Pressure ulcer left heel Stage 4 w/ osteomyelitis

lschoutenlschouten
in Home Care Coding General
How do you code pressure ulcer left heel stage 4 and now developed acute osteomyelitis with necrotic Achilles tendon. Had partial calcanectomy with debridement of Achilles tendon. No muscle flap
M1011 L89624
M86172
M70872?
M1021 Still have Pressure ulcer stage IV and now to you code surgical aftercare?
L89.624
Z48.89? or Z48.817

Comments

  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    Is the pressure ulcer still present or has it been excised with the I&D and partial bone excision to treat the osteomyelitis?

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • lschoutenlschouten
    Heel is sutured closed
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    Meaning the ulcer was excised?
    If that is the case, then you will no longer have a pressure ulcer, you have a surgical wound and underlying osteomyelitis in the adjacent bone. 2 processes.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • lschoutenlschouten
    Isn't it still a pressure ulcer unless you have muscle flap?
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    If it is resected, then it is no longer there.
    The flaps are for PU's that are not resected/resectable.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • eharcourt@ecommunity.comeharcourt@ecommunity.com
    edited April 2017
    Has something changed? According to what I was taught by Lisa Selman-Holman, the only time it change from a Stage 4 Ulcer was when the patient had a Muscle Flap. Even then we still are instructed to mark it as a surgical wound on the Oasis M questions, but continue to code an unstageable Ulcer. In fact I just checked her website and the Wound Information I found there had not changed.



    Thank you,
    Evelyn Harcourt HCS-D
    Data Entry/Coding Specialist
    621-4822
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    That is for pressure ulcers that are still present post-op and are flapped either for a "dressing" or to replace the PU (muscle flap, rotational flap).
    If the ulcer is in a place that can be cut out (excised), then the ulcer is no longer present on the body, period.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    I think you are confusing excisional debridement with resection.
    Look up those terms and you will see the difference.
    I just ran across a surgical case report of an Ischial Tuberosity Resection to eliminate the pressure ulcer.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
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