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Discussion

section M question

We had a resident admitted who stayed a few days, then back to hospital, readmitted to us for 36 hrs, then back to hospital, now back again. Already did two PPS assessments that I combined with the discharges. She had documented everywhere-referral forms from hospital and last SNF, MD history and physical on both admits to us, admission nursing assessments, etc multiple stage 2 and 3 pressure ulcers. All were coded on section M on those two assessments already done and transmitted. Now on this last admission, the DON states the areas are not pressure ulcers, but should be coded as other lesions, as they are the result of shingles she had 3 years ago. She states she has now documented this in a nurses note and has discussed it with the RNP in the building as well. Does that make sense to anyone out there? I am not sure what to do about this-do I modify the two assessments I already sent in? Do I code these areas as other lesions? How can we be sure they are not pressure related? Anyone have any advice on this one please.........

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    section m data should be evidence-base.

    should the previous mds be modified? if the ulcers were captured as pressure ulcers based on the documents available as of the ard, then they are considered accurate and need not be modified.

    when completing the new mds, the more current documentation describing these ulcers as lesions, should be captured. your next question is "then, how should i code m0900a?" i will code it as no (0). if your software has a logic check, you will get inconsistency flags (when compared to the previous mds). however, they will not be fatal when submitted.

    (can't merge, see next post)

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    CAVEAT: Shingles (Herpes zoster) usually resolves in 2-3 weeks and seldom recurs. If it happened 3 years ago, these lesions are likely unrelated to that condition. If at all minutely relevant, they may now be vascular ulcers (arterial or venous). If I were the surveyor, identifying these same sites now as shingles-related lesions (contrary to documents provided by the previous SNF and hosp. physicians, including yours) is a deliberate attempt to manipulate the QI/QM report.

    I would strongly advise an MD (not the RNP) substantiate the finding and ... good luck!

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