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Skin Conditions Starting With M

MDS 3.0. Provider Updates Section M

Music playing Dave Nolley Welcome to the Centers for Medicare and Medicaid Services Post Acute Care Provider Training Series. My name is Dave Nolley and I’m moderating today’s training session of MDS 3.0, specifically we will focus on the coding of Section M Skin Conditions. Before we begin discussing this section of the MDS 3.0, I would like to offer an important reminder. While the 2013 MDS 3.0 education programs provide great information about select sections of the MDS 3.0, it’s critical to remember that the RAI User’s Manual, which is available at the CMS.

Website must be used routinely by assessors to ensure accuracy in coding the MDS 3.0. Chapter three of the RAI User’s Manual provides the assessor with stepbystep coding instructions for each section found on the MDS 3.0. Now, before I go any further, I would like to introduce our panelist for this program. Joining us today are Jennifer Pettis and Lori Grocholski. Hello Jennifer and Lori, and thank you for joining us. In addition to discussing the encoding instructions for select items in Section M, Jennifer and Lori will use examples to demonstrate some coding scenarios related to M0700, most severe.

Tissue type for any pressure ulcer. Throughout the program we will address frequently asked questions from providers regarding Section M. We will not cover all items in Section M in this training, but instead we’ll focus on the few items that generate the most questions related to skin conditions. In chapter three of the RAI User’s Manual the reasons for including each group of assessment items in the MDS is described in the section’s intent. Now, Jennifer, would you explain the intent of Section M, Skin conditions, with our audience Jennifer Pettis.

Sure Dave I’d be happy to. The items in Section M document the risk, presence, and appearance of pressure ulcers as well as changes related to pressure ulcers. This section also documents other skin ulcers, wounds, or lesions and documents some treatment categories related to skin injury or avoiding injury. It’s also important for the clinical team to recognize and evaluate each resident’s risk factors and to identify and evaluate all areas at risk of constant pressure. A complete skin assessment is essential to effective pressure ulcer prevention in skin treatment program. Nursing home staff should be certain to take a holistic.

Approach to the assessment process, part of which is to determine the ideology or the cause of all wounds and lesions, as this will determine and direct the proper treatment and management of the wound. Dave Nolley Now, you said that it is imperative that the etiology of the wound be assessed in order to direct proper treatment and management. Can you talk a little more about that Jennifer Pettis Well, Dave, on the MDS 3.0 Section M captures several types of wounds, ulcers, and skin conditions. When assessing an ulcer one of the first and perhaps.

Greatest clues as to the ideology is its location. Let’s talk about just four types of skin conditions and the ideology associated with each to start today’s training, pressure ulcers, diabetic foot ulcers, venous ulcers, and arterial ulcers. The location of the ulcer will provide key information as to its ideology. For instance bony prominences, such as the sacrum, the coccyx, trochanters, ischial tuberosities, and heels are areas on the body that are known places where pressure ulcers develop. Additionally, other areas such as bony deformities skin under braces, and skin subjected to excessive pressure,.

Shear, or friction is also at risk for pressure ulcers. Diabetic foot ulcers tend to be found on the plantar or bottom surface of the foot closer to the metatarsal. Arterial wounds do not typically occur over a bony prominence, they are usually seen on the tips and tops of the toes, tops of the feet, or distal to the medial malleolus or inner ankle. Venous wounds most commonly occur proximal to the medial or lateral malleolus or on the lower calf area of the leg. Consider the example of a resident with diabetes. A person with diabetes may.

Have one or more types of ulcers previously mentioned. If a resident with diabetes has an ulcer on the foot the specific location will be a tremendous clue to the assessor as to the type of wound. If the diabetic resident presents with a heel ulcer from pressure, the ulcer would be coded as a pressure ulcer on the MDS 3.0 whereas if a resident with diabetes has an ulcer on the plantar or bottom surface of the foot closer to the metatarsal, it’s much more likely that it’s a diabetic foot ulcer. In the case of the latter, pressure is still likely.

A factor and would need to be addressed to promote healing, but in this case it would likely not be the primary cause. Dave Nolley Well, thanks for the helpful information, Jennifer. Lori, we heard from Jennifer how significant location is in determining etiology and ulcer type. What are other factors that will be considered in differentiating various ulcers such as venous, arterial and neuropathic’ Lori Grocholski Some other characteristics of ulcers to consider include sensation, the amount of exadate spelled phonetically, and the tissues in and surrounding the ulcer. Venous ulcers may or may not be painful and are typically shallow with irregular.

Wound edges and a red granular or bumpy wound bed. These ulcers tend to present with minimal to moderate amounts of yellow, fibrinous material and they generally have moderate to large amounts of exadate. The surrounding tissues may be erythematous, or reddened, or appear browntinged due to a protein that contains iron called hemosiderin, leg edema or swelling may also be present. Arterial ulcers are often painful and have a pale pink wound bed or present with neurotic tissue, a deep round punched out appearance with irregular but distinct boundaries, minimal to no exadate, poor granulation tissue, and minimal or no.

Bleeding. Arterial ulcers may also exhibit coolness to touch, absent pedal pulses, decreased pain when feet are dependant, increased pain when elevated, blanching upon elevation, delayed capillary refill time, hair loss, and top of the foot and toes, and toenail thickening. Diabetic foot ulcers are caused by the neuropathic and small blood vessel complications of diabetes. The ulcers are usually deep with neurotic tissue, moderates about of exadate, and callous wound edges. The wounds are very regular in shape and the wound edges are even with a punched out appearance. These.

Wounds are typically not painful. While Jennifer already mentioned that diabetic neuropathic ulcers generally occur on the plantar surface of the foot, it is also important to mention that foot deformities may be seen in the diabetic resident including Charcot Foot. Charcot Foot occurs in people with significant neuropathy. The neuropathy causes weakening of the bones in the foot that may lead to fracture and as the disorder progresses there are fractures leading to the foot taking on an abnormal shape, often presenting with a rocker bottom appearance. Dave Nolley What would clinicians look for that would lead them to the conclusion that the.

Etiology of an ulcer is pressure Lori Grocholski For pressure ulcers it might be helpful to refer to the definition. A pressure ulcer is localized injury to the skin andor underlying tissue, usually over a bony prominence as a result of pressure or pressure and combination with shear. So really anything that could cause pressure to bony prominences or contribute to shearing of the skin are things that the assessor needs to be aware of. As far as clinical characteristics of pressure ulcers go, once a pressure ulcer is identified, the stage of a pressure ulcer will greatly determine what the.

Assessor will see in the wound itself. The appearance of skin surrounding the ulcer and characteristics of the drainage can vary greatly with pressure ulcers regardless of the stage. Pressure ulcer staging is based on the ulcers deepest anatomic soft tissue damage that is visible or palpable. If a pressure ulcer’s tissues are obscured such that the depth of soft tissue damage cannot be observed, it is considered to be unstageable. Dave Nolley It sounds like there is a lot of information for the assessor to consider when determining ulcer type. What can you tell us about the staging system and how it.

Relates to the MDS 3.0. Lori Grocholski Before we get into the actual staging system itself it is important to understand that CMS has adapted the 2007 National Pressure Ulcer Advisory Panel or NPUAP staging guidelines in the MDS 3.0. Please be aware that the definitions used do not perfectly correlate with each stage as described by the NPUAP. The assessor must use MDS 3.0 staging definitions. Although the MDS does not track each specific pressure ulcer over time, it does capture current pressure ulcers, pressure ulcers present on admission, and pressure ulcers that have worsened or.

Healed within the lookback period. Dave Nolley Thanks, Lori. It’s important to understand that a difference in staging guidelines exists between the NPUAP and the MDS 3.0 definitions. Let’s continue discussing how to document pressure ulcers on the MDS 3.0. Lori Grocholski Once the assessor has determined that the lesion andor skin condition being assessed is primarily related to pressure and that other conditions have been ruled out, it is captured as a pressure ulcer in M0300 on the MDS 3.0. the assessor also documents for all stages other than stage one, whether or not the.

Ulcer is present on admission and documents the date of origin of the oldest stage two pressure ulcer. I’ll discuss stages one through four and then Jennifer will review the three unstageable pressure ulcers that are captured on the MDS 3.0. A stage one pressure ulcer is defined on the MDS 3.0 as an observable, pressurerelated alteration of intact skin, which may include changes in one or more of the following parameters. Skin temperature, the area may be warmer or cooler than the surrounding tissue. The tissue consistency may be more firm or.

Boggy than the surrounding tissue or opposite area. There may be a change in sensation in the area such as pain or itching andor there may be a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones the ulcer may appear with persistent red, blue, or purple hues. The number of stage one pressure ulcers is documented in M0300A. Stage two pressure ulcers have particle thickness loss of dermis, which present as a shallow, open ulcer with a red, pink wound bed without slough. They may.

Also present as an intact or open ruptured blister. Stage two pressure ulcers are documented in M0300B as is the date of the oldest stage two pressure ulcer and if this pressure ulcer was present on admission. Stage three and four pressure ulcers are both full thickness wounds in which subcutaneous fat may be visible and which may include undermining or tunneling. To differentiate a stage three from a stage four pressure ulcer, the assessor should note that bone, tendon, or muscle is not exposed in stage three ulcers. And in stage four pressure ulcers, at least one of these structures are exposed.

In other words, at least one of these structures will be visible or directly palpable. Slough may be present in a stage three but it does not obscure the depth of tissue loss. In a stage four, slough or eschar may be present on some parts of the wound bed. Stage three and four pressure ulcers are documented in M0300C and D respectively, as well as whether or not these ulcers were present on admission. Dave Nolley Thanks, Lori, for that description of Stage one through four pressure ulcers. Now, Jennifer, before describing unstageable pressure ulcers, would you tell us.

About determining whether or not a pressure ulcer is present on admission We do get many provider questions about that. Jennifer Pettis In order for a pressure ulcer to be considered present on admission it must be present at the time of admission, entry, or reentry and not acquired while the resident was in the care of the nursing home. The assessor should first consider current and historical levels of tissue involvement and refer to scenarios that are detailed in the RAI User’s Manual for clarification. Dave Nolley Well, one question comes from Arizona. On admission, the resident has three.

Small Stage 2 pressure ulcers on her coccyx. Two weeks later, two of the Stage two pressure ulcers have merged and the third has increased in numerical stage to a Stage three pressure ulcer. The provider goes on to ask how the merged pressure ulcers should be addressed in M0300 including related to present on admission. Jennifer Pettis The two stage two ulcers that have merged, even though merged, are still considered present on admission because they did not change in numerical staging. The assessor will code the two merged ulcers as one stage two pressure.

Ulcers in M0300B1, number of stage two pressure ulcers and M0300B2, number of these stage two pressure ulcers that were present on admission, entry, or reentry as one. In M0300B3, date of oldest stage two pressure ulcer, the assessor should enter the date of origin of the older of the two merged ulcers. The third ulcer increased in numerical stage subsequent to admission from a stage two to a stage three and is therefore coded in M0300C1, number of stage three pressure ulcers as one, and M0300C2, number of these stage three pressure.

Ulcers that were present on admission, entry, or reentry will be coded as zero. This ulcer is not considered as present on admission any longer because it has increased in numerical stage from a stage two to a stage three since admission. Dave Nolley Ok, I see. Now, we heard from Lori about the Stage one through four pressure ulcers and Jennifer, you discussed the concept of present on admission. Where do the unstageable pressure ulcers fit into this discussion Jennifer Pettis The MDS 3.0 allows the assessor to document the presence of three types of.

Unstageable pressure ulcers. Unstageable pressure ulcers related to nonremovable dressings or devices are captures in M0300E. Examples of nonremovable dressings or devices include a dressing that is not able to be removed per physician’s order, an orthopedic device, or a cast. If the pressure ulcer is unstageable due to the presence of slough andor eschar, it would be documented in M0300F and ulcers that present as suspected deep tissue injury or SDTI are captured in M0300G. Deep tissue injury is defined in the RAI User’s Manual as a purple or maroon area of discolored, intact skin due to damage of.

Underlying soft tissue. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared to adjacent tissue. For all of these ulcers, the assessor will determine whether or not it was present on admission. It is important to note that if the pressure ulcer was unstageable on admission, entry, or reentry but becomes numerically stageable later, it should be considered as present on admission at the stage at which it first becomes numerically stageable. If it is subsequently increases in numerical stage, that higher stage should not be considered present on admission.

Dave Nolley We received a provider question from a provider in Colorado related to coding a pressure ulcer in M0300. The provider states that the resident arrived two weeks ago to the nursing home. Upon admission, he had a pressure ulcer on the right metatarsal head that was completely obscured with eschar. On his fiveday PPS assessment, which was combined with his Admission assessment, the ulcer was coded in M0300F, Unstageable Slough andor eschar. In M0300F2, the pressure ulcer was coded as present on admission. The facility has been treating the.

Ulcer with an enzymatic debridement agent and it is now approximately eighty percent covered with slough, visually obscuring the true depth of the ulcer, but the metatarsal head is palpable. How should this pressure ulcer be coded on the 14 day assessment And Lori, can you offer the provider some advice on how to code this Lori Grocholski The pressure ulcer does not have to be completely debrided or free of all slough andor eschar tissue in order for reclassification of stage to occur. To spite being approximately 80 percent covered by slough, the resident’s bone is.

Directly palpable and the ulcer now meets the definition of a stage four pressure ulcer and will be coded as such in item M0300D stage four. Because the pressure ulcer was unstageable on admission, it is not considered to be worsened because this is the first assessment that the pressure ulcer is able to be numerically staged. The pressure ulcer will continue to be considered present on admission. Dave Nolley Thanks, Lori. Before we move on, let’s tackle another provider question. This one comes from Kentucky and asks Mr. K was admitted to the facility earlier in.

The week. Mr. K was reported to have a Stage two pressure ulcer on his right ischial tuberosity as noted on his admission skin assessment. The nurse completing the admission skin assessment described the ulcer as two centimeters by one centimeter by point one centimeter and recorded that the wound bed contained one hundred percent red granulation tissue. Now, according to RAI User’s Manual Stage two pressure ulcers do not have granulation tissue, slough, or eschar. What should we do to ensure accurate coding of section M So, Jennifer, any advice for this provider.

Jennifer Pettis Well, review of the medical record including skin care flow sheets and other skin tracking forms is an important step in completing Section M. It’s also important that the assessor speak with direct care staff including the treatment nurse to confirm conclusions from the medical record review as well as conduct a physical assessment of the resident. For each pressure ulcer, the clinical team must determine the deepest anatomical stage and be sure to consider current and historical levels of tissue involvement. Because stage two pressure ulcers are partial thickness wounds and heal by a reepithelization, the presence of.

Granulation tissue in the wound would indicate that it is in fact a full thickness wound and not a partial thickness wound therefore in this example, this pressure ulcer could not be coded as a stage two pressure ulcer. Being able to differentiate tissue types and understand the definitions of the pressure ulcer stages is an essential component to ensuring accuracy of the assessment and subsequent treatment and care. It may be necessary to involve the resident’s physician, nurse practitioner, or other care provider in this assessment. It would also be important in this case to review documentation that may provide.

Insights into the history of the pressure ulcer. If the pressure ulcer has ever been classified at a higher numerical stage than what it is observed now, it should be continued to be classified at that higher stage. For example, if a resident’s transfer records indicated that two months ago the resident had a stage three pressure ulcer on his right ischial tuberosity, this pressure ulcer would be coded in item M0300C1 as an unhealed stage three pressure ulcer and in M0300C2 as present on admission. Dave Nolley I understand there is another item that is closely related to determining.

Present on admission. This item M0800, Worsening in Pressure Ulcer Status Since Prior Assessment OBRA or Scheduled PPS or last admissionentry or reentry, had some additional language added in Version one point ten of the RAI User’s Manual. Jennifer, I understand these changes hinge around the definition of worsening pressure ulcers. Jennifer Pettis That’s right Dave. CMS’s definition of worsening is, a pressure ulcer that has progressed to a deeper level of tissue damage and is therefore staged at a higher number using a numerical scale one through four. Using the staging.

Assessment system classifications assigned to each stage, starting at stage one and increasing in severity to stage four on an assessment as compared to the previous assessment therefore if a numerical stage is not available to compare to a prior numerical stage, the determination of worsening cannot be made according to this definition. However, CMS realizes that if in for example, a stage two pressure ulcer becomes covered with slough it has indeed clinically worsened to at least a stage three pressure ulcer since stage two pressure ulcers cannot contain slough. At this point in time, this distinction is not.

Reflected in Section M coding however, it is something that the assessor should understand. Again, only when numerical stages are available for comparison can a determination of worsening be made in item M0800, according to the current definition of worsening in the RAI User’s Manual. The information added includes two important points. The first is if a pressure ulcer was numerically staged and becomes unstageable due to slough or eschar, the assessor should not consider this pressure ulcer as worsened. The only way to determine if this pressure ulcer has worsened is to remove enough slough or.

Eschar that the wound bed becomes visible. Once enough of the wound bed can be visualized andor palpated such that the tissues can be identified and the wound can be restaged, the determination of worsening can be made. The second added instruction addressed when two pressure ulcers merge. This instruction states not to code the merged pressure ulcers as worsened although two merged ulcers might increase the overall surface area of the pressure ulcer, there would need to be an increase in numerical stage in order for it to be considered as.

Worsened. Dave Nolley So, when a Stage two pressure ulcer becomes covered with slough it has clinically worsened to at least a Stage three but this distinction is not reflected in the Section M coding. Lori, are there any other examples that may not be reflected in the MDS 3.0. which are especially pertinent to our discussion of Section M Lori Grocholski The MDS 3.0 does not capture all functional and clinical issues occurring with the resident, it only captures what is specifically detailed on the item set and in the RAI User’s Manual. There is another great example of this in Section M.

With mucosal pressure ulcers. This is one of the additions to the RAI User’s Manual that’s based on the evolving science related to skin assessment and pressure ulcer coding. Ulcers due to pressure that occur on a mucosa are not staged using the NPUAP skin staging system as anatomical tissue comparisons cannot be made. In their position statement on this issue, the NPUAP states that it is understood that these ulcers may indeed be due to pressure, however anatomically analogous tissue comparisons cannot be made. The NPUAP goes on to state, further it is NPUAP’s position that mucosal pressure ulcers not be.

Classified as partial or full thickness because clinical assessment of the tissue does not allow the distinction. CMS agreed with this position statement and decided that it was an important distinction to add to the RAI User’s Manual therefore, pressure ulcers on mucosal tissue are not coded in Section M. If pressure ulcers are identified in oral mucosa, they should be coded in Section L item L0200C, abnormal mouth tissue. If a mucosal pressure ulcer occurs on a mucus membrane other than nose and the mouth, it will not be captured on.

The MDS 3.0. Consider this scenario regarding a resident that was admitted after gastrointestinal surgery. The resident had a nasogastric tube removed the day prior to coming to the facility. On the admission nursing assessment, the nurse noted that there was an intranasal mucosal ulcer on the medial aspect of the resident’s left nostril that appeared to have been caused by the nasogastric tube. There were no pressure ulcers or other skin or mucosal issues noted on the resident’s skin assessment. The assessor rightly did not code the mucosal ulcer in Section M as a pressure ulcer she did however code the medicated ointment.

Being used on the intranasal ulcer in item M 1200H, applications of ointments, medications other than to feet. Dave Nolley Interesting, interesting. Let’s address one more provider question about staging of pressure ulcers before we move on to discuss pressure ulcer measurement. A provider from Michigan asked the following. In 2012, the NPUAP issued a position statement which states that pressure ulcers with exposed cartilage are stage four pressure ulcers. Does CMS agree with this when it comes to coding the MDS 3.0 Lori Grocholski CMS does agree with the NPUAP’s position statement and in fact, there is a.

Coding tip that was added to the RAI User’s Manual that addresses this very issue, where it states, cartilage serves the same anatomical function as bone therefore, pressure ulcers that have exposed cartilage should be classified as a stage four. Dave Nolley Ok, great. Well let’s move on to discussing M0610, Dimensions of unhealed, Stage three or four pressure ulcers or unstageable pressure ulcer due to slough and or eschar. Let’s spend a few minutes reviewing some general information about coding this item and then address a relevant provider question. Jennifer.

Jennifer Pettis Thanks, Dave. To code M0610, if a resident has one or more unhealed stage three or four pressure ulcers or an unstageable pressure ulcer due to slough andor eschar, the assessor will identify the pressure ulcer with the largest surface area as determined by multiplying length by width and record its dimensions in centimeters in this item. It is critical that providers note the MDS 3.0 definitions for length, width, and depth. Using the pressure ulcer with the largest surface area, determine these values by considering the following, the.

Longest length from head to toe is the length of the wound, the width is the longest point that is side to side and perpendicular or at a 90 degree angle to length, and the depth of the same pressure ulcer should be measured from the visible surface to the deepest area of the ulcer. If depth is unknown, the assessor should enter a dash in each box. There are several steps to measuring outlined in the RAI User’s Manual as well as some coding tips. Assessors should be sure to refer to this information prior.

To completing M0610. Dave Nolley A provider writes, I am the MDS Coordinator in a facility with a wound care nurse who assesses all residents with wounds on a weekly basis. The wound nurse is concerned that the measurements that are noted on the MDS 3.0 don’t account for undermining or tunneling. She is especially concerned that this is not accounted for in one particular resident with three centimeters of undermining from two to nine o’clock on the wound. Should I obtain this resident’s wound measurements only by measuring the distance between healthy skin tissue at each.

Margin for the length and width or should I somehow include this undermining What should I do to ensure my MDS is accurate Jennifer Pettis Another great question, assessment of the pressure ulcer for tunneling and undermining is an important part of the complete pressure ulcer assessment. Measurement of tunneling and undermining is not recorded on the MDS 3.0, but should be assessed, monitored, and treated as part of the comprehensive care plan. To ensure the MDS 3.0 measurements are accurate, length is simply measured as the distance between healthy skin at the longest point head to toe and width.

Is measured between healthy skin perpendicular to that, in other words, the longest point side to side. Dave Nolley Ok. I’m going to turn to both of you for discussion at this point for the last item that we’re addressing in today’s training. M0700, Most Severe Tissue type for Any Pressure Ulcer. To demonstrate the coding options for this item we’ve prepared five scenarios along with five coding options. We’ll offer each of you one of the various scenarios, one at a time, and ask you to provide us with the.

Correct code along with a little more information about that code. Now Lori, the first scenario is for you to consider. A Stage three pressure ulcer on the sacrum presents with red bumpy tissue that has filled seventy five percent of the ulcer and light pink tissue that has resurfaced twenty five percent of the ulcer. Lori Grocholski There are two tissue types that you described there. The light pink tissue sounds like epithelial tissue and the red bumpy tissue in the stage three ulcer meets the definition of granulation tissue. In this scenario that you describe,.

The correct code is 2, granulation tissue which should be used if the wound is free of slough and eschar tissue and contains granulation tissue which is red tissue with a cobblestone or bumpy appearance. Granulation tissue bleeds easily when injured. Dave Nolley Ok. Jennifer, the next scenario is for you. A Stage 2 pressure ulcer is noted to have light pink, shiny tissue becoming visible in the wound. How would you code this in M0700 Jennifer Pettis The correct coding for that would be 1, epithelial tissue. Epithelial tissue is.

New skin that is light pink and shiny, even in persons with darkly pigmented skin. In stage two pressure ulcers, epithelial tissue is seen in the center and edges of the wound, whereas in fully sickness stage three and four pressure ulcers, epithelial tissue advances from the edges of the wound. Dave Nolley Ok, Lori, back to you. A Stage four pressure ulcer has twenty five percent black hard tissue present, seventy five bumpy red tissue present, and scant epithelialization at the edges of the wound. How would this be coded.

Lori Grocholski In that case, the correct coding is for eschar. Eschar is dead or devitalized tissue that is hard or soft in texture, usually black, brown, or tan in color and may appear scab like. Eschar is usually firmly adherent to the base of the wound and often the sides or edges of the wound even though there is less eschar present in the wound than granulation tissue, eschar is the answer since it is the more severe tissue type present in the wound. Dave Nolley Ok. This next one’s for you Jennifer. A pressure ulcer presents as a purple area.

Of discolored skin. The area is boggy and warmer than the surrounding tissue. Jennifer Pettis That scenario describes suspected deep tissue injury or SDTI. And none of the tissue types presented in M0700 apply to SDTI so correct coding is nine, none of the above. Code nine indicates that none of the choices available apply. This would be coded in the case of a stage one pressure ulcer, a stage two pressure ulcer with an intact blister, an unstageable pressure ulcer related to a nonremovable dressing or device, or an unstageable pressure ulcer related to.

Suspected deep tissue injury. The code of nine is being used in these instances because the wound bed cannot be visualized and therefore cannot be assessed. Dave Nolley Oh, Ok. Lori, the last scenario is for you. A Stage three pressure ulcer is covered with seventy five percent granulation and contains yellow stringy tissue covering approximately twenty five percent of the ulcer. Lori Grocholski Dave, that yellow, stringy tissue meets the description of code three, slough. Slough is nonviable tissue that is usually moist, can be soft, stringy, and mucinous in texture. It is possible that slough be one of several colors.

Including yellow, tan, gray, green, or brown. Slough may be adherent to the base of the wound or present in clumps throughout the wound bed. Dave Nolley Thank you, ladies. That was a great way to demonstrate the coding of M0700. We’ve covered a lot of information in today’s training, but Section M of the MDS 3.0 has many items that we did not discuss. It’s imperative that the RAI User’s Manual be reviewed carefully regarding coding all sections of the MDS 3.0 including Section M, skin conditions. We would like to thank our presenters.

Jennifer and Lori. And if you have additional questions regarding Section M, please refer to the RAI User’s Manual. If you need further clarification, please feel free to contact your state RAI coordinator. The work that you do is important to ensure that the best possible care and quality of life is afforded to the residents at America’s nursing homes. music playing And to all of you taking part in this educational activity, I would like to extend a final thank you on behalf of myself, Jennifer, Lori, and CMS. CMS Section M 3 31214.

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