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Checked
Condition applies under the item instruction.
Manual page M-32DiraChart MDS item reference
M1040ASection Mv1.20.1Manual page M-32
Other skin problems: infection of the foot
This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.
Quick coding
Answer Codes
Use the item-specific response choices below when structured codes apply.
Response format: Check all that apply
—
Not checked
Condition does not apply under the item instruction.
Manual page M-32Item-specific instructions
Coding Guidance
Review what the item asks, how to choose the response, and what should be verified before submission.
Steps for Assessment
1. Review the medical record, including skin care flow sheets
or other skin tracking forms.
2. Speak with direct care staff and the treatment nurse to
confirm conclusions from the medical record review.
3. Examine the resident and determine whether any ulcers,
wounds, or skin problems are present.
•
Key areas for diabetic foot ulcers include the plantar
(bottom) surface of the foot, especially the metatarsal
heads (the ball of the foot).
Coding Instructions
Check all that apply in the last 7 days. If there is no evidence
of such problems in the last 7 days, check none of the above.
Pressure ulcers/injuries coded in items M0210 through M0300
should not be coded here.
•
M1040A, Infection of the foot (e.g., cellulitis, purulent
drainage)
•
M1040B, Diabetic foot ulcer(s)
•
M1040C, Other open lesion(s) on the foot (e.g., cuts,
fissures)
•
M1040D, Open lesion(s) other than ulcers, rashes, cuts
(e.g., bullous pemphigoid)
•
M1040E, Surgical wound(s)
•
M1040F, Burn(s)(second or third degree)
•
M1040G, Skin tear(s)
•
M1040H, Moisture Associated Skin Damage (MASD)
(e.g., incontinence-associated dermatitis (IAD),
perspiration, drainage)
•
M1040Z, None of the above were present
DEFINITIONS
DIABETIC FOOT
ULCERS
Ulcers caused by the
neuropathic and small blood
vessel complications of
diabetes. Diabetic foot ulcers
typically occur over the
plantar (bottom) surface of
the foot on load bearing
areas such as the ball of the
foot. Ulcers are usually deep,
with necrotic tissue,
moderate amounts of
exudate, and callused wound
edges. The wounds are very
regular in shape and the
wound edges are even with a
punched-out appearance.
These wounds are typically
not painful.
SURGICAL WOUNDS
Any healing and non-healing,
open or closed surgical
incisions, skin grafts or
drainage sites.
OPEN LESION(S)
OTHER THAN ULCERS,
RASHES, CUTS
Most typically skin lesions
that develop as a result of
diseases and conditions such
as syphilis and cancer.
BURNS (SECOND OR
THIRD DEGREE)
Skin and tissue injury caused
by heat or chemicals and
may be in any stage of
healing.
M1040: Other Ulcers, Wounds and Skin Problems (cont.)
Coding Tips
M1040B Diabetic Foot Ulcers
•
Diabetic neuropathy affects the lower extremities of individuals with diabetes. Individuals
with diabetic neuropathy can have decreased awareness of pain in their feet. This means
they are at high risk for foot injury, such as burns from hot water or heating pads, cuts or
scrapes from stepping on foreign objects, and blisters from inappropriate or tight-fitting
shoes. Because of decreased circulation and sensation, the resident may not be aware of
the wound.
•
Neuropathy can also cause changes in the structure of the bones and tissue in the foot.
This means the individual with diabetes experiences pressure on the foot in areas not
meant to bear pressure. Neuropathy can also cause changes in normal sweating, which
means the individual with diabetes can have dry, cracked skin on their other foot.
•
Do not include pressure ulcers/injuries that occur on residents with diabetes mellitus
here. For example, an ulcer caused by pressure on the heel of a diabetic resident is a
pressure ulcer and not a diabetic foot ulcer.
M1040D Open Lesion(s) Other than Ulcers, Rashes, Cuts
•
Open lesions that develop as part of a disease or condition and are not coded elsewhere
on the MDS, such as wounds, boils, cysts, and vesicles, should be coded in this item.
•
Do not code rashes, abrasions, or cuts/lacerations here. Although not recorded on the
MDS assessment, these skin conditions should be considered in the plan of care.
•
Do not code pressure ulcers/injuries, venous or arterial ulcers, diabetic foot ulcers, or
skin tears here. These conditions are coded in other items on the MDS.
M1040E Surgical Wounds
•
This category does not include healed surgical sites and healed stomas or lacerations that
require suturing or butterfly closure as surgical wounds. PICC sites, central line sites, and
peripheral IV sites are not coded as surgical wounds.
•
Surgical debridement of a pressure ulcer does not create a surgical wound. Surgical
debridement is used to remove necrotic or infected tissue from the pressure ulcer in order
to facilitate healing. A pressure ulcer that has been surgically debrided should continue to
be coded as a pressure ulcer.
•
Code pressure ulcers that require surgical intervention for closure with graft and/or flap
procedures in this item (e.g., excision of pressure ulcer with myocutaneous flap). Once a
pressure ulcer is excised and a graft and/or flap is applied, it is no longer considered a
pressure ulcer, but a surgical wound.
M1040: Other Ulcers, Wounds and Skin Problems (cont.)
M1040F Burns (Second or Third Degree)
•
Do not include first degree burns (changes in skin color only).
M1040G Skin Tear(s)
•
Skin tears are a result of shearing, friction or trauma to the skin that causes a separation of
the skin layers. They can be partial or full thickness. Code all skin tears in this item, even
if already coded in Item J1900B.
•
Do not code cuts/lacerations or abrasions here. Although not recorded on the MDS, these
skin conditions should be considered in the plan of care.
M1040H Moisture Associated Skin Damage (MASD)
•
MASD is also referred to as maceration and includes
incontinence-associated dermatitis, intertriginous
dermatitis, periwound moisture-associated dermatitis,
and peristomal moisture-associated dermatitis.
•
Moisture exposure and MASD are risk factors for
pressure ulcer/injury development. Provision of optimal
skin care and early identification and treatment of minor
cases of MASD can help avoid progression and skin
breakdown.
•
MASD without skin erosion is characterized by
red/bright red color (hyperpigmentation), and the
surrounding skin may be white (hypopigmentation). The skin damage is usually
blanchable and diffuse and has irregular edges. Inflammation of the skin may also be
present.
•
MASD with skin erosion has superficial/partial thickness skin loss and may have hyper-
or hypopigmentation; the tissue is blanchable and diffuse and has irregular edges.
Inflammation of the skin may also be present. Necrosis is not found in MASD.
•
If pressure and moisture are both present, code the skin damage as a pressure ulcer/injury
in M0300.
•
If there is tissue damage extending into the subcutaneous tissue or deeper and/or necrosis
is present, code the skin damage as a pressure ulcer in M0300.
DEFINITION
MOISTURE
ASSOCIATED SKIN
DAMAGE
Is superficial skin damage
caused by sustained
exposure to moisture such as
incontinence, wound
exudate, or perspiration.
M1040: Other Ulcers, Wounds and Skin Problems (cont.)
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