Physician Practice

No pressure: Ulcer reporting to change in ICD-10-CM

Physician Practice Insider, September 22, 2015

Healthcare facilities spend considerable resources trying to prevent and treat pressure ulcers, but they are a common condition that can occur in any setting, including residences and nursing homes. More than 2.5 million people are affected annually by pressure ulcers, according to the Centers for Disease Control.

A pressure ulcer develops due to prolonged pressure, leading to injuries of the skin and underlying tissue. They most often develop on skin that covers bony areas of the body, such as heels, ankles, hips and buttocks, says Jaci Johnson Kipreos, CPC, CPMA, CEMC, COC, CPC-I, AAPC National Advisory Board president and president of Practice Integrity of Henrico, Virginia.

Pressure ulcer stages
The National Pressure Ulcer Advisory Panel (NPUAP) categorizes pressure ulcers by four main stages. Similarly to ICD-9-CM, codes in ICD-10-CM follow NPUAP definitions for pressure ulcer stages.

Stage 1 is identified by non-blanchable erythema, or redness, on the skin. This means on people with lighter skin color, the skin won’t briefly lighten, or blanch, when touched, according to Kipreos.

On people with darker skin, no change in color may be apparent, but the skin won’t blanch when touched, says Kipreos. It could also appear ashen, bluish, or purple.

The skin is intact with a stage 1 press ulcer, but the area may be painful, firm, soft, warmer, or cooler to the touch, according to the NPUAP.

A stage 2 pressure ulcer is an open wound that occurs when the epidermis (outer layer of the skin) and part of the dermis (underlying layer of the skin) is damaged or lost, according to Kipreos. The pressure ulcer may appear as a shallow, pink or red basin-like wound, she says. It may also appear as an intact or ruptured fluid-filled blister.

The NPUAP defines a stage 2 pressure ulcer as having partial thickness skin loss, and notes this stage should not be used to describe skin tears, tape burns, incontinence-associated dermatitis, maceration, or excoriation.

At stage 3, a pressure ulcer is a deep wound, Kipreos says. The ulcer has a crater-like appearance and the loss of skin usually exposes some amount of subcutaneous fat. The damage may extend beyond the primary wound below layers of healthy skin. The wound may include slough (yellowish dead tissue), but it does not obscure the depth of tissue loss.

Stage 3 pressure ulcers include full thickness skin loss, according to the NPUAP, but bones or tendons are not visible. The depth of the wound depends on its anatomical location. For example, the ear does not have subcutaneous fat tissue and the wound may be shallow. However, a stage 3 pressure ulcer on the buttocks would be much deeper.

A stage 4 pressure ulcer exhibits large-scale loss of tissue, according to Kipreos. The wound may expose muscle, bone, or tendon. The bottom of the wound is likely to contain slough or eschar, a dark, crusty dead tissue. The damage will often extend beyond the primary wound below layers of health skin, she says.

Stage 4 pressure ulcers can extend into muscle and supporting structures, such as fascia and tendons, leading to osteomyelitis or osteitis, infection or inflammation of the bones, according to the NPUAP. The NPUAP, and ICD-10-CM, also include a fifth stage for unstageable pressure ulcers. These are defined as wounds with full thickness skin or tissue loss in which the depth of the ulcer is obscured by slough and/or eschar in the wound bed. Once the dead tissue has been removed, the true depth can be determined and the wound will be classified as either stage 3 or 4.

Read more on HCPro’s website.

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