With the new ICD-10-CM codes for 2017 already decided, codes will not be updated to incorporate these terminology changes until at least October 1, 2018.“This is much like how we struggled with the professional descriptions related to systolic and diastolic heart failure versus the more recent terminology of reduced or preserved ejection fraction,” says Sharme Brodie, RN, CCDS, clinical documentation improvement specialist with HCPro, a division of BLR, in Danvers Massachusetts.The percentage of agreement was 94.5% and the multi-rater Kappa was 0.80 (Defloor & Schoonhoven, 2004).Lesions secondary to incontinence were most often misclassified as grade 2 (blisters) or grade 3 pressure ulcers (Defloor & Schoonhoven, 2004).Problems with Staging Systems Inherent to the accuracy of pressure ulcer staging is: (1) knowledge of the integumentary anatomy and deeper tissue layers including the ability to identify and differentiate between these layers; (2) assessment and differential diagnostic skill (Nix, 2006); (3) and validity (accuracy) and reliability (consistency of results) of the staging system.Illustratively, a 2007 inter-rater reliability study comparing pressure ulcer staging between staff nurses and certified wound, ostomy, continence nurses (CWOCN) in two National Database of Nursing Quality Indicators (NDNQI) prevalence surveys using the NPUAP staging system reported a 65% agreement between raters Kappa = 0.514 across all stages of pressure ulcers (Nickoley, Helvig, Ritter, & Heinsler, 2007).Definitions were drafted with the goal of achieving accuracy, clarity, succinctness, clinical utility, and discrimination between and among other definitions for both stages of pressure ulcers and other types of wounds.
Given the ulcer’s anatomical location, herpetic, fungal, and moisture lesions are of ten misclassified as pressure ulcerations (Defloor et al., 2005).
National Pressure Ulcer Advisory Panel’s Updated Pressure Ulcer Staging System Abstract The National Pressure Ulcer Advisory Panel has updated the definition of a pressure ulcer and the stages of pressure ulcers based on current research and expert opinion solicited from hundreds of clinicians, educators, and researchers across the country.
The amount of anatomical tissue loss described with each stage has not changed.
The National Pressure Ulcer Advisory Panel (NPUAP) has redefined the definition of a pressure ulcer and the stages of pressure ulcers, including the original four stages and adding two stages on deep tissue injury and unstageable pressure ulcers.
Sepsis isn’t the only clinical condition with an updated definition that could impact coding and documentation.
Thus began an intensive 2-year examination and revision of the entire staging system. Opinions were actively solicited from researchers, clinicians, educators, and public policymakers at a variety of public meetings and forums. NPUAP board members engaged their colleagues at the EPUAP to discuss their common concern of accurately staging (or grading) pressure ulcers.