Understanding and Coding MDS 3.0 Item K0100B: Swallow Disorder - Holds Food in Mouth or Cheeks

Understanding and Coding MDS 3.0 Item K0100B: Swallow Disorder – Holds Food in Mouth or Cheeks

Introduction

Purpose:
MDS Item K0100B, Swallow Disorder – Holds Food in Mouth or Cheeks, identifies residents who exhibit signs of a swallowing disorder, specifically pocketing food in their mouth or cheeks. Pocketing can indicate difficulties in swallowing or chewing, which can lead to malnutrition, dehydration, and even choking. Correct coding of this item helps ensure that residents receive appropriate interventions, such as dietary modifications or therapy. This article provides detailed instructions on how to code MDS Item K0100B based on the MDS 3.0 guidelines.

What is MDS Item K0100B?

Explanation:
MDS Item K0100B documents whether a resident holds food or medication in their mouth or cheeks without swallowing. This behavior, known as pocketing, may indicate an underlying dysphagia or difficulty in chewing and swallowing. Pocketing food is a symptom of various conditions, including:

• Neurological disorders such as stroke or Parkinson’s disease,
• Dental issues like poorly fitting dentures,
• Cognitive impairments that affect the resident's ability to swallow.

Residents who hold food in their mouth or cheeks may be at higher risk for:

• Choking,
• Aspiration pneumonia (if food or liquids enter the airway),
• Inadequate nutrition or hydration.

Early identification of pocketing helps prevent these complications and allows the care team to implement interventions.

Guidelines for Coding K0100B

Coding Instructions:
To accurately code Item K0100B, follow these steps:

1. Observe the Resident During Meals:

   • Watch the resident closely during meals to determine if they are pocketing food or medications in their mouth or cheeks without swallowing. This might include food staying in the mouth for extended periods or the resident appearing to “store” food in their cheeks.

2. Interview the Resident or Family Members:

   • Ask the resident, if appropriate, or family members about any history of swallowing difficulties, including holding food in their mouth or cheeks. Some residents may not be aware of the behavior, but family members or caregivers might have noticed it.

3. Review the Resident’s Medical Records:

   • Review previous assessments, such as speech therapy evaluations or medical records, to check for any documentation of pocketing or similar swallowing difficulties.

4. Code Based on the Resident’s Symptoms:

   • Code “1” for Holds Food in Mouth or Cheeks if the resident is observed or reported to have pocketed food or medication.
   • If the resident does not display this symptom, leave this item unmarked.

5. Enter the Response in Item K0100B:

   • If pocketing of food or medication is observed, enter “1” in K0100B.

Example Scenario 1:
A resident is observed holding food in their cheeks during meals, often without swallowing for long periods. This behavior has been noted by the nursing staff. In this case, “1” would be entered in K0100B to document the pocketing behavior.

Example Scenario 2:
During a mealtime observation, a resident was noted to hold pills in their mouth without swallowing them for several minutes. “1” would be entered in K0100B to record the difficulty swallowing medications.

Best Practices for Accurate Coding

Observation and Assessment:

• Regularly observe the resident during meals and medication administration to determine if they hold food or medication in their mouth or cheeks.
• Pay attention to other signs of dysphagia, such as choking, coughing, or gagging during eating or drinking.

Documentation:

• Document all instances of pocketing food or medication in the resident’s medical records, including the frequency and type of food involved.
• Ensure that any interventions or dietary modifications (e.g., softer foods or thickened liquids) are documented in the resident’s care plan.

Communication:

• Share the resident’s symptoms with the interdisciplinary care team, including speech-language pathologists, dietitians, and nurses, to ensure appropriate interventions are in place.
• Inform the resident and their family about the risks associated with pocketing food and discuss strategies for managing the behavior, such as modified diets or swallowing therapy.

Conclusion

Summary:
MDS Item K0100B is used to document the presence of a swallowing disorder characterized by holding food or medication in the mouth or cheeks. Proper coding of this item ensures that residents at risk of swallowing difficulties are identified and receive appropriate care. By following the guidelines and best practices outlined in this article, healthcare professionals can accurately assess and document swallowing disorders, helping to prevent complications such as choking and malnutrition.

Click here to see a detailed step-by-step on how to complete this item set

Reference

CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. Refer to [Chapter 3, Page 3-88] for detailed guidelines on coding swallowing disorders, including pocketing food or medication.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item K0100B: Swallow Disorder – Holds Food in Mouth or Cheeks was originally based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. Every effort will be made to update it to the most current version. The MDS 3.0 Manual is typically updated every October. If there are no changes to the Item Set, there will be no changes to this guide. This guidance is intended to assist healthcare professionals, particularly new nurses or MDS coordinators, in understanding and applying the correct coding procedures for this specific item within MDS 3.0. The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.