M1040D: Other Skin Problems - Lesions, Not Ulcers, Rashes, Cuts, Step-by-Step

Step-by-Step Coding Guide for M1040D: Other Skin Problems - Lesions, Not Ulcers, Rashes, Cuts

1. Review of Medical Records

Objective: Identify if the resident has any open lesions, excluding ulcers, rashes, and cuts, during the assessment period.
Actions:

• Access the resident’s medical records, including skin care flow sheets, physician notes, and nursing assessments.
• Confirm the presence of open lesions that do not fall under the categories of ulcers, rashes, or cuts. Examples include conditions such as boils, cysts, or bullous pemphigoid​​.

2. Understanding Definitions

M1040D: Open Lesions Other Than Ulcers, Rashes, Cuts: This category includes lesions that result from diseases or conditions and are not classified as ulcers, rashes, or cuts.

• Examples of Other Lesions:
  • Boils
  • Cysts
  • Vesicles
  • Bullous Pemphigoid​.

Illustration 1:

Scenario: A resident is diagnosed with bullous pemphigoid, which causes blistering and open lesions. These lesions are not considered ulcers, rashes, or cuts.

Result: M1040D is coded "Yes" to reflect the presence of open lesions caused by bullous pemphigoid.

3. Coding Instructions

Step-by-Step:

• Step 1: Review the medical records to determine whether any open lesions other than ulcers, rashes, or cuts were present in the past seven days.
• Step 2: Confirm that the lesions are caused by a specific disease or condition (e.g., bullous pemphigoid or boils).
• Step 3: If these types of lesions are present, check M1040D as "Yes".
• Step 4: If no such lesions were present, check M1040D as "No".

Illustration 2:

Scenario: A resident has a blistering condition due to bullous pemphigoid with open and weeping lesions present during the assessment period.

Result: M1040D is coded "Yes" to document these open lesions.

4. Coding Tips

• Exclude Ulcers, Rashes, Cuts: Ensure that the lesion is not an ulcer, rash, or cut. These conditions are coded separately in other sections.
• Check for Disease-Related Lesions: Only code lesions that are a direct result of a disease or condition (e.g., syphilis, cancer). This does not include minor skin issues like cuts or abrasions​.

5. Documentation

Objective: Ensure the presence of lesions is properly documented and noted in the care plan.
Actions:

• Record the type of lesion and the underlying disease or condition causing it.
• Document any relevant wound care treatments or dressings used for these lesions.

Illustration 3:

Scenario: A resident with cancer develops open lesions on their skin, which are documented in the medical record, and appropriate wound care is provided.

Documentation: Ensure that the lesions are clearly noted in the medical record and M1040D is coded "Yes".

6. Common Errors to Avoid

• Misclassifying Lesions: Ensure that rashes, cuts, or pressure ulcers are not mistakenly coded as M1040D. These conditions should be classified elsewhere on the MDS​.
• Incomplete Documentation: Do not code M1040D unless the lesion and its underlying cause are clearly documented in the resident’s medical record.

Illustration 4:

Scenario: A resident’s chart lists a rash caused by allergic dermatitis, but no other lesions are present.

Error: Do not code M1040D for rashes or skin irritations. This scenario should be coded under the appropriate section for rashes.

7. Practical Application

• Example 1: A resident with boils caused by an infection has multiple open lesions during the look-back period. M1040D is coded "Yes".
• Example 2: A resident develops a skin tear after bumping into a table. Since this is a minor cut, M1040D is coded "No".

Please note that the information provided in this guide for MDS 3.0 Item set M1040D was originally based on the CMS's RAI Version 3.0 Manual, October 2023 edition. Every effort will be made to update it to the most current version. The MDS 3.0 Manual is typically updated every October. If there are no changes to the Item Set, there will be no changes to this guide. This guidance is intended to assist healthcare professionals, particularly new nurses or MDS coordinators, in understanding and applying the correct coding procedures for this specific item within MDS 3.0.  

The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding.  

Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.