Home Health Diagnosis Coding: Pressure Ulcer or Dehisced Wound

by Alin S

Article by Jan Mater Cavagnero

If 1 can not certain whether or not to go for pressure ulcer coding or dehisced surgical wound coding in a certain scenario, read on to find much more on this.Question: 1 of our patients was admitted to service following a revision of a pedicle or flap graft (procedure code 86.75). The wound is becoming known as a dehisced surgical wound as it was at begin of care. The wound was originally a pressure ulcer prior to the first flap process. The depth is 2 cm while the wound bed is 50/50 granulation/difficult black eschar. And whilst the wound length is 7 cm, the width is 2 cm. So does this stay a dehisced surgical wound or is it now a pressure ulcer considering that the flap procedure has met with failure? Answer: OASIS C guidance points out that this wound is no longer a pressure ulcer once a flap process has been performed. It's a surgical wound. If the present wound started with dehiscence of the flap, it's still a dehisced wound. If the flap had healed and consequently broken down, it would be a pressure ulcer. This scenario brings to the fore an answered dilemma...As per the coding guidelines, you should code for a pressure ulcer with a muscle flap as an unstageable pressure ulcer with a code from the 707.0x Pressure ulcer) series, reporting the appropriate location in the fifth digit. You would want to follow this with 707.25x (pressure ulcer unstageable). Even so, in your scenario, you also have a dehisced surgical wound. In case there are no official guidance on the matter, report the dehisced surgical wound with 998.32 (Disruption of external operation [surgical] wound) and then follow the code with a list of pressure ulcer codes. But do well to remember that even if you could see down to the patient's bone by means of this wound, you are not coding for an open wound. That's not a right assumption in ICD-9 coding. Open wounds in actuality are trauma wounds. If the wound wasn't developed as a consequence of trauma such as a laceration puncture wound, cut, avulsion, or animal bite, it's not apt to list a code from the 870.x-897.x (Open wounds) categories. Alternatively: Complex surgical wounds occur when a surgical wound is not healing as was expected. Some thing has lead to the surgical wound becoming complex. Examples of complex surgical wounds are non-healing, infected, and postoperative fistulas. For a lot more info on pressure ulcer coding and wound care coding, there are different sources to support you out.

About the Author

Jan Mater-Cavagnero MA, HCS-D, specializes in diagnosis coding for residence well being agencies, as properly as the wide variety of issues that impact the hospice industry. Jan is an editor-in-chief for Eli Healthcare, where she has written Home Wellness ICD-9 Alert for five years.