NPUAP Revised Pressure Injury Definitions
Released on 14 May 2020

Wounds Australia Board congratulate the NPUAP for adopting the term ”pressure injury” in their recent list of definitions as announced in a NPUAP Media Release, dated 14 May, 2016. However, Wounds Australia Board strongly recommends that members continue to use the definitions for pressure injury staging as outlined in the Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury (2011) and the joint NPUAP, EPUAP and PPPIA Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline (referred to as the International Guideline) (2014), until the revised joint International Guideline is published in 2019. This review will commence in 2017 and will afford an opportunity to examine the proposed NPUAP definition changes in line with the evidence in the literature and expanded consensus development. Wounds Australia look forward to the continuing collaboration with our international partners on this project.

The rationale for this recommendation is based on the need to align definitions used in clinical practice with those used in the guidelines and the WHO ICD-10 AM version L89 pressure injury staging definitions. It is proposed that adherence to our guideline definitions will facilitate national benchmarking and reduce confusion amongst clinicians, carers and coders.

In regards to mucosal pressure injuries, we have been informed that the ICD Technical Group (ITG) are recommending that mucosal pressure injuries not be classified to L89 Pressure injury as they do not occur in skin. The Australian Consortium for Classification Development (ACCD) considered but does not support the creation of a code for mucosal pressure injuries, but proposes to classify them as per the classification of ‘ulcer by site’ (e.g. tongue, gastrointestinal, nasal, urethra, vaginal canal). As mucosal pressure injuries are due to a complication of a medical device, where classification will be subject to the updated guidelines in ACS 1904 Procedural Complications; i.e. where a complication is related to a prosthetic device, implant or graft, it is usually classified to T82-T85 Complications of prosthetic devices, implants and grafts. Therefore, a relevant code from T82-T85 will be assigned, to mucosal pressure injuries with an additional diagnosis chapter code (ulcer/by site) as appropriate. This proposal regarding mucosal pressure injuries is currently out for comment amongst the ITG members.