Changes to end-of-life wound classification in a recent Minimum Data Set update should be a positive for long-term care, but regulatory and legal ambiguity still surrounded the new coding procedures at press time.
The MDS changes overhauled the patient assessment process, including a key change to Section M, which covers skin conditions, a panel of wound care experts hosted by the Post Acute Wound & Skin Integrity Council noted in February.
The Centers for Medicare & Medicaid Services now recognizes that some skin changes at the end of life may be inevitable, much like other forms of organ failure. Such skin changes — often identified broadly as “skin changes at the end of life” (SCALE), or more narrowly as Kennedy Terminal Ulcers — can no longer be coded as pressure wounds under Section M.
Martha Kelso, CEO of Wound Care Plus, called it “a complete about-face.”
But the panel said CMS left providers with unanswered questions about how and where such wounds should now be coded. Improper classification could lead to lower star ratings following audits or to legal problems if there’s evidence that end-of-life care was handled inappropriately.
