What does “Pressure injury” mean?
Short answer
A pressure injury is skin and tissue damage from steady pressure, often over a bone. CMS treats it as the same as a pressure ulcer and cites F686.
Also known as: pressure ulcer, bedsore, decubitus ulcer, PU/PI
Definition and stages
CMS Appendix PP says clinicians may use pressure ulcer, pressure injury, pressure sore, decubitus ulcer or bed sore, as long as pressure is the main cause.
It usually forms over a bony area or under a medical device, often with shear (skin dragged against a surface). An injury can show as intact skin, and an ulcer as an open wound.
| Stage | CMS description (summarized) |
|---|---|
| Stage 1 | Redness of intact skin that does not fade when pressed |
| Stage 2 | Partial loss of skin thickness, with the dermis (inner skin layer) showing |
| Stage 3 | Full loss of skin thickness; fat may show |
| Stage 4 | Full loss of thickness, with fascia, muscle, tendon, ligament, cartilage or bone showing |
| Unstageable | Depth cannot be seen because dead tissue (slough or eschar) covers the wound |
| Deep tissue | Deep red, maroon or purple color in intact skin that does not go away |
The rule
F686 (42 CFR 483.25(b)(1)) requires care that meets professional standards to prevent pressure ulcers. A resident must not develop one unless the clinical condition shows it was unavoidable.
Residents who have one must get treatment to help it heal and to prevent infection and new ulcers.
Mix-up: avoidable versus unavoidable. CMS calls an ulcer unavoidable only if the facility checked the risk, set steps that fit the resident's needs, goals and standards, monitored them and changed them as needed. Stage 2 should not describe moisture-related skin damage or skin tears.
Example: a Stage 3 pressure injury is found two weeks after admission. The facility logs it as an incident, reviews the risk assessment and repositioning records, and brings it to its QAPI review.
Frequently asked questions
Are pressure ulcer and pressure injury the same thing?
CMS treats them as the same when pressure is the main cause. An injury can show as intact skin, and an ulcer as an open wound. Some clinicians use them for different looks.
What makes a pressure injury unavoidable?
Only if it developed even though the facility checked the resident's condition and risks, set fitting steps, monitored them and revised them as needed.
Which F-tag covers pressure injuries?
F686 (42 CFR 483.25(b)(1)), which requires prevention care and treatment. F689 (accidents) and F684 (quality of care) may be cited with it.
Sources
- CMS State Operations Manual, Appendix PP: Guidance to Surveyors for Long Term Care Facilities
- CMS State Operations Manual, Chapter 7: Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities
Reviewed against the sources above on Oct 5, 2026. Rules change: confirm current requirements with the issuing body or your counsel before relying on any summary.
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