Q&A: Clarifying new guidance for pressure ulcers, deep-tissue damage

Q: Our coding department was told there were changes made for fiscal year (FY) 2020 when it comes to reporting healed/healing pressure ulcers and pressure-induced deep tissue damage. Can you explain any recent updates?

A: You are right, there have been updates to guidance surrounding these diagnoses.

First, the FY 2020 ICD-10-CM Official Guidelines for Coding and Reporting have additional clarity on patients admitted with pressure ulcers documented as healed. The guidelines added the phrase “at the time of admission.” The guidelines now state that “there is currently no code assignment for pressure ulcers that are completely healed at the time of admission.”

In contrast, if the pressure ulcer is documented as healing but not yet healed, the coder is to code the pressure ulcer to the appropriate pressure ulcer stage at the time of admission. Meaning, if the pressure ulcer was to the bone (stage 4) but improves during the stay to only include the depth of the subcutaneous tissue (stage 3), the pressure ulcer is to be reported as a stage 4 pressure ulcer, not a stage 3.

If a pressure ulcer was present on admission and is healed at the time of discharge, the site and stage of the pressure ulcer at the time of admission should be reported. Remember, healed at the time of admission is the only time a pressure ulcer would not be reported, because it no longer exists.

It is not uncommon for a pressure ulcer present on admission to be at one stage and advance to another stage during their hospital stay. In this situation, the coder is to assign two codes. The first code reported is for the site and stage of the pressure ulcer at the time of admission, and the second code reported is for the same ulcer site but reported to the highest stage documented during the stay.

Also, the new coding guidelines for 2020 have added guidance on pressure-induced deep tissue damage to go along with the new FY 2020 ICD-10-CM codes for pressure ulcers. The new codes for deep-tissue injury, which specify the affected body part and laterality, include codes such as:

• L89.126, pressure-induced deep tissue damage of left upper back            
• L89.156, pressure-induced deep tissue damage of sacral region 

According to the guidelines, when reporting pressure-induced deep tissue damage or a deep-tissue pressure injury, assign only the appropriate code for pressure-induced tissue damage.

The rules for non-pressure chronic ulcers are essentially the same as coding for pressure ulcers. The 2020 guidelines clarify that when a patient is admitted with a non-pressure ulcer that is healed at the time of admission, the non-pressure ulcer is not reported.

Editor’s note: Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, partner with the American Regulatory Compliance Society in Grand Haven, Michigan, answered this question.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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