What is important to know about wounds and PDPM?
Ensuring proper diagnoses and assessments of wounds is key. Under the Patient-Driven Payment Model, wounds can impact reimbursement under the nursing and non-therapy ancillary (NTA) components.
Depending on the diagnosis and clinical concern, you will achieve a higher case-mix group in nursing and qualify for points under NTA: for example, two points if the wound has an infection and an additional point for a multidrug-resistant organism.
If the resident is diabetic and has a foot ulcer, ensure it is diagnosed properly. Diabetics are prone to both lack of blood supply and peripheral neuropathy (loss of innervation), so the wound could be diagnosed as such instead of as diabetic; work closely with the physician to ensure proper diagnosis. A diabetic foot ulcer is one point under the NTA component and places the resident in the Special Care Low category for the nursing component.
A foot infection such as cellulitis or other open lesion such as a cut or fissure (but not a diabetic foot ulcer) qualifies for one point under the NTA component and for the Special Care Low category under nursing.
Proper staging of pressure injuries also is important. An unhealed Stage 4 pressure injury qualifies for one point. However, any Stage 2 or 4 pressure ulcer, or two or more Stage 2 pressure ulcers, will qualify for the Special Care Low category. A severe skin burn or condition will qualify for one point under NTA and for Clinically Complex under the nursing component.
Train your nurses to be competent in the following: etiology of pressure injuries and diabetic, arterial, venous and peripheral neuropathy wounds; pressure injury staging; and signs, assessments and diagnoses of infections.
Please send your wound treatment-related questions to “Ask the Expert” at firstname.lastname@example.org.