section M question

[glm777, BSN, RN]

A resident developed a deep tissue injury that we coded on his last MDS as a stage 4 - Deep Tissue Injury. It has since opened and is now a stage 2 pressure ulcer. Should I code this as a "worsening" pressure ulcer on the MDS I need to do this week? Is it considered "worse" just because it is now open?

Also, if a pressure ulcer is coded as a stage 3 on the last MDs and it is now a stage 2 - am I correct in coding it as a stage 3 still, since back staging is not allowed? What if it starts out as a stage 2 then progresses to a stage 3? I would code it as a stage 3 - correct? You don't backstage but you can upstage.

I have to wonder if they really needed to make this section so complex

[PsychNurseWannaBe, BSN, RN]

Thankfully I don't have a lot of experience in section M because I do not have pressure ulcers on my unit. Is Stage IV, sDTI an option? That does not make sense to me sense sDTI is INTACT skin and therefore you can not see any depth. Again, haven't had to code anything like this in a while. I do know that we don't reverse stage. If it is a stage IV and it is healing, it remains a stage IV until it is healed. If it was a stage II and went to a stage III then it is a worsening pressure ulcer depending on the circumstances. If the II to III happened in the facility then it will "count" against you. If a sDTI progresses and opens, then it is coded according to the stage it currently is. I would really have to walk through section M next time I get a pressure ulcer just to make sure I coded it right.

[Talino]

A resident developed a deep tissue injury that we coded on his last MDS as a stage 4 - Deep Tissue Injury. It has since opened and is now a stage 2 pressure ulcer. Should I code this as a "worsening" pressure ulcer on the MDS I need to do this week? Is it considered "worse" just because it is now open?

If it is one and the same site, you cannot call it a St IV and at the same time a DTI. If you coded it as both, you are referring to two different sites which you'll need to correct if already submitted. A DTI that opened will be reclassified to the actual stage - St II in your case. Since this is the first staging, code M0800 A,B,C = 0.

Also, if a pressure ulcer is coded as a stage 3 on the last MDs and it is now a stage 2 - am I correct in coding it as a stage 3 still, since back staging is not allowed? What if it starts out as a stage 2 then progresses to a stage 3? I would code it as a stage 3 - correct?

Correct!

[glm777, BSN, RN]

Thank you!