Section K assesses a resident’s swallowing and nutritional status by looking at swallowing disorders, weight and weight changes, and nutritional approaches. This section has a significant impact on the Case Mix for Speech Language Pathology under the Patient Driven Payment Model, making accurate coding critical.
Documentation during the 7-day look back period must support the coding on the MDS for this item. Dietary notes and Speech Therapy documentation should be thoroughly reviewed for indications the resident presents with an issue. For example, the Speech Language Pathologist may note ”resident presents with pocketing with regular foods”. In this case, K0100B could be checked if this occurred during the look back period.
In addition, nursing and physician notes should be reviewed for indications of a swallowing issue. Dietary and Speech Therapy might be the ones to initially identify the problem, however, nursing and the physician should provide additional documentation to support the condition. Clinical collaboration is essential as the items in Section K0100 can be coded even if it occurred one time during the look back period.
When determining coding for nutritional approaches, it is important to keep in mind the lookback period. On Admission and At Discharge look at a 3-daywindow, the first 3 days and the last 3 days respectively. While Not a Resident and While a Resident looks at the last 7 days.
Parenteral or IV feeding can include IV fluids for:
· Hyperalimentation (TPN)
· Keep Vein Open (KVO)
· Piggybacks
· Hypodermoclysis and subcutaneous ports
It does not include IV medications which should be coded in Section O0100H or IV fluid flushes. IV fluids as part of an operative or diagnostic procedure or recovery room stay should also not be coded here. In addition, parenteral or IV fluids administered as part of chemotherapy or dialysis should not be coded here.
When coding a mechanically altered diet, documentation must note the following:
· Modifications in texture of food or liquids
· Change in texture is related to swallowing
· Physician’s order
If there is an order but no documentation to support the altered diet or if the altered diet is due to injuries impacting a resident’s ability to cut foods, it cannot be coded.
A therapeutic diet would also be coded in this section. Enteral feeding can be coded here if they are used to manage a health condition, i.e., diabetes.
As evidenced here, Section K is complicated and full of traps for miscoding. Team collaboration and thorough record review are crucial steps to getting it right.