MDS 3.0--recording DTI--feedback to CMS needed

Published May 24, 2010

123 Posts

hi.

as most of you are aware, cms in the process of updating the rai manual. these updates will include modifications already announced via q & a's and train-the-trainer conferences, as well as others that cms deems appropriate.

one of the proposed changes--

(summarized and paraphrased)

do not follow npuap pressure ulcer staging guidelines. require mds-specific definitions for coding of suspected dti in evolution and stage ii ulcers.

information

npuap--suspected deep tissue injury:

purple or maroon localized area of discolored intact skin

or blood-filled blister

due to damage of underlying soft tissue from pressure and/or shear. the area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

change to--remove

or blood-filled blister

suspected deep tissue injury:

purple or maroon localized area of discolored intact skin due to damage of underlying soft tissue from pressure and/or shear. the area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

and

npuap--stage ii:

partial thickness loss of dermis presenting as a shallow open ulcer with a

red pink wound bed

, without slough. may also present as

an intact or open/ruptured serum-filled blister.

change to--

add blood

stage ii:

stage 2: partial thickness loss of dermis presenting as a shallow open ulcer with a

red or pink wound bed

, without slough. may also present as an intact or serum

or blood

-filled blister.

issue

accurate ulcer staging using agreed-upon clinical guidelines is the basis for statistics, research, outcome measurement, and treatment protocols.

in my opinion as a clinician, there is no legitimate reason for this change--and

it would make my job harder as i try to explain to the er, a surveyor, a family member or a jury that "...this stage ii wasn't a real stage ii--it was just "accurately coded" that way. we had all appropriate preventative and therapeutic programs in place--and knew that it would evolve into a stage iii or iv no matter what we did..."
clinicians in all healthcare settings must use the same clinical terminology whenever possible--and trust that the terminology has the same meaning across settings.

cms is still evaluating whether or not it will change the coding definition.

please send your comments as a clinician to cms at [email protected] now.

use as subject--coding of pressure ulcer stages

body--please indicate whether cms should or should not follow npuap definitions in reporting/recording pressure ulcer stages in the mds 3.0.

thank you.