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

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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.