inpatient reimbursement. Because stage 3 or 4 pressure ulcers are major complications and comorbidities (MCC) that add $8,400 to an average base surgical admission, no one can afford to mischaracterize them. Unfortunately, coding staff members cannot code these from the wound care nurse’s assessment; physician documentation and staging is mandatory.
The National Pressure Ulcer Advisory Panel stages pressure ulcers as follows:
- Suspected deep tissue injury. Consists of discolored areas of intact skin or blood-filled blisters due to damage of underlying soft tissue from pressure and/or shear.
- Stage 1. Presents as intact skin with nonblanchable redness or other color change of a localized area usually over a bony prominence.
- Stage 2. Presents as partial thickness loss of dermis and appears as a shallow open ulcer with a red pink wound bed, without slough, or as a blister.
- Stage 3. Occurs when there is full thickness tissue loss without visible bone, tendon, or muscle. Note that the bridge of the nose, ear, occiput, and malleolus do not have subcutaneous tissue, thus stage 3 ulcers in these locations can be shallow.
- Stage 4. Occurs when there is full thickness tissue loss with exposed bone, tendon, or muscle.
- Unstageable. Occurs when there is full thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar in the wound bed.
Visit www.npuap.org/pr2.htm for more information on these stages and descriptions.
Editor’s note: This tip was adapted from the June issue of Medical Records Briefing. For more information or to purchase a copy of the article for $10, visit www.hcpro.com/content/211139.cfm.
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