M1340: CMS OASIS Q&As

A gastrostomy that is being allowed to close would be excluded from consideration as a surgical wound, because it is an ostomy.

The site of a peritoneal dialysis catheter is considered a surgical wound. The opening in the abdominal wall is referred to as the exit site and is not an ostomy.

Yes.

Yes, the surgical sites where such devices were implanted would be considered surgical wounds. It does not matter whether the device is accessed at a particular frequency or not.

The VANTAS® Implant is inserted just under the skin in the upper arm and provides a continuous 12-month administration of histrelin acetate for the palliative treatment of advanced prostate cancer. Once the surgical incision that was created to implant the device is made and until the implant device is removed, it is considered a surgical wound for M1340.

Yes, as long as the venous access device is in place, it is considered to be a surgical wound whether or not it is functional or currently being accessed.

While the surgical connection of a vein to an artery is not a synthetic access/device, an AV fistula is considered a current surgical wound once it is surgically created and as long as it is present in the patient's body. This is true even if the fistula never matures, and/or is not currently used for vascular access. In addition to AV fistulas, the sites of implanted venous access devices or other implanted infusion devices such as medication pumps, catheters for peritoneal dialysis, AV shunts or AV grafts should all be considered surgical wounds for as long as they are present, whether functional or not.

No, the presence of sutures does not automatically equate to a surgical wound. In the examples given, a peripheral IV, even if sutured in place, is not a surgical wound. A pressure ulcer does not become a surgical wound by being sutured closed, and the bowel ostomy would be excluded from M1340 - Does this patient have a Surgical Wound.

An implanted venous access device is considered a current surgical wound as long as it is implanted in the patient's body. When first implanted, the incision is the surgical wound. The assessing clinician will follow the guidance in Ch. 3 of the current OASIS Guidance Manual and the CMS OASIS Q&As to determine the healing status of the incision. Once it is fully epithelialized, the site due to the implanted device will remain a current surgical wound with a status of "Newly epithelialized" for as long as it is present in the patient's body, unless it later develops complications.

A simple incision and drainage (I&D) or simple debridement are not surgical wounds for OASIS reporting. A surgical procedure that involves excision of necrotic tissue beyond general debridement (such as excision of a necrotic mass), excision of mesh or other appliances or structures goes beyond a simple I&D/debridement and the resulting lesion would be reported as a surgical wound for M1340 until re-epithelialization has been present for approximately 30 days at which time it becomes a scar.

The wound in the example you cite would continue to be considered a diabetic foot ulcer, and not reported as a surgical wound.

Yes. Even though the opening was created percutaneously, it is considered a surgical wound because a drain was inserted.

For purposes of scoring the OASIS integumentary items, a typical incision and drainage procedure does not result in a surgical wound. The procedure would be reported as a surgical wound if a drain was placed following the procedure. Also, if the abscess was surgically excised, the abscess no longer exists and the patient would have a surgical wound. It is considered a surgical wound until re-epithelialization has been present for approximately 30 days at which time it becomes a scar.

The OASIS item response will not always mirror diagnoses and ICD-10 codes found in M1021/M1023 - Primary Diagnosis/Other Diagnoses. Continue to score the OASIS following current CMS guidance and follow ICD-10-CM coding guidance for code selection for M1021 and M1023.

When a surgical procedure creates a wound in which a drain is placed (e.g., an incision or stab wound), the presence of the drain (or drain wound site until re-epithelialization has been present for approximately 30 days at which time it becomes a scar) should be reported as a surgical wound. If a needle was inserted to aspirate abdominal fluid and then removed (no drain left in place), it should not be reported as a surgical wound.

Simply suturing a traumatic laceration does not create a surgical wound. A traumatic wound that required surgery to repair the injury would be considered a surgical wound (e.g., repair of a torn tendon, repair of a ruptured abdominal organ, or repair of other internal damage), and the correct response to M1340 - Surgical Wound for this type of wound would be 1 - Yes, this patient has at least one observable surgical wound or 2 - Surgical wound known but not observable due to non-removable dressing/device depending on whether or not it was observable.

Even though the physician utilized fluoroscopy to insert the peripherally inserted central catheter (PICC) and sutured it in place, it is not a surgical wound, as PICC lines are excluded as surgical wounds for OASIS data collection purposes.

Central venous catheters or central lines are those with the catheter tip located in the superior vena cava. Central lines can be peripherally inserted (i.e., basilic or cephalic vein in upper arm, or femoral vein in the groin) or centrally inserted (i.e., internal jugular vein in the neck, or subclavian or axillary vein in the chest). Central lines that are centrally inserted (as in the internal jugular example) ARE considered surgical wounds for M1340 because of the central insertion, even if the type of catheter inserted into the central vein was intended to be inserted peripherally. Central lines that are peripherally inserted are not considered surgical wounds.

If a cardiac catheterization was performed via a puncture with a needle into the femoral artery, the catheter insertion site is not reported as a surgical wound for M1340. The fact that a stent was placed does not have an impact.

If an incision or "cut down" was completed in order to perform a procedure per femoral sheath, this incision would be considered a surgical wound. A femoral puncture site created without "cut down" is not a surgical wound on M1340.

A wound with a drain is reported as a surgical wound at M1340. It remains a surgical wound after the drain is pulled until re-epithelialization has been present for approximately 30 days at which time it becomes a scar.

A shave, punch or excisional biopsy, utilized to remove and/or diagnose skin lesions, does result in a surgical wound. It is considered a surgical wound until re-epithelialization has been present for approximately 30 days at which time it becomes a scar.

Yes.

A lesion resultant from cryosurgery is not considered a surgical wound when scoring M1340 - Surgical Wound.

A callus that was removed is NOT considered a surgical wound when scoring M1340 – Surgical Wound.

When a surgical procedure creates a wound in which a drain is placed (e.g., an incision or stab wound), the presence of the drain (or drain wound site until re-epithelialization has been present for approximately 30 days at which time it becomes a scar) should be reported as a surgical wound. If a needle was inserted to aspirate fluid and then removed, (no drain left in place), it should not be reported as a surgical wound. If a physician performs a surgical procedure via arthroscopy, the arthrocentesis site would be considered a surgical wound until re-epithelialization has been present for approximately 30 days at which time it becomes a scar.

Per existing guidance, for M1340 - Surgical Wound, an incision created for the purpose of laparoscopic surgery, arthroscopy, and other minimally invasive surgery/procedure would be considered a surgical wound. It remains a current surgical wound until the site is completely epithelialized and is without signs/symptoms of infection for approximately 30 days, at which time it becomes a scar.

The Left Ventricular Assist Device’s (LVAD/HeartMate) cannula exit site would be considered a surgical wound until the LVAD is discontinued and the wound is re-epithelialized for approximately 30 days at which time it becomes a scar.

A chest tube site is a thoracostomy. Ostomies are excluded as surgical wounds in the OASIS. A chest tube site is not a surgical wound even if a chest tube or drain is present.

The wound described should be considered a thoracostomy and is not considered a surgical wound when completing M1340 – Surgical Wound.

A fistula is a complication of surgery but it is not a surgical wound. Though fistulas are sometimes located within surgical wounds, answering M1340 - Surgical Wound & M1342 Status of Most problematic Surgical Wound that is Observable would be based on the condition of the surgical wound, not the fistula, using the healing status guidance outlined in the OASIS Guidance Manual. For example, if the only opening in a 3-month-old closed surgical wound healed by primary intention was an enterocutaneous fistula then the answer to M1340 - Surgical Wound would be “0-No”.

No, a retention suture that utilizes a button to prevent damage to the skin is not considered a surgical wound.

The ON-Q pump was developed to continuously infuse local anesthetic through 2 small catheters inserted at the wound site. If the catheters are inserted into the surgical incision, they are not considered separate surgical wounds. If the surgeon implanted the catheters at locations other than the surgical incision, the insertion sites would be considered separate surgical wounds, as the ON-Q pump catheters are implanted infusion devices. After discontinuation of the infusion, the insertion sites would be considered current surgical wounds until re-epithelialization has been present for approximately 30 days at which time it becomes a scar.

The incision created to implant the VP shunt is a surgical wound until reepithelialization has been present for approximately 30 days at which time it becomes a scar. At this point it is no longer considered a current surgical wound, as the VP shunt is neither venous access device nor an infusion device.

Removal or excision of a toenail is not considered a surgical wound. If a surgical procedure was performed that goes beyond simple excision, it would be considered a surgical wound.

If the infusion device is implanted, it would also qualify as a surgical wound under M1340. An external device infusing medication via a SQ needle is not counted as a surgical wound.

For the purposes of the OASIS Integumentary Status items, a burr hole is a hole that is surgically placed in the skull, or cranium and is considered a surgical wound. It remains a current surgical wound until the site is completely epithelialized and is without signs/symptoms of infection for approximately 30 days, at which time it becomes a scar.

A peritoneal dialysis catheter (or an AV shunt) is considered a surgical wound in OASIS, as long as it is present in the patient’s body. This is also true for central lines and implanted vascular access devices.

Based on the details provided in the question, the incision created to insert the balloon catheter is considered a surgical wound in OASIS. Utilize existing CMS guidance to determine the healing status.

If the kyphoplasty procedure was performed percutaneously and resulted in a pinpoint needle puncture site where the bone cement was injected, it would not be considered a surgical wound. If the kyphoplasty procedure involved an open approach, requiring a surgical incision, the resulting wound would be considered a surgical wound for M1340.

The presence of a specific catheter type does not define a surgical wound. A Pleurx catheter inserted as a chest tube is considered a thoracostomy and would not be considered a surgical wound. All ostomies (including those with drains) are excluded as surgical wounds. A surgical procedure that creates a wound that is not an “ostomy”, and that has a drain (for example a Pleurx catheter, a Jackson-Pratt, etc.) would be considered a surgical wound.

For OASIS coding purposes, when any type of ulcer is treated surgically with any kind of graft or flap, it is considered a surgical wound for M1340 - Does this patient have a Surgical Wound until approximately 30 days after complete re-epithelialization.

For OASIS coding purposes, when any type of ulcer or burn is surgically treated with any kind of graft or flap, it is considered a surgical wound for M1340 - Does this patient have a Surgical Wound until approximately 30 days after complete re-epithelialization.

M1340 - Does this patient have a Surgical Wound identifies the presence of a wound resulting from a surgical procedure. The fasciotomy incision would be considered a surgical wound.

The incisions created to implant a pacemaker or loop recording device are surgical wounds until re-epithelialization has been present for approximately 30 days at which time, they become scars. At that point they would no longer be considered current surgical wounds, as neither the pacemaker nor the loop recording device, are a venous access device nor an infusion device.

If, at the SOC or other assessment time points, the clinician assesses the wound to be completely epithelialized (including no sign of infection or separation), and the date of complete epithelialization is unknown, the clinician will have to make a determination regarding the wound status based on the history of the date of surgery, any reported wound healing progress/complications and clinical assessment findings. Since for the purposes of the OASIS, a surgical wound is considered healed and no longer counted as a current surgical wound once re-epithelialization has been present for approximately 30 days (assuming no sign of infection or separation), then if based on the surgery date, it is clear that the completely epithelialized wound could not possibly have been fully epithelialized for at least 30 days, Response 0-Newly epithelialized should be reported. If the wound appears completely epithelialized (no sign of infection or separation) and the date of epithelialization is unknown, but based on the known wound history and date of surgery it is possible that the wound could have been fully epithelialized for at least 30 days, then the wound status is deemed “healed” and no longer reportable as a surgical wound.

Please refer to the definition of “not observable” used in the OASIS surgical wound items in the current OASIS Guidance Manual – “not observable” is an appropriate response ONLY when a non-removable dressing is present. This is not the case with a mediport. As long as the mediport is present, whether it is being accessed or not, the patient is considered as having a current surgical wound.

M1340 & M1342. Steri-strips are skin closures (similar in intent to sutures or staples) and not a dressing or device. Steri-strips will remain in place until they fall off unless there is a specific clinical reason and/or direction from the physician/allowed practitioner to remove them sooner. While they are in place, if the placement of the steri-strips allows sufficient visualization of the wound, the assessing clinician can determine and report on M1342 – Status of Most Problematic Surgical Wound that is Observable the appropriate healing status response, based on the healing status guidance outlined in the OASIS Guidance Manual. If the steri-strips completely obscure the incision, or obscure the incision to the point that the assessing clinician is unable to visualize the incision well-enough to determine the healing status, then M1340 Surgical Wound should be reported as Response 2 - Surgical wound known but not observable due to non-removable dressing/device, and M1342 would be skipped. Note that while steristrips are clinically different than a dressing or a device, the limitations of the OASIS data responses make this the best response in the situation described.

When a portion of the surgical wound is intact/healed, and a portion of the wound is open and healing by secondary intention, to determine the healing status consider the portion of the wound bed that is healing by secondary intention when applying the healing status coding criteria of “% of the wound bed covered with granulation tissue” or “% of wound bed covered with avascular tissue”. If the surgical wound has more than one area healing by secondary intention, separated by one or more areas of intact/healed tissue, all open areas healing by secondary intention would be included as the "wound bed”, when applying the percentages to determine healing status.