Source anchor
CMS MDS 3.0 RAI Manual v1.20.1 is the governed baseline currently attached to this lookup item.
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MDS Lookup
Number of Venous and Arterial Ulcers
Item Rationale
Matrix review
6 matrix group(s) are already attached for review on this item.
Answer coverage
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Answer Codes
No answer codes are defined for this item. This item may use a check-all or numeric entry format.
What this item is
Item Rationale
When to use it
Use this item when the facility is completing content tied to Section M and needs to stay anchored to v1.20.1.
Reminders
- Current source status: Published.
- Item locator: Manual page M-30
- CMS exact locator: Manual page M-30
- This item does not yet have governed answer rows attached.
Source awareness
This page is grounded in CMS MDS 3.0 RAI Manual v1.20.1. Review the exact text and locators before treating the item as final reference content.
Source & Review
Manual
CMS MDS 3.0 RAI Manual v1.20.1
Status
Published
Effective start
2025-10-01
Item locator
Manual page M-30
CMS exact locator
Manual page M-30
Full CMS Text
Item Rationale
Health-related Quality of Life
Skin wounds and lesions affect quality of life for residents because they may limit activity, may be painful, and may require time-consuming treatments and dressing changes.
Planning for Care
The presence of venous and arterial ulcers should be accounted for in the interdisciplinary care plan. This information identifies residents at risk for further complications or skin injury.
Steps for Assessment
1. Review the medical record, including skin care flow sheet
or other skin tracking form.
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 venous or
arterial ulcers are present. Key areas for venous ulcer development include the area proximal to the lateral and medial malleolus (e.g., above the inner and outer ankle area). Key areas for arterial ulcer development include the distal part of the foot, dorsum or tops of the foot, or tips and tops of the toes. Venous ulcers may or may not be painful and are typically shallow with irregular wound edges, a red granular (e.g., bumpy) wound bed, minimal to moderate amounts of yellow fibrinous material, and moderate to large amounts of exudate. The surrounding tissues may be erythematous or reddened, or appear brown-tinged due to hemosiderin staining. Leg edema may also be present. Arterial ulcers are often painful and have a pale pink wound bed, necrotic tissue, minimal exudate, and minimal bleeding.
DEFINITIONS
VENOUS ULCERS Ulcers caused by peripheral venous disease, which most commonly occur proximal to the medial or lateral malleolus, above the inner or outer ankle, or on the lower calf area of the leg. ARTERIAL ULCERS Ulcers caused by peripheral arterial disease, which commonly occur on the tips and tops of the toes, tops of the foot, or distal to the medial malleolus.
DEFINITION
HEMOSIDERIN An intracellular storage form of iron; the granules consist of an ill-defined complex of ferric hydroxides, polysaccharides, and proteins having an iron content of approximately 33% by weight. It appears as a dark yellow-brown pigment.
Coding Instructions
Pressure ulcers/injuries coded in M0210 through M0300 should not be coded here. Enter the number of venous and arterial ulcers present. Enter 0: if there were no venous or arterial ulcers present.
Coding Tips
Arterial Ulcers Trophic skin changes (e.g., dry skin, loss of hair growth, muscle atrophy, brittle nails) may also be present. The wound may start with some kind of minor trauma, such as hitting the leg on a wheelchair. The wound does not typically occur over a bony prominence, however, can occur on the tops of the toes. Pressure forces play virtually no role in the development of the ulcer, however, for some residents, pressure may play a part. Ischemia is the major etiology of these ulcers. Lower extremity and foot pulses may be diminished or absent. Venous Ulcers The wound may start with some kind of minor trauma, such as hitting the leg on a wheelchair. The wound does not typically occur over a bony prominence, and pressure forces play virtually no role in the development of the ulcer. Example 1. A resident has three toes on their right foot that have black tips. They do not have diabetes, but have been diagnosed with peripheral vascular disease.
Coding: Code M1030 as 3.
Rationale: Ischemic changes point to the ulcer being vascular.
Matrix Applicability
Nursing Home Subsets
NC - Comprehensive
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NQ - Quarterly
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
NP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Swing Bed Subsets
SP - PPS 5 Day
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Program and Policy Use
PDPM
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Shared NH/SB Subsets
IPA - Interim Payment
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Stand Alone Assessments
OBRA Admission A=01, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Quarterly A=02, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
OBRA Annual / Sig Chg A=03, B=99, F=99, G=^, H=0 A= 04, B=99, F=99, G=^, H=0
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4
Item Subset Required Use ISC Skip Patterns
PDPM (A0310B = 01 or 08)
Marker: x
applies
Locator: MDS Item Matrix v1.20.1 v4