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  1. Is a debrided ulcer considered a nonhealing chronic wound or is it a nonhealing surgical wound?
    You should consider a debrided ulcer to be an ulcer and code it as such. Debridement does not make the ulcer a surgical wound. The best strategy is to go with the wound’s origin.
    For example, your patient has a previously staged stage IV pressure ulcer on the hip covered with eschar and slough. She undergoes sharp debridement. You would still code the wound as a pressure ulcer. Debridement is an ulcer treatment and does not make the pressure ulcer a surgical wound.
    So, at first you would code for the pressure ulcer with 707.04 (Pressure ulcer; hip) and 707.25 (Pressure ulcer, unstageable). After the debridement, you would report the pressure ulcer with 707.04 and 707.24 (Pressure ulcer stage IV).
  2. What's this I hear about having to report ICD-9 codes for the stages of pressure ulcers?
    There are now two subcategories for pressure ulcers:  one to identify the site (707.00-707.09) and another to describe the stage (707.20-707.25).  Follow these guidelines for reporting a pressure ulcer.
    Report two codes (site) to completely describe a pressure ulcer.  Report the pressure ulcer site as a primary or other diagnosis (M1020/M1022, diagnoses, lines a through f), depending on the plan of care.  Then list the pressure ulcer stage as a pertinent diagnosis (lines b through f).  Pressure ulcer stage cannot serve as the principal diagnosis.
    When a patient has bilateral pressure ulcers with the same documented stage, report the code for the site and one code for the stage. 
    If the bilateral pressure ulcers have different stages, assign one code for the site and the appropriate codes for the stage.  Even though the case-mix payment will apply to one ulcer only, sequence the ulcers in order of priority, that is, the most problematic and/or the one with the most impact on the plan of care. 
    When a patient has multiple pressure ulcers at different sites such as the heel, buttock, and hip, and each pressure ulcer is at a different stage, assign the appropriate codes for each different site and a code for each different pressure ulcer stage.  Follow the sequencing guidance in the previous point