Frank talk about reporting surgical wounds on OASIS







EDITOR’S NOTE: This seasonally-related post about how Frankenstein’s monster’s wounds might be reported on OASIS first appeared in an October issue of The Monday Fix. Our weekly e-newsletter features  free coding  and OASIS tips. Click here to subscribe to The Monday Fix.

Mary Shelley never specified in her classic novel exactly how Dr. Frankenstein’s tragic monster came to be, but Hollywood’s cinematic speculation has given life to a gruesome version we all know well.
Stitched and sutured together from body parts snatched from the graveyard, skin grafted onto a gigantic and ill-assembled human frame with surgical pins still in place, the Creature was animated via lightning strike and shambled forth to terrorize nearby villagers.
We’re doing a bit of seasonally-inspired speculating, ourselves, in today’s Coding Tip, for fun and review purposes, to determine just how some of those monstrous issues might be reported on the OASIS data collection form.
OASIS has its own set of rules for determining what a surgical wound is and is not. Guidelines define a surgical wound as, “a wound created by a surgical procedure,” and ask clinicians to provide information about the wound at M1340 and M1342.
But clinicians can’t assume that the wound meets OASIS reporting criteria just because a surgeon was involved in the procedure – or even because a surgical incision was made.
Frankenstein’s Creature illustrates a few great examples of – well, certain oddities in OASIS reporting criteria for surgical wounds. Clinicians need to become aware of them, and memorize which procedures should and which procedures shouldn’t be reported as surgical wounds. Better yet, keep a copy of our helpful M1340 Cheat Sheet handy and refer to it. Click here to see our M1340 Cheat Sheet. 

Sutures galore – or is it gore?

Frankenstein’s Creature probably had more than a few traumatic lacerations, having been cobbled together from various corpses. We’re pretty sure all those railroad track stitches on the Creature show exactly where Dr. Frankenstein did a lot of careful suturing.
But whatever you do, don’t report those Sutured Traumatic Lacerations as observable surgical wounds at M1340.
Sutured Traumatic Lacerations are NOT considered surgical wounds on OASIS.
Nor does it count if Dr. Frankenstein happened to perform a little debridement on those traumatic wounds. Debridement does not change a burn, pressure ulcer, stasis ulcer or traumatic wound into a surgical wound.

Here’s the skinny on grafts

What about all those skin grafts?
The Creature would have had plenty of those, wouldn’t he?
Well, here is one of those OASIS oddities we mentioned earlier. For the purposes of OASIS, Recipient Skin Graft Sites are NOT reported as surgical wounds – at least not right now. But Donor Skin Graft Sites are — so if you were completing OASIS documentation on any of the poor folks who contributed some of their skin to Dr. Frankenstein’s efforts, you would want to report their wounds as surgical wounds on OASIS. Except that … well, they’re corpses. Don’t overthink this analogy.

IMPORTANT NOTE: The revised version of OASIS known as C-2 will correct this particular contradiction when changes become effective Jan. 1. Under C-2, both Recipient and Donor Skin Graft Sites will be considered surgical wounds for OASIS reporting. 

Are those things surgical pins?

Frankly, we’re not sure exactly what those strange-looking bolts are in the neck of the Creature, but they’ve certainly become the trademark look. We’re guessing they help hold his head in place – kinda like surgical pins.
Orthopedic pin sites CAN be reported as surgical wounds on OASIS.
In fact, OASIS recognizes as a surgical wound any site where hardware is used to align and stabilize fractures or to repair traumatic injury such as ruptured organs, torn tendons, ligaments or muscles. The Creature probably has plenty of those.

Internal – or is that infernal?

Exactly how the Creature is animated remains a scientific mystery in both Shelley’s novel, where alchemy is vaguely referenced, and in film versions, where lightning often alludes to some sort of electrical impulse firing up the body’s organs.
But it couldn’t have been an easy process. And if his heart required a bit of help to get going – perhaps in the form of a pacemaker or an internal defibrillator – would those implanted devices be reported as surgical wounds on OASIS?
It depends on how long ago the animation procedure for the Creature took place — and on epithelialization, which is the epidermal resurfacing (skin growing over the wound.) If the Creature’s pacemaker or internal defibrillator was just placed, the incision will be reported as a surgical wound until it has been epithelialized for 30 days. After that it wouldn’t be reported in M1340. A surgical wound is only reported on the OASIS until it has been completely epithelialized for 30 days or more with no S/S of infection and no evidence of complications.
What if the Creature needed cardiac catheterization via needle puncture (even if a stent was placed), or any sort of chest tube, with or without a drain? Those items would NOT be reported as surgical wounds on OASIS.

Want a little practice to see what you know? How about a self quiz?

frankie-asksClick here to check out our M1340 Quiz to test yourself on your knowledge about which wounds should and should not be reported as surgical wounds on OASIS.