✓
Checked
Condition applies under the item instruction.
Manual page M-37DiraChart MDS item reference
M1200CSection Mv1.20.1Manual page M-37
Skin/ulcer treatments: turning/repositioning
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-37Item-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 treatment records and health care provider orders for
documented skin treatments during the past 7 days. Some skin treatments may be part of
routine standard care for residents, so check the nursing facility’s policies and procedures and
indicate here if administered during the look-back period.
2. Speak with direct care staff and the treatment nurse to confirm conclusions from the medical
record review.
3. Some skin treatments can be determined by observation. For example, observation of the
resident’s wheelchair and bed will reveal if the resident is using pressure-reducing devices for
the bed or wheelchair.
DEFINITION
PRESSURE REDUCING
DEVICE(S)
Equipment that aims to
relieve pressure away from
areas of high risk. May
include foam, air, water gel,
or other cushioning placed on
a chair, wheelchair, or bed.
Include pressure relieving,
pressure reducing, and
pressure redistributing
devices. Devices are
available for use with beds
and seating.
M1200: Skin and Ulcer/Injury Treatments (cont.)
Coding Instructions
Check all that apply in the last 7 days. Check Z, None of the above were provided, if none
applied in the past 7 days.
•
M1200A, Pressure reducing device for chair
•
M1200B, Pressure reducing device for bed
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M1200C, Turning/repositioning program
•
M1200D, Nutrition or hydration intervention to manage skin problems
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M1200E, Pressure ulcer/injury care
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M1200F, Surgical wound care
•
M1200G, Application of non-surgical dressings (with or without topical medications)
other than to feet. Non- surgical dressings do not include Band-Aids.
•
M1200H, Application of ointments/medications other than to feet
•
M1200I, Application of dressings to feet (with or without topical medications)
•
M1200Z, None of the above were provided
M1200: Skin and Ulcer/Injury Treatments (cont.)
Coding Tips
M1200A/M1200B Pressure Reducing
Devices
•
Pressure reducing devices redistribute pressure so that
there is some relief on or near the area of the
ulcer/injury. The appropriate pressure reducing device
should be selected based on the individualized needs of
the resident.
•
Do not include egg crate cushions of any type in this
category.
•
Do not include doughnut or ring devices in chairs.
M1200C Turning/Repositioning Program
•
The turning/repositioning program is specific as to the
approaches for changing the resident’s position and
realigning the body. The program should specify the
intervention (e.g., reposition on side, pillows between
knees) and frequency (e.g., every 2 hours).
•
Progress notes, assessments, and other documentation
(as dictated by facility policy) should support that the
turning/repositioning program is monitored and
reassessed to determine the effectiveness of the
intervention.
M1200D Nutrition or Hydration
Intervention to Manage Skin Problems
•
The determination as to whether or not one should
receive nutritional or hydration interventions for skin
problems should be based on an individualized
nutritional assessment. The interdisciplinary team
should review the resident’s diet and determine if the
resident is taking in sufficient amounts of nutrients and
fluids or are already taking supplements that are fortified with the US Recommended
Daily Intake (US RDI) of nutrients.
DEFINITIONS
TURNING/
REPOSITIONING
PROGRAM
Includes a consistent
program for changing the
resident’s position and
realigning the body.
“Program” is defined as a
specific approach that is
organized, planned,
documented, monitored, and
evaluated based on an
assessment of the resident’s
needs.
NUTRITION OR
HYDRATION
INTERVENTION TO
MANAGE SKIN
PROBLEMS
Dietary measures received
by the resident for the
purpose of preventing or
treating specific skin
conditions, e.g., wheat-free
diet to prevent allergic
dermatitis, high calorie diet
with added supplementation
to prevent skin breakdown,
high-protein supplementation
for wound healing.
M1200: Skin and Ulcer/Injury Treatments (cont.)
•
Additional supplementation above the US RDI has not been proven to provide any further
benefits for management of skin problems including pressure ulcers/injuries. Vitamin and
mineral supplementation should only be employed as an intervention for managing skin
problems, including pressure ulcers/injuries, when nutritional deficiencies are confirmed
or suspected through a thorough nutritional assessment. If it is determined that nutritional
supplementation, that is, adding additional protein, calories, or nutrients is warranted, the
facility should document the nutrition or hydration factors that are influencing skin
problems and/or wound healing and tailor nutritional supplementation to the individual’s
intake, degree of under-nutrition, and relative impact of nutrition as a factor overall; and
obtain dietary consultation as needed.
•
It is important to remember that additional supplementation is not automatically required
for pressure ulcer/injury management. Any interventions should be specifically tailored to
the resident’s needs, condition, and prognosis.
M1200E Pressure Ulcer/Injury Care
•
Pressure ulcer care includes any intervention for treating pressure ulcers coded in Current
Number of Unhealed Pressure Ulcers/Injuries at Each Stage (M0300A–G).
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