K0520B2. Nutritional Approaches: Feeding Tube- Not a Res, Step-by-Step

Step-by-Step Coding Guide for Item Set: K0520B2. Nutritional Approaches: Feeding Tube - Not a Resident

1. Review of Medical Records

   • Begin with an in-depth review of the resident's medical records, focusing on documentation related to nutritional management. Look for physician orders, nutritional or dietician assessments, and nursing notes that indicate the use of a feeding tube after the initial admission phase but discontinued before the current assessment period.

2. Understanding Definitions

   • Feeding Tube: A medical device used to provide nutrition to individuals who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. Types of feeding tubes include nasogastric (NG), percutaneous endoscopic gastrostomy (PEG), and jejunostomy tubes.
   • Not a Resident: This indicates that the feeding tube was used at some point during the resident's stay but is not being used at the time of the current MDS assessment, signifying that the resident has transitioned off this nutritional approach.

3. Coding Instructions

   • Code 0: No - If the resident has never used a feeding tube beyond the admission phase or is currently using a feeding tube.
   • Code 1: Yes - If the resident was using a feeding tube for nutrition at some point during their stay but has since discontinued its use by the time of the MDS assessment.
   • Base your coding decision on the timeline of feeding tube usage as documented in the medical records.

4. Coding Tips

   • Verify the specific dates or periods when the feeding tube was in use, ensuring it does not coincide with the admission period or the current assessment period.
   • Collaborate with the interdisciplinary team, including dieticians, speech-language pathologists, and nursing staff, for accurate information on the feeding tube's use and discontinuation.

5. Documentation

   • Document the coding decision in the MDS. In the resident’s medical record, include comprehensive notes on the feeding tube use, detailing the type of tube, the duration of use, reasons for initiation and discontinuation, and any transition to other forms of nutrition.
   • Ensure the care plan reflects the transition from feeding tube nutrition and includes any ongoing nutritional management strategies or monitoring following its discontinuation.

6. Common Errors to Avoid

   • Misclassifying residents who are still using a feeding tube as "Not a Resident" due to misunderstanding the item's phrasing.
   • Overlooking documentation that accurately captures the transition off the feeding tube, potentially leading to inaccurate coding.

7. Practical Application

   • Example: Mrs. Henderson was admitted with a PEG tube in place following a stroke that significantly impaired her swallowing. During her rehabilitation, she made significant progress in swallowing therapy. Two months into her stay, after careful assessment and a successful trial of oral feeding, her PEG tube was removed. By the time of the MDS assessment, Mrs. Henderson had been off tube feeding for several weeks and was maintaining adequate nutrition orally. For K0520B2, Mrs. Henderson is coded as "1" for Yes, indicating that while she was a resident, the feeding tube was used but has been discontinued by the time of the assessment. Detailed documentation in her care plan outlines the successful transition to oral feeding, including the support and monitoring provided during this change.

The Step-by-Step Coding Guide for item K0520B2 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.