Pressure ulcers (also called pressure sores or bed sores) are areas of skin that break down when you stay in one position for too long without shifting your weight. Depending on how a physician treats the ulcer will depend on how it is coded and billed. This article will address the formation of pressure ulcers, treatment of pressure ulcers, and coding of pressure ulcers.
Pressure Ulcers
A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head. Anatomically, the buttock region is by far the most common area for pressure sores to develop. These account for over 70% of all occurrences, with sacral (46%) and ischial (26%) locations being most common.
These factors increase the risk for pressure ulcers:
- Being bedridden or in a wheelchair
- Fragile skin
- Having a chronic condition that prevents areas of the body from receiving proper blood flow (diabetes or vascular disease)
- Inability to move certain parts of your body without assistance, such as after spinal or brain injury or if you have a neuromuscular disease (like multiple sclerosis)
- Malnourishment
- Mental disability from conditions such as Alzheimer's disease -- the patient may not be able to properly prevent or treat pressure ulcers
- Older age
- Urinary incontinence or bowel incontinence
The National Pressure Ulcer Advisory Panel (NPUAP) has developed illustrations of the stages of pressure ulcers (Stage I-IV). NPUAP updated the stages of pressure ulcers in 2007 and these stages are commonly cited in references and in lectures.
Stage I:
Intact skin with non-blanchable (does not turn white) redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.