Section M

RE: dialysis shunt site. This is surgically created.

Therefore, it is possible that you could code:
M4g. Surgical Wounds - Includes healing and non-healing, open or closed surgical incisions, skin grafts or drainage sites on any part of the body. This category does not include surgical wounds of the eyes or oral mucosa, healed surgical sites, stomas, or lacerations that require suturing or butterfly closure as surgical wounds. PICC sites, central line sites, and peripheral IV sites are not coded as surgical wounds.

But only if the shunt site is not yet healed.

AND-
M5f. Surgical Wound Care - Includes any intervention for treating or protecting any type of surgical wound. Examples of care include topical cleansing, wound irrigation, application of antimicrobial ointments, application of dressings of any type, suture removal, and warm soaks or heat application.

If this care is given.

Good luck!

I would not code a dialysis shunt under section M (for the same intent you don't code PICC's and IV's!).

Perfectly understand your concern. However, the RAI Manual does not specifically exclude dialysis AV shunt sites.

The difference is that a dialysis shunt is PLACED SURGICALLY--and, obviously, requires different observations and can have far different complications. A central IV line, a PICC line, and a peripheral IV are NOT placed surgically (though a surgeon may place the line, and an x-ray may be taken to confirm proper placement.)

Hopefully, MDS 3.0 will provide more clarity in each item so that we do not have to "guess" or presume the item intent.

Well I guess we will have to agree to disagree. Until the RAI INCLUDES dialysis shunt sites, I won't be coding it. I live in Indiana. As well as being audited by state surveyors, we are also audited annually by an independent contractor (EDS) to ensure our CMI rates are justifiable. They are nice people, but EXTREMELY strict... if you cann't prove beyond a shadow of a doubt that you are allowed to code something, then you are penalized for coding it. You also are required to have an 80% pass rate of all records audited or the facility is fined. I can't afford to be wrong.