News: National agency changes terminology associated with pressure ulcers

It seems change lurks near every corner we turn this year. While not every change results in significant shifts in CDI or coding practices, many still require our attention. In that regard, the National Pressure Ulcer Advisory Panel (NPUAP) announced two changes in the description of pressure ulcers recently.

 

The first, and relatively minor, change is a shift from Roman to Arabic numbers to identify the pressure wound stages to describe the extent or depth of the wound. Otherwise, the wound descriptions of stages 1-4, unstageable, and deep tissue injury, have not changed and are consistent with the ICD-10-CM code set. (For further information, related to the staging and wound descriptions visit http://www.npuap.org/.)

 

The second, and potentially more problematic, change regards NPUAP’s shift from the term “pressure ulcer” to the term “pressure injury” to more accurately describe damage to both intact and ulcerated skin. It describes a pressure injury as localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical device. The injury can present as intact skin or an open ulcer. These injuries result from intense and/or prolonged pressure or pressure combined with shear.

 

One reason behind the change is to alleviate the confusion between a stage 1 and deep tissue injury which are both used to describe an injury of intact skin, while the other stages describe open ulcers to the skin.

 

The term “suspected” has also been removed from the title of deep tissue injury.

 

ICD-10-CM includes phrases such as bed sore, decubitus ulcer, plaster ulcer, pressure area, and pressure sore as inclusion terms, meaning documentation of these terms will allow for the assignment of a code from the L89 code group for pressure ulcer. The term “pressure injury,” however is not listed.

 

The NPUAP is viewed as the leading authority related to pressure ulcer prevention and treatment. This panel provides education and research related to improved outcomes and prevention of pressure ulcers. Therefore, CDI professionals will likely soon begin to see providers using the term “pressure injury” in their documentation. The question is how will such documentation affect code assignment since there is no diagnosis code for “pressure injury.”

 

As CDI professionals we must now work with the issue that the expected professional terminology does not match the wording within the code set. This is much like how we struggled with the professional descriptions related to systolic and diastolic heart failure versus the more recent terminology of reduced or preserved ejection fraction.

 

When providers use terms that were not evident within the code set we have to query for the needed specification. Fortunately, after a number of years a change was made with the most recent AHA Coding Clinic that allows more flexibility related to the coding of heart failure.