Please clarify whether the chapter specific guidelines for Chapter 12 addressing an evolving pressure ulcer apply to home health reporting. The guideline states that if a patient is admitted with a pressure ulcer at one stage and it progresses to a higher stage, two separate codes should be assigned: one code for the site and stage of the ulcer on admission and a second code for the same ulcer site and the highest stage reported during the stay. Home health assigns codes every 60 days to represent the current diagnoses. In other words, if a patient was admitted with a stage 2 pressure ulcer and 60 days later the patient is recertified to remain on service because the same pressure ulcer has worsened to a stage 3, we have always been required to code the ulcer at its present stage, so we would not code the stage 2, as it no longer exists, we would code the stage 3.
The guideline requiring two codes for evolving pressure ulcers does not apply to home health reporting. The guideline was intended for inpatient hospital reporting to allow the most accurate reporting of the present on admission (POA) indicator in order to track the change in stage during an inpatient admission.