OASIS-C tip of the week (bonus feature): Healing status of a surgical wound

Dear readers, you are in for a rare treat because today I am posting a bonus OASIS-C tip! That’s two OASIS-C tips in one week! That’s like going to the State Fair and winning a giant teddy bear after you’ve had your mini donuts and saltwater taffy. What more could you ask for?!
 
Q: I need clarification on the correct answers to m1342 of Oasis regarding status of most problematic surgical wound. We are in disagreement about using the term granulation to describe the healing of surgical wounds. Is is correct to mark granulation if the wound is not fully epithelialized and it is not – not healing?
 
A: Here is the CMS response to a similar question:
CMS Response: When determining the healing status of a surgical wound, the clinician should first evaluate if the surgical incision is healing by primary intention, with edges well approximated, or by secondary intention due dehiscence or interruption of the incision.  If the wound is healing by primary intention, the assessing clinician will observe if the incision line has re-epithelialized.  (If there is no interruption in the healing process, this generally takes from a matter of hours to three days.)  If there is not full epithelial resurfacing, such as in the case of a scab adhering to underlying tissue, then the correct response would be “not healing” for the wound healing by primary intention. 

The presence of a scab does not automatically equate to a “not healing” response. The clinician must first assess if the wound is healing entirely by primary intention (complete closure with no openings), or if there is a portion healing by secondary intention.  If it is determined that there is incisional separation, it is healing by secondary intention, and the clinician will then have to determine the status of healing, which may be “non-healing”, “early-partial granulation”, “fully granulated” and eventually “newly epithelialized”. 

“Epidermal resurfacing” means the opening created during the surgery is covered by epithelial cells. If epidermal resurfacing has occurred completely, the correct response in the OASIS would be “Newly epithelialized”, until 30 days have passed, at which time it is no longer a reportable surgical wound.

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6 thoughts on “OASIS-C tip of the week (bonus feature): Healing status of a surgical wound

  1. Re: non-healing surgical wounds
    If a patient has a surgical wound that is over 90 days old and in the initial 30 days it was an infected abdominal surgical wound then during day 90 the physician states the wound is granulating and is approximately 1cm x 0.5 cm x 0.5 cm. Is is correct to classify the surgical wound as non-healing?

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      • I have a question regarding a scab covering a wound that was closed by ‘secondary’ intention, e.g. skin cancer removed from leg and now covered in a scab Is the scab considered granulation tissue and if > than 25 percent and in this case, the entire wound bed is covered, would it be considered ‘fully granulating’? The only thing I can find anywhere is dealing with primary intention, which does not address this question. Thx

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