Alicia: Pressure ulcers these are fun,not quite as much fun as neoplasms, but most people that start out in the medical fieldwhen they’re young they end up working in, they used to be called nursing homes now.They are skilled facilities and stuff like that. So most of us have time in there, andpressure ulcers are something that is kind of the bane of the healthcare profession becausethey are very hard to treat and prevent. Q: It was asked by one of the students previously,pressure ulcers, how do we code them? You have to code the site where it’s located andyou have to code the stage. So, she wanted to know is it site stage, site stage; or isit site, site, stage, stage?
A: First, let’s figure out what a pressureulcer is. Pressure ulcers on the skin reduce blood flowto the area. Without enough blood, the skin can die and an ulcer may form. An ulcer isliterally like how you get a cold sore on your lip or something like that. That’s what’shappening. You are more likely to get a pressure ulcerif you are in a wheelchair. It doesn’t matter how old you are but you’ve got constant pressureon your buttocks, in your sacrum and stuff. Usually if you’re in a wheelchair you can’tfeel, so you don’t know when it’s starting to go numb.
If you’re an older adult, cannot move certainparts of your body without help because of a spinal injury or multiple sclerosis, havea disease that affects blood flow including diabetes or vascular disease like PVD orneuropathy or stuff like that and you’re not able to feel. You have Alzheimer’s diseaseor another condition that affects your mental status. In other words, you’re sitting fora long period of time and you don’t think to get up. You have fragile skin, the older you get,if you’ve noticed if you look at somebody that’s a whole lot older than you, you’llnotice their skin gets papery thin and you
can see the vessels and stuff. You have urinaryincontinence or bowel incontinence. Again, this goes with Alzheimer’s disease, if you’resitting in a chair and Alzheimer’s isn’t like you forgot where your keys are. Alzheimer’sis like when you can’t remember what a key is used for. If you can’t remember that youhave to go to the bathroom when you feel that discomfort, you have urinary incontinence.You do not get enough nutrition (malnutrition) that’s another keyway to have problems. Here are the main places that pressure ulcersoccur: The back of the neck, the head because of the bed, on your elbows. If you’ve everhad to be bedridden like if you were pregnant
or something, they made you stay in bed fora long time and you’re constantly pushing yourself, sliding yourself up in the bed,you’ll get pressure ulcers on the elbows. Your sacrum (the tailbone), buttock area,because that’s where people like to lay on their back and stuff, or on their sides orsacrums; that’s why they say you have to move every two hours or more often. The ankle andthe heel, you don’t think about that, but if you’re not moving and your foot sits fortwo hours in one position, your foot can go numb. So, that’s the most common places. Let’s get into the coding aspect of it. Theseare the common codes for pressure ulcers:
You’ve got 707.00 and they start with a zero.It goes all the way down to different body parts and they mainly list those red bulletedareas that we were talking about. Then, there are stages. Now these are going to be 707.02codes and each one of those is going to indicate a different. I did list all of these becauseI wanted to give you this description so you have a better understanding. Stage 1 is considered a superficial lesionwith discoloration of the skin, but the lesion is not actually an ulcer at this point. Itpresents as a nonblanching reddened area on the skin. Stage 1 indicates a higher riskfor serious pressure ulcer but does not cause