HOPE Guidance Manual v1.02, Item M1200

Timepoint(s) Item Completed

Admission (ADM)

HOPE Update Visit 1 (HUV1)

HOPE Update Visit 2 (HUV2)

Item-Specific Instructions

• Review the medical record, including treatment records and health care provider orders, for documented

skin treatments.

• Ask the patient, caregiver, and responsible party about any wound treatments.

• For patients living in a facility, speak with direct-care staff and the treatment nurse to confirm

conclusions from the medical record review.

• Some skin treatments can be determined by observation. For example, observation of the patient’s

wheelchair and bed will reveal if the patient is using pressure-reducing devices for the bed or

wheelchair.

Coding Instructions

• Check all that apply at the time of assessment, including those initiated or continued.

• Treatment is considered initiated when the hospice has received the order and there is documentation that

the patient/caregiver was instructed to begin use of the medication or treatment.

Coding Tips

• Pressure reducing devices redistribute pressure so that there is some relief on or near the area of the

ulcer/injury.

• Turning/repositioning includes a consistent program for changing the patient’s position and realigning

the body.

• Dietary measures include those received by the patient for the purpose of preventing or treating specific

skin conditions (e.g., high calorie diet with added supplementation to prevent skin breakdown).

• Pressure ulcer care includes any intervention for treating pressure ulcers (e.g., topical dressings;

enzymatic, debridement, wound irrigations, negative pressure wound therapy).

• Surgical wound care may include any intervention for treating or protecting any type of surgical wound

(e.g., topical cleansing, wound irrigation, application of antimicrobial ointments, application of dressings

of any type).

• Non-surgical dressings do not have to be applied daily in order to be coded in this item.

o May include, but not limited to, dry gauze dressings, dressings moistened with saline or other

solutions, transparent dressings, hydrogel dressings, compression bandages, etc.

o Do not include adhesive bandages (e.g., BAND- AID® bandages, wound closure strips).

• Application of Ointments/medications may include topical creams, powders, and liquid sealants used to

treat or prevent skin conditions. This category does not include ointments used to treat non-skin

conditions (e.g., nitropaste for chest pain).

Examples for Items M1190-M1200

1. The patient was admitted to hospice following discharge to home after an episode of acute respiratory

distress from his end-stage lung cancer. During the initial nursing assessment, the nurse asked the

patient and caregiver about any skin conditions. The patient explained that they had a skin tear on the

right elbow and had a dressing over a wound on the buttocks. Upon examination, the nurse identified a

Stage 2 pressure ulcer on the coccyx. The patient did not have any other wounds, lesions, or skin

conditions. The patient is receiving ulcer care with application of a dressing applied to the coccygeal

ulcer. The patient’s skin tear treatment consists of a nonadherent dressing with antimicrobial gel. The

patient also has pressure-reducing devices on their bed and chair. The nurse recommended a frequent

turning and repositioning schedule (every 1 ½ to 2 hours) as the caregiver is able and as tolerated by the

patient.

Coding – Admission:

• M1190 (Skin Conditions): Code 1, Yes.

• M1195 (Types of Skin Conditions): Check C (Pressure Ulcer(s)/Injuries), E (Skin tear(s).

• M1200 (Skin and Ulcer/Injury Treatments): Check A (Pressure reducing device for chair), B

(Pressure reducing device for bed), C (Turning/repositioning program), E (Pressure Ulcer/Injury

care), and G (Application of nonsurgical dressings – with or without topical medications – other

than to feet).

Rationale: The patient was admitted to hospice and was found to have a skin tear on the right elbow,

and a coccygeal Stage 2 pressure ulcer. The hospice staff is providing both pressure ulcer and skin tear

treatments with dressings. To aid in prevention of further skin ulcer/injury, the patient also has pressure

reducing devices on their chair and bed, and a turning/repositioning schedule protocol was instituted.

2. A patient was admitted to hospice with late-stage Congestive Heart Failure (CHF) and

cardiomyopathy. Upon admission, the hospice nurse found the patient to have no skin condition.

However, when the nurse conducting the HOPE Update Visit (HUV1) arrived at the home on day

eight, the patient was found to have a venous ulcer on the right leg. The nurse consulted with the

hospice medical director and an order was received to begin a three-layer compression-bandaging

protocol, which after the first application, is to be reapplied every five days. The patient was also

provided with a pressure-reducing pad for their mattress and another one for their wheelchair.

Coding – HUV1:

• M1190 (Skin Conditions): Code 1, Yes.

• M1195 (Types of Skin Conditions): Check G (Ulcers other than diabetic or pressure ulcers).

• M1200 (Skin and Ulcer/Injury Treatments): Check A (Pressure reducing device for chair), B

(Pressure reducing device for bed), and G (Application of nonsurgical dressings – with or

without topical medications – other than to feet).

Rationale: The HUV1 was conducted on day eight. The patient was noted to have a venous ulcer and

had treatments ordered which included a pressure reducing pad (M1200A) for their wheelchair and

mattress (M1200B) as well as application of a compression-bandaging system (M1200G) for the

patient’s venous ulcer.