New or worsened pressure ulcers, short stay (S038.02)

The short-stay pressure ulcer measure counts Medicare Part A stays that end with a pressure ulcer or injury the resident didn’t come in with, or one that got worse. It is decided on a single assessment, the PPS Discharge, and mostly by one column on it: how many ulcers at each stage were present on admission.

What it measures

This is the SNF Quality Reporting Program measure Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury, CMS ID S038.02. Five-Star calls it the percentage of SNF residents with pressure ulcers/pressure injuries that are new or worsened, and scores it as one of the six short-stay measures, worth up to 100 points. Lower is better, and the rate is risk-adjusted.

The unit is a Part A stay: a 5-Day PPS assessment matched to the PPS Discharge that ends the stay. Every stay that ends in the 12-month window counts, so a resident with two Part A stays can be counted twice.

The discharge assessment decides it

For each stage, CMS subtracts the “present on admission” count from the total count on the discharge assessment. If any of the six differences is above zero, the stay is in the numerator.

Two things follow. Stage 1 isn’t in the measure. And CMS does not compare the 5-Day’s counts with the discharge’s counts. It reads the discharge assessment’s own “present on admission” column, so what matters is whether the record supports that column when the discharge is coded. The admission skin assessment is that record.

What counts as present on admission

The RAI Manual’s rules, in plain words:

• An ulcer that gets deeper in the building is coded at the new stage, and the new stage is not present on admission.
• A stageable ulcer that becomes covered in slough or eschar during the stay is coded at M0300F and is not present on admission.
• An ulcer unstageable on admission is present on admission at the first numerical stage it shows once it can be staged. If it gets deeper after that, the deeper stage is not.
• An ulcer unstageable on admission that becomes unstageable for another reason stays present on admission. A deep tissue injury that opens into a slough-covered wound is the RAI Manual’s example.
• Two ulcers that were both present on admission and merge stay present on admission, unless the stage increases.
• An ulcer that worsens during a hospital stay is present on admission when the resident comes back. One acquired in the building, which returns from the hospital at the same stage, is not.

One rule changed in the October 2026 RAI Manual (v1.20.11). The October 2025 version said an ulcer documented on admission that closed and reopened at the same stage was coded present on admission. The new version says the opposite:

So under the manual in effect from October 1, 2026, an admission ulcer that heals and breaks down again before discharge counts as new. v1.20.11 also added a line to M0210: an advanced wound care dressing or skin substitute is not a surgical procedure, graft or flap, so an ulcer treated that way is still coded as a pressure ulcer. (One closed surgically with a flap or graft is coded as a surgical wound.)

Exclusions

A stay is left out of the rate only if:

• All six pairs are missing on the discharge: for every stage, the total or the present-on-admission count is a dash.
• The resident died in the facility (the 5-Day is matched to a Death in Facility tracking record).

There is no exclusion for residents admitted with ulcers. They stay in the denominator, which is why documenting what came in the door matters so much.

Risk adjustment

CMS estimates each stay’s chance of a new or worsened ulcer from four facts on the 5-Day assessment:

• Lying to sitting on the side of the bed (GG0170C1) coded 01 or 02, or not attempted (07, 09, 10, 88).
• Bowel incontinence at least occasionally (H0400 = 1, 2 or 3).
• Peripheral vascular or arterial disease (I0900) or diabetes (I2900).
• Low body mass index, 12.0 to 19.0, from height and weight (K0200A, K0200B).

The building’s expected rate is the average of those per-stay chances. CMS then compares the observed rate with the expected rate and scales the result to the national average. A building with no new or worsened ulcers scores 0.00 regardless of its expected rate.

When it locks, and when corrections still count

The stay is scored on its PPS Discharge, and nothing later changes it. A modification that corrects a wrong M0300 count counts only if CMS has it by the SNF QRP submission deadline for the quarter: 4.5 months after the quarter for target dates before January 1, 2027, and the 15th day of the second month after the quarter from then on.

Common coding mistakes

• An admission skin assessment that is late, partial or unmeasured. It is the only proof of what was present on admission.
• Coding a deep tissue injury as Stage 1. It is unstageable (M0300G), and Stage 1 isn’t in the measure.
• Reverse staging a healing ulcer. A Stage 3 stays a Stage 3 until it heals, unless it becomes unstageable.
• Carrying “present on admission” onto an ulcer that healed and reopened (the v1.20.11 change).
• Coding venous, arterial or diabetic ulcers in M0300. Code there only when pressure is the primary cause.
• Losing the stage history across a hospital return. What came back worse from the hospital is present on admission; what the building caused and the hospital didn’t change is not.

How Five-Star scores it

Five-Star uses a full year of stays, and scores the measure by quintile, 20 to 100 points. Because so many buildings report zero, CMS gives every zero the full 100:

One new ulcer takes a building from 100 points to 80 at best. These cut points were set from 2019 data.

SuperQM scores every Part A stay on this measure from your own MDS, so you can see which stays counted, and on which stage, before the quarter reaches Care Compare.