AMN RCS Deep Tissue Medical Coding

New Codes – Deep Pressure Tissue Injuries

Beginning with October 1, 2019 discharges coders will have to understand deep pressure injuries and know how to code them.  

In 2016 The National Pressure Ulcer Advisory Panel (NPUAP) redefined the definitions of pressure injuries.  These updates can be found at: https://npuap.org/page/PressureInjuryStages

The excerpt below is the official definition of a deep pressure injury as defined by the NPUAP. 

“Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood-filled blister. Pain and temperature change often precede skin color changes.  Discoloration may appear differently in dark pigmented skin.  This condition results from intense and/or prolonged pressure and shear forces at the bone-muscle interface.  The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss.”

This type of pressure injury differs from the pressure injuries coders are accustomed to coding as those injuries occur at skin level and progress downward through the tissues.  It is from this vantage point that the pressure injury stage can be identified and coded appropriately.  As described in the definition above, a deep pressure injury occurs at the bone muscle interface and works up to the surface.  Because the injury is deep it may not be noticed or visible in its early stages. This fact alone can leave healthcare facilities vulnerable for quality of care concerns.  Consider the patient who falls at home and is unable to move until someone comes to check on them.  The patient is admitted to the hospital and examined closely only to develop an area of purplish discoloration over the sacrum several days after admission.

Deep pressure injury ICD-10-CM codes have the 6th character of “6” and appear within each body location subcategory for pressure injuries.  Considering the example of the patient who fell at home the code would be L89.156 Pressure-induced deep tissue damage of sacral region.

New this year also is an update to the official guidelines for coding and reporting: “For pressure-induced deep tissue damage or deep tissue pressure injury, assign only the appropriate code for pressure-induced deep tissue damage (L89.–6).” 

Going forward coding professionals and clinical documentation specialists need to provide education to all hospital staff and providers regarding these new codes.  Documentation of physical exam on admission will be critical if a deep pressure injury appears after admission.    

Understanding the diagnosis as well as the signs and symptoms of deep tissue pressure injury is imperative for proper coding and reporting.  Our coders are provided both clinical and coding education through our LMS (learning management system) to help them understand the new codes and the impact on coding and reporting to prevent the over-coding or under-coding commonly seen among inexperienced coders.  We have the workforce solutions to assist with all of your HIM coding needs.

 

Dee Mandley, RHIT, CCS, CCS-P, CDIP

Content Manager HIM