Ulcers - Decubitus only

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Template:Discussion Hi guys

  • Besides the 4 stages of pressure ulcer which we are collecting there is another category we are going to add: Unstageable pressure injury - Obscured full-thickness skin and tissue loss.
    • Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels is normally protective and should not be removed.This is apparently worse than stage 4.
  • Question:
    • do you see this charted? If you so see it charted how do you code? Trish Ostryzniuk 17:06, 2017 August 21 (CDT)
      • I don't t recall seeing this at the Grace ICU or Medicine, it would be charted by the wound care team and nursing, with dressing changes.Lisa Kaita 07:37, 2017 August 22 (CDT)
      • I will start looking for this description. All along so far I just try to quickly determine which stage 1-4 it is and I do not read further about it.--LKolesar 08:28, 2017 August 22 (CDT)
      • I have coded 94500-Ulcers - Decubitus only with no subcode for unstageable pressure injuries. I recall seeing instructions to code this way at one time on WIKI but can't find now Pamela Piche 09:05, 2017 August 22 (CDT)
      • I haven't encountered unstageable pressure ulcers so far. Usually when they come in and it's unclear, the patient gets wound care consult and the pressure ulcer gets staged. I have attended a wound care lecture before and deep tissue injury is deemed as another type of pressure ulcer (for more info, DTI). Malcudia 13:27, 2017 August 22 (CDT)


Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Decubitus (pressure) ulcer, Stage I (surface reddening), Decubitus (pressure) ulcer, Stage II (to fascia, just under skin), Decubitus (pressure) ulcer, Stage III (deep, to but not including muscle), Decubitus (pressure) ulcer, stage not indicated, Decubitus (pressure) ulcer, Stage IV (involves muscle, tendon, or bone)

Click Expand to show legacy content.


edit dx infobox
Category/Organ
System:
Category: Dermatological Non-Infectious (old)

Type:

Category: Medical Problem (old)

Main Diagnosis: Ulcers - Decubitus only
Sub Diagnosis: ULCERS - DECUBITUS only
Diagnosis Code:
  • 94500 - Ulcers - Decubitus only
  • 94501 - Stage 1 - surface reddening of skin
  • 94502 - Stage 2 - just under skin
  • 94503 - Stage 3 - deep-to muscle
  • 94504 - Stage 4 - full layer-to bone
Comorbid Diagnosis: No
Charlson Comorbid coding (pre ICD10): 0
Program:
Status:
StopDate: "" contains an extrinsic dash or other characters that are invalid for a date interpretation.

Collectability of Decubitus Ulcers

Template:Discussion Are collectors able to easily pick up from charts if patient has a decubitus ulcer? Reason I am asking is that one site is reporting a high number of bedsores compared to others? Wondering if there collection practice differences?--TOstryzniuk 15:00, 30 April 2010 (CDT)Trish Ostryzniuk 22:24, 2012 October 12 (CDT)

  • is the Braden Bed score sheet being used on all medicine wards now in the Region?Trish Ostryzniuk 19:07, 2012 October 11 (CDT)
    • Yes all Hsc medicine wards use the Braden Score.--CMarks 13:33, 2012 November 16 (EST)
      • yes all GGH medicine wards use the Braden Score Lisa Kaita 12:26, 2017 May 18 (CDT)
    • The Braden Score is used at STB--LKolesar 08:13, 2017 August 22 (CDT)

HSC

ICU HSC

  • ?

Medicine HSC

  • HSC B3- Pat is finding that there is poor documentation on charts about when and decubitus ulcer present on admission or when acquired after coming to a ward. (exception, HSC_D5 is excellent with documentation. Stage of ulcer is rarely documented in the chart. Pat looks at the nursing FLOW SHEET for indication of some sort of a dressing change that would clue her in that there may be a bed sore. Pat will then track down a bedside nurse to find out what dressing is for and if bedsore what would be the stage. Most time it is a guess because of poor documentation by both Doc and Nurse. PStein
  • On A4 I check for the following: note from Dr Embil (if applicable),nurse's notes, any consults if they mention it/them, nursing flow sheet. Quite often it is a guessing game for the most part.--CMarks 11:37, 6 May 2010 (CDT)

STB

    • Currently, as soon as I note a dressing or documentation about skin breakdown, I try to find out if the patient came with this or if it is a new thing. Sometimes it is easy to find but sometimes it can be almost impossible to find the information. If it is a significant decubitus ulcer, it is usually well documented.--LKolesar 08:22, 2017 August 22 (CDT)

ICU STB

    • what we are seeing in ICU 2010-2012 is that Decubitus is not coded in admit or acquired. In these 153 cases where TISS76 item84is marked but not coded in diagnosis, 60 have all 6 admit slots filled up but only 3 have all 9 complication slots filled up. So the reason reason being that complication slots are mostly filled up is not a correct assumption. One of the issue at STB is that collectors don't find clear documentation in chart.Trish Ostryzniuk 19:03, 2012 October 11 (CDT)
      • It is important to note that if skin breakdown is already present on admission, it will not be put in the complication section even if there is room for this. --LKolesar 10:11, 2012 October 12 (CDT)
        • Since this is a quality of care issue and should be monitored more, we will asked the ICU Task team, QI team and ICU director for further input. If we need to raise the importance of collectors finding this information on chart, & if poor charting, how can ICU better document? Another option is to include it on new TISS28. Will follow up with email to Jodi Walker Tweed.-Trish Ostryzniuk 19:03, 2012 October 11 (CDT)
          • See: Significant complications ICU & Significant complications medicine.
            • I think it should be included on the new tiss for 4 reasons: 1. the nurses are the ones to notice the skin condition and should be the ones to document this. 2. The nurses are used to doing this already on the TISS. 3.It is not always well documented in the physicians notes. 4. It would be the easiest way to have this in the database because reviewing charts for this type of information is very time consuming!--LKolesar 10:09, 2012 October 12 (CDT)

Medicine STB

Medical wards have same problem as described by Pat S. Rarely, there will acctually be a very good note, by the 'skin and wound' nurse.ENagy 15:45, 7 May 2010 (CDT)

VIC

ICU VIC

  • ?

Medicine VIC

  • At the Vic
  • Available information sources on EPR:
    • 1. Under Flowsheet tab-Care and Assessment-Integumentary System-provides skin status assessment on patients located in VIC ER
    • 2. Under Documents tab-Assessment Emergency-Nursing-Integumentary-provides skin status assessment on patients located in VIC ER
  • Available information sources found on paper:
    • 1. Nursing Assessment and Handoff Unit (Part 2) Assessment Update and Admission Form-Integumentary section. This paper form is completed by ER staff prior to transferring patient to unit
    • 2. Skin and Wound Assessment Form A (Braden Pressure Ulcer Risk Assessment) form completed in ER or on admit to unit
    • 3. Patient Care Flow Sheet-"SKIN" section completed daily by nursing
    • 4. IPN entries
    • 5. Wound and Skin Consults and Responses completed PRN
    • 6. In Hospital Transfer Report Sending Unit form under "Skin" section completed by sending unit nursing staff with intrafacility patient transfers. On the back of the form is the In Hospital Transfer Form Receiving Unit form under "Skin" section completed by the receiving unit/nursing staff.

GRA

ICU GRA

  • The nurses do a very good job of documenting ulcers under skin integrity on their daily flow sheet Lisa Kaita 12:25, 2017 May 18 (CDT)

Medicine GRA

  • The Medicine flow sheets at the Grace have a large area for daily documentation of skin care and integrity; usually reddened areas and wounds are noted here. To accurately grade the ulcer we use Braden score sheets which are filled in fairly well, otherwise the documentation is found on the IPN.

CON ICU

We have a section in our flow sheet for skin integrity. If the wound is such that they have consulted the wound care nurse, then I will have a good idea of how deep it is, but otherwise not. Generally if the wound is infected I will be able to pick that up in the charting too. Often I will see a new dressing, but am not able to find out why the drsg is being applied.

OAK ICU

  • At the Oaks information re: "skin-cwcm" condition is documented under CVS on the ICU Patient assessment record/flowsheet and/or IPN. If the area breaks down and requires a dressing the staff list the dressing site on the same flow sheet under "dressings"--I have not found that many since covering here.Mlaporte 08:01, 11 May 2010 (CDT)

See Also