Whats New? MDS 3.0 Update in Wound Care
March and April, CMS has reconsidered its original guidance regarding how to code blister pressure ulcers on the revised Minimum Data Set (MDS) version 3.0. Previously, CMS directed that any pressure ulcer that presents as a blister regardless of what type of fluid seen (serous, sero-anguineous, or blood filled) was to be coded as a stage 2 . This is no longer true, not all pressure ulcer blisters are coded as stage 2 for MDS 3.0.This
July, CMS posted new information on its website that shifts the coding
of pressure ulcer blisters to differentiate between those that are
stage 2 (M0300B) from those that are unstageable suspected deep tissue
injury (M0300G) based on a more comprehensive assessment of the resident and ulcer site.
Visual observation of the type of fluid in the blister is not enough;
you must now do a complete staging assessment that includes determining
if the tissue adjacent to or surrounding the blister has any signs of
tissue injury. These can include skin color changes (darker than
surrounding skin), differences in tissue consistency (bogginess or
firmness), tenderness, or skin temperature changes (warm or cool).
Remember that despite an adequate lighting source, assessment of deep
tissue injury may be difficult in residents with darkly pigmented skin.
CMS has stated in the updated RAI manual that “Stage 2 ulcers will generally
lack the surrounding characteristics found with a deep tissue injury”
while “blood-filled blisters related primarily to pressure are more
likely than serous filled blisters to be associated with a suspected
deep tissue injury.” “Do not code M0300G when a lesion related to
pressure presents with an intact blister and the surrounding or adjacent soft tissue does not have the characteristics of Deep Tissue Injury.”
While CMS continues to use the adapted NPUAP 2007 pressure ulcer staging definitions in section M for MDS 3.0, this most recent coding change brings long term care staging guidance more closely in alignment with pressure ulcer staging in other care settings.
MDS
3.0 is brand new, and we will continue to have late breaking updates,
so please be patient and understand that standards are continuing to
evolve. Continue to visit the official CMS website for any other changes or updates as we countdown the days to the planned MDS 3.0 implementation date of October 1, 2010.
Our
EMR has reflects the assessment and documentation needed for you to
complete the MDS 3.0 M section. Our wound specialist and our EMR are
the ultimate resource to help you maintain compliance with MDS 3.0
documentation to achieve superior outcomes in wound healing.
