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Eschar (cont.)
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Eschar (cont.)
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Eschar (cont.) 4. Resident M was admitted to the nursing facility with pressure ulcers that were unstageable due to eschar on both heels, as well as a Stage 2 pressure ulcer on the coccyx. Resident M’s pressure ulcers were reassessed before the subsequent assessment, and it was noted in the medical record that the Stage 2 coccyx pressure ulcer had healed. The left-heel eschar became fluctuant, showed signs of infection, and had to be debrided at the bedside. The left heel was subsequently numerically staged as a Stage 4 pressure ulcer. The right-heel eschar remained stable and dry (i.e., remained unstageable).
Coding: On admission, code M0300B1, Stage 2 as 1, M0300B2, present on
admission/entry or reentry as 1; and M0300F1 Unstageable due to slough/eschar as 2 and M0300F2 as 2, present on admission, entry or reentry. On the subsequent assessment, code M0300D1 as 1, and M0300D2 as 1, present on admission/entry or reentry; and M0300F1 as 1, and M0300F2 as 1, present on admission/entry or reentry.
Rationale: Since both of Resident M’s heels cannot be numerically staged, because the
level of tissue damage cannot be determined as a result of the eschar present, they are coded on admission as unstageable pressure ulcers due to slough/eschar. The left heel eschar was subsequently debrided and is coded as a Stage 4 on the subsequent assessment—since the left heel eschar was debrided, and the first time an unstageable ulcer/injury is staged, it is considered as present on admission/entry or reentry at the stage at which it is initially assessed. The other heel eschar remained unstageable and is coded as present on admission/entry or reentry, and the Stage 2 pressure ulcer on the coccyx healed, so it is not coded on the subsequent assessment.