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Pressure Ulcers in Hospitals

Pressure Ulcers in Hospitals. Joanne Lynn, MD, MA, MS Medical Officer, OCSQ/QMHAG. The New ICD-9 Coding. Previously, could code only site Now, must also code stage Six codes – Stage I, II, III, IV and unspecified and unstageable

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Pressure Ulcers in Hospitals

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  1. Pressure Ulcers in Hospitals Joanne Lynn, MD, MA, MS Medical Officer, OCSQ/QMHAG

  2. The New ICD-9 Coding • Previously, could code only site • Now, must also code stage • Six codes – Stage I, II, III, IV and unspecified and unstageable Unstageable = not observable, Deep tissue injury, and slough/eschar

  3. The Hospital - Acquired ConditionPresent on Admission (HAC-POA) • Hospital payment will increase substantially if patient has Stage III or IV PU ON ADMISSION (or if they have another major complication) • Hospital payment will be unaffected by a Stage III or IV PU ACQUIRED DURING HOSPITALIZATION

  4. Determining “Present on Admission” • By coders at discharge – using physician notes and orders • Coded as clearly present on admission, clearly not present on admission, and unclear • At least starting in October, payment for “unclear” will track with “not present on admission” (and will be monitored)

  5. Measurement considerations • CMS picks up 9 ICD-9 codes for co-morbidity – codes beyond this are invisible • Coding software will tend to put codes in the first 9 when they increase payment • Can’t sort causes of “unstageable,” “unspecified,” and “unclear re POA” • Multiple lesions will be complicated…

  6. Merits of HAC-POA • Widely thought to have substantial payment impact • Strongly focusing the attention of hospital leadership • With the new MDS (Oct 2009) and OASIS (Jan 2010), analyses can illuminate hospital usage of codes and quality

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