K0520A4. Nutritional approaches: Parental/IV Feeding- At Discharge, Step-by-Step

Step-by-Step Coding Guide for Item Set: K0520A4. Nutritional Approaches: Parenteral/IV Feeding - At Discharge

1. Review of Medical Records

   • Initiate the process by reviewing the resident's medical records closely, focusing on the period leading up to discharge. Look for physician orders, nutritionist or dietician reports, and nursing notes that detail the use of parenteral or IV feeding as a means of nutrition and hydration near the time of discharge.

2. Understanding Definitions

   • Parenteral/IV Feeding: This method delivers nutrition directly into the bloodstream, bypassing the gastrointestinal tract, typically used when a resident cannot meet their nutritional needs through oral or enteral routes.
   • At Discharge: This refers to the nutritional approaches in place at the time the resident is being discharged from the facility.

3. Coding Instructions

   • Code 0: No - If the resident was not receiving parenteral or IV feeding for nutrition at the time of discharge.
   • Code 1: Yes - If the resident was receiving parenteral or IV feeding as their primary or supplementary form of nutrition at discharge.
   • Base your coding decision on the most current documentation available prior to the resident's discharge.

4. Coding Tips

   • Ensure that the documented use of parenteral or IV feeding specifically references its use for nutrition and hydration, not just for medication administration.
   • Confirm the continuation of parenteral or IV feeding up to the point of discharge, recognizing that plans may change as the resident's condition evolves.

5. Documentation

   • Accurately document the coding decision in the MDS. Additionally, in the resident's medical record, include detailed notes regarding the parenteral or IV feeding regimen, specifying the composition of the nutrition provided, the rationale for its use, and any planned continuation of this approach post-discharge.
   • Note any instructions or coordination with other healthcare providers or facilities regarding the continuation of parenteral nutrition after discharge.

6. Common Errors to Avoid

   • Coding parenteral or IV feeding as "At Discharge" without confirming its actual use for nutrition at that specific time, rather than at some point during the stay.
   • Overlooking the need for detailed documentation that supports the decision to continue parenteral or IV feeding after the resident leaves the facility.

7. Practical Application

   • Example: Ms. Nguyen, who has been in the facility for recovery post-major abdominal surgery, required parenteral nutrition due to complications affecting her digestive system. As her discharge approached, her condition had not improved to the point of tolerating oral or enteral nutrition. The medical team decided to continue parenteral nutrition as she transitioned to a specialized recovery facility. For K0520A4, Ms. Nguyen is coded as "1" for Yes, indicating that parenteral/IV feeding was part of her nutritional approach at discharge. Her discharge planning documentation includes a detailed parenteral nutrition plan, liaisons with the receiving facility, and a follow-up schedule for reevaluation.

The Step-by-Step Coding Guide for item K0520A4 in MDS 3.0 Section K is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.