M1306: CMS OASIS Q&As

If a patient develops two pressure ulcers that are separated by intact skin but have a tunnel which connects the two, they remain two pressure ulcers.

If the cause of a wound is solely a friction force which leads to visible skin impairment, such as the serum filled blister cited in the scenario, it would NOT be categorized as a pressure ulcer.

These items are a report of the clinician's integumentary status assessment findings. A pressure ulcer/injury may be reported on OASIS based on visualization of the wound, patient assessment and interview, review of relevant related historical documentation and clinical judgment re: etiology. Although the assessing clinician can report the observed ulcer/injury on the OASIS integumentary status items without physician confirmation, collaboration with the physician is required in order to add a diagnosis and ICD-10-CM code to the OASIS diagnosis items and the patient’s Plan of Care and to receive related orders and/or provide physician ordered care related to the pressure ulcer/injury.

Once the full thickness pressure ulcer is completely covered with new epithelial tissue, the wound is considered healed and no longer reportable as a pressure ulcer on the OASIS.

If a pressure ulcer is closed with a muscle flap (defined as full thickness skin and subcutaneous tissue partially attached to the body by a narrow strip of tissue so that it retains its blood supply), the new tissue completely replaces the pressure ulcer. In this scenario, the pressure ulcer "goes away" and is replaced by a surgical wound. If the muscle flap healed completely, but then began to break down due to pressure, it would be considered a new pressure ulcer. If the flap had never healed completely, it would be considered a non-healing surgical wound.

If a pressure ulcer/injury was surgically closed with a skin graft or flap, the surgical wound healed, and another pressure ulcer/injury forms in the same anatomical location due to pressure, then this would be considered a pressure ulcer/injury. Note it should be staged at the highest stage the pressure ulcer/injury was prior to closure, unless currently presenting at a higher stage or unstageable.

For OASIS coding purposes, when a pressure ulcer is treated surgically with any kind of graft or flap, it is no longer considered a pressure ulcer and is considered a surgical wound until approximately 30 days after re-epithelialization. In your example, as this ulcer was surgically closed with a skin substitute, the wound should be reported as a surgical wound until the graft is completely healed and no longer reportable. If the flap or graft fails, it should continue to be considered a surgical wound until approximately 30 days after re-epithelialization.

If all the tissue damaged by pressure is removed surgically, e.g., amputation or surgical excision, there is no longer a pressure ulcer. It becomes a surgical wound until healed.

Only one pressure ulcer is present.

No. In order to stage the pressure ulcer as a Stage 4, bone, muscle, tendon, or joint capsule (Stage 4 structures) must be visible or directly palpable. A pressure ulcer that has some degree of necrotic tissue (eschar or slough) present that the clinician believes may be obscuring the visualization of the wound bed such that the level of tissue damage cannot be assessed, should be reported as unstageable due to slough and/or eschar, even if it was previously numerically stageable.

The first clinical skin assessment is the assessment used to complete the OASIS.This is to ensure consistency of data collection across all post-acute care (PAC) providers. The guidance to assess and report the pressure ulcer stage and status as close to SOC/ROC as possible applies to all OASIS pressure ulcer items.

If an ulcer/injury arises from a combination of factors that are primarily caused by pressure, then the ulcer/injury should be included in pressure ulcer items as a pressure ulcer/injury. End of life ulcers (also known as Kennedy ulcers or terminal ulcers) result from organ failure and are not considered pressure ulcers and therefore not reported on the OASIS pressure ulcer items.

OASIS data set integumentary items only include wounds and lesions to the integumentary system and do not include mucosal membrane wounds or lesions. Pressure ulcers occurring to mucosal membranes would be reported in the comprehensive assessment and clinical documentation but not in any of the OASIS integumentary items.

A patient with diabetes mellitus (DM) can have a pressure, venous, arterial, or diabetic neuropathic ulcer. The primary etiology should be considered when reporting whether a patient with DM has an ulcer/injury that is caused by pressure or other factors. Once etiology is determined, the ulcer would be reported in the appropriate OASIS item(s), if applicable. If, for example, a patient with DM has a heel ulcer/injury from pressure, the etiology of the ulcer would be considered pressure, not a diabetic or stasis ulcer, and would therefore be reported in the OASIS pressure ulcer items. The key to coding pressure ulcers is to determine if the primary etiology of the ulcer is pressure. The OASIS includes specific items to capture pressure ulcers, stasis ulcers or surgical wounds. Not all types of wounds will be captured in these items.

If a pressure ulcer is closed with a muscle flap, and before the muscle flap suture line heals completely, pressure causes new breakdown within the flap area (not along the suture line), this would be considered a new pressure ulcer, and until the muscle flap suture site is completely epithelialized for approximately 30 days, the flap site would remain a surgical wound. In this scenario, the patient would have both a new pressure ulcer and a surgical wound simultaneously.