Re: section M, coding--PLease help a.s.a.p.

[Michelle Witges]

In the manual on page 3-165 is the definition of an open lesion/sore, "A local loss of epidermis and variable levels of dermis and subcutaneous tissue.  This open sore MAY develop because of injury or in association with other diseases such as syphilis."  It does not state that it is to be coded ONLY if syphilis.  The emphasis on MAY and ONLY are my own.  I would show the surveyor this and if she continues to insist that is coded incorrectly, ask her to show documentation as to her determination.  If she continues to cite you I would ask for IDR. Michelle ----- Original Message ----- From: Heidi Ebertowski To: [EMAIL PROTECTED] Sent: Tuesday, December 02, 2003 3:24 PM Subject: RE: section M, coding--PLease help a.s.a.p. Here is the funny thing.  I was told by the Medicaid reviewer that you can only code �open lesion/sores� if it is a open lesion from syphyllis or cancerous lesion.  I guess I�ve always coded open lesion/sores if it is not a skin tear, not an abrasion or rash then it seems to fit in the �open lesions/other category� .  Am I wrong???? I coded this resident as having an open lesion in her abdominal fold.  Her contributing factors were her diabetes and obesity---in other words diagnosis linked to her developing the open �sore�.  I don�t know how to win this one.  She is coded it down so therefore we lose $$$ for three months.  Any advise, suggestions, comments appreciated.   Heidi Ebertowski,R.N. MDS Care Coordinator Valley Memorial Homes Grand Forks, ND (701)787-7937   fax (701)787-7901 Confidentiality Statement: This message is intended for the sole use of the individual and entity to whom it is addressed, and may contain information that is privileged,confidential and exempt from disclosure under applicable law.  If you are not the intended addressee,nor authorized to receive for the intended addressee,you are hereby notified that you may not use,copy,disclose or distribute to anyone the message or any information contained in the message.  If you have received this message in error,please immediately advise the sender by reply email and delete the message.  Thank you. -----Original Message----- From: Michelle Witges [mailto:[EMAIL PROTECTED] Sent: Tuesday, December 02, 2003 2:50 PM To: [EMAIL PROTECTED] Subject: Re: section M, coding--PLease help a.s.a.p.   I would code as a rash and other open lesions, as there is an actual break in the skin.  I would also code medication and dressing. Michelle ----- Original Message ----- From: Heidi Ebertowski To: [EMAIL PROTECTED] Sent: Tuesday, December 02, 2003 12:12 PM Subject: section M, coding--PLease help a.s.a.p.   We are currently undergoing Medicaid review on some of our resident�s assessments from 2002.  I am in disagreement with the reviewer on how to code in section M.  Here is the example: A morbidly obese resident has open sores in abdominal folds.  Nurses are charting open slit to abdominal fold.  Applying nystatin and kling to abdominal folds daily.  How would you guys code this under section m4 and m5???   Heidi Ebertowski,R.N. MDS Care Coordinator Valley Memorial Homes Grand Forks, ND (701)787-7937   fax (701)787-7901 Confidentiality Statement: This message is intended for the sole use of the individual and entity to whom it is addressed, and may contain information that is privileged,confidential and exempt from disclosure under applicable law.  If you are not the intended addressee,nor authorized to receive for the intended addressee,you are hereby notified that you may not use,copy,disclose or distribute to anyone the message or any information contained in the message.  If you have received this message in error,please immediately advise the sender by reply email and delete the message.  Thank you.

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