The development or worsening of a pressure ulcer while a resident is at your facility affects your quality measures, which can impact your overall 5-Star rating. The national three-quarter average of pressure ulcers in high-risk patients is 6 percent for long-stay residents and 1.1 percent for short-stay residents.
Quality of Care
More than $9.1 billion is spent annually on pressure ulcer treatment in long-term care and hospital settings. It has been estimated that treating the cost of pressure ulcers is 2.5 times the cost of preventing them.
Pressure ulcers in long-term care facilities cost on average between $1,284 and $4,647 per ulcer, per resident, to treat. For example, in a 100-bed facility housing 500 residents per year, PU treatment costs can exceed $300,000 annually.
What Is Tissue Tolerance?
Tissue tolerance is the tissue’s ability to resist the effects of pressure without injury. When tissue tolerance is limited, injury in areas of pressure can occur in an abbreviated amount of time.
Testing and Regulations
F686 (previously F314) explains that facilities must prove that there are resident-specific interventions provided for pressure relief. The Guidance to Surveyors for Long Term Care Facilities F Tag 686 (previously F314) indicates that when assessing pressure ulcer risk, the resident’s skin integrity and tissue tolerance are to be observed after pressure over bony prominences is relieved.
Documenting Bill for the Test
Nursing will update the care plan for a patient based on therapist recommendation for a positioning schedule. Currently we use CPT code 87530 as our billing code due to the test being based on positioning of the patient.
Ankle-Brachial Index (ABI) is a quick, noninvasive way to check a resident’s risk of peripheral artery disease (PAD). The screening of ABI may identify residents of long-term care facilities who had no previous diagnosis of PAD.
We’re also given an indication of wound healing potential in order to plan better patient-specific care, and we are able to create greater collaboration between Nursing, Therapy and providers.
Note that both Nursing and Therapy can perform the testing. Documentation from Therapy presents an IDT approach to pressure relief. This is skilled service, and Therapy can bill for their time!
This approach to pressure relief give us an earlier assessment or identification of a pressure area or ulcer formation risk factors. Additional benefits include:
- Earlier referral to physicians for disease management
- Development of individualized POC and interventions to reduce resident risk for skin breakdown
- Reimbursable skilled therapy service, helping to build Medicare Part B caseload for therapy revenue
- An increase in case mix reimbursement
- Improved quality measures
- Most important of all, happier residents!
View poster: IDT Wound Management/Prevention using ABI and TTT (PDF format)
Chelsey Terrell, RN – C. Scott Hollander, DPT, DOR