Accurate MDS pressure ulcer coding is critical for nursing facilities to maintain compliance and demonstrate quality care. Understanding how your coding decisions directly impact pressure ulcer quality measures can help your facility avoid penalties while ensuring residents receive optimal care.
Understanding the Two Key Pressure Ulcer Quality Measures
The MDS system tracks pressure ulcers through two distinct quality measures that serve different resident populations:
Short-Stay Quality Measure: Changes in Skin Integrity Post-Acute Care
This measure focuses on Medicare Part A SNF residents with stays of 100 days or less. It specifically tracks whether residents develop new or worsened pressure ulcers during their stay.
What Gets Counted in the Numerator:
- Type 1 SNF stays with matched PPS 5-Day Assessment (A0310B = 01) and PPS Discharge Assessment (A0310H = 1)
- New or worsened Stage II-IV pressure ulcers at discharge
- Unstageable pressure ulcers due to non-removable dressing/device, slough/eschar, or deep tissue injury
Critical Coding Elements: The measure triggers when any of these MDS items show values >0:
- M0300B1-B2 (Stage 2)
- M0300C1-C2 (Stage 3)
- M0300D1-D2 (Stage 4)
- M0300E1-E2 (Unstageable due to non-removable dressing/device)
- M0300F1-F2 (Unstageable due to slough/eschar)
- M0300G1-G2 (Unstageable due to deep tissue injury)
Long-Stay Quality Measure: Percentage of Residents with Pressure Ulcers
This measure captures the percentage of long-stay residents (101+ days) with Stage II-IV or unstageable pressure ulcers based on their most recent assessment.
Key Difference in Coding: For long-stay measures, only the M0300B1, C1, D1, E1, F1, and G1 items matter - any value from 1-9 includes the resident in the numerator.
Critical Exclusions That Affect Your Measures
Understanding exclusions is essential for accurate reporting:
Short-Stay Exclusions:
- Missing data on pressure ulcer fields (coded as "-")
- Residents who died during the SNF stay (Type 2 SNF Stays)
Long-Stay Exclusions:
- OBRA Admission assessments (A0310A = 01)
- PPS 5-day assessments (A0310B = 01)
- Missing pressure ulcer data for residents not in the numerator
Risk Adjustment Factors You Need to Know
Both measures use risk adjustment to account for resident characteristics that increase pressure ulcer risk:
Universal Risk Factors:
- Impaired Functional Mobility: Difficulty lying to sitting (GG0170C = 01, 02, 07, 09, 10, 88)
- Bowel Incontinence: Any level of incontinence (H0400 = 1, 2, 3)
- Peripheral Vascular Disease or Diabetes: (I0900 = 1 or I2900 = 1)
- Low BMI: Between 12.0-19.0 based on height and weight data
Additional Long-Stay Risk Factors:
- Malnutrition or risk of malnutrition (I5600 = 1)
- Dehydration (J1550C = 1)
- Infections including MDRO, pneumonia, septicemia, or UTI
- Moisture-associated skin damage (M1040H = 1)
- Hospice care (O0110K1b = 1)
Best Practices for Accurate MDS Pressure Ulcer Coding
1. Ensure Proper Assessment Timing
- Complete 5-day assessments within the required timeframe
- Document discharge assessments accurately for all short-stay residents
- Maintain consistent assessment schedules for long-stay residents
2. Accurate Pressure Ulcer Staging
- Follow current pressure ulcer staging guidelines
- Distinguish between pressure ulcers and other skin conditions
- Document unstageable ulcers with specific reasons (dressing, slough/eschar, deep tissue injury)
3. Complete Risk Factor Documentation
- Assess and document all functional mobility limitations
- Record accurate height and weight measurements for BMI calculations
- Document all relevant diagnoses that impact pressure ulcer risk
4. Avoid Common Coding Errors
- Don't leave pressure ulcer fields blank - use "0" when no ulcers are present
- Ensure consistent coding between admission and discharge assessments
- Verify that assessment reference dates align with actual assessment completion
The Impact on Your Facility
Accurate MDS pressure ulcer coding affects:
- Star Ratings: Poor performance on quality measures directly impacts your facility's star rating
- Value-Based Purchasing: Quality measure performance affects reimbursement rates
- Survey Focus: Poor quality measure performance may trigger increased survey scrutiny
- Marketing and Reputation: Quality ratings influence family decision-making
Get Your Free MDS Pressure Ulcer Coding Reference Guide
To help your team implement these best practices immediately, we've created a comprehensive resource that puts all the essential information at your fingertips.
Download our FREE MDS Pressure Ulcer Coding Quick Reference Guide and get:
- Complete MDS item codes for all pressure ulcer stages and types
- Quality measure calculation flowcharts for both short-stay and long-stay measures
- Risk adjustment factor checklist to ensure complete documentation
- Common coding error prevention tips based on real survey findings
- Step-by-step assessment timeline for optimal compliance
This printable reference guide is perfect for posting at MDS workstations or including in staff training materials.
[Download Your Free Guide Now →]
Moving Forward with Confidence
Successful MDS pressure ulcer coding requires ongoing attention to detail and regular training. By understanding how each coding decision impacts quality measures, your team can ensure accurate documentation that reflects the true quality of care your facility provides.
Remember to always consult the current MDS RAI Manual for the most up-to-date coding guidance, as requirements and definitions may change over time.
