Understanding and Coding MDS 3.0 Item K0520B1: Nutritional Approaches – Feeding Tube at Admission

Introduction

Purpose:
MDS Item K0520B1, Nutritional Approaches – Feeding Tube at Admission, tracks whether a resident was using a feeding tube upon admission to the facility. Feeding tubes are essential for individuals who cannot eat or swallow safely due to medical conditions such as dysphagia, gastrointestinal issues, or severe malnutrition. Proper coding of this item ensures accurate documentation of the resident’s nutritional needs and helps inform care planning from the beginning of their stay. This article provides detailed guidance on how to code MDS Item K0520B1 according to the MDS 3.0 guidelines.

What is MDS Item K0520B1?

Explanation:
MDS Item K0520B1 applies to residents who had a feeding tube in place at the time of admission. A feeding tube provides enteral nutrition to individuals who are unable to eat orally or require direct nutritional support. The most common types of feeding tubes include:

• Nasogastric (NG) tube,
• Gastrostomy (G-tube),
• Jejunostomy (J-tube).

This item is crucial for documenting the use of a feeding tube at the time of entry into the facility to ensure appropriate care planning.

Guidelines for Coding K0520B1

Coding Instructions:
To accurately code Item K0520B1, follow these steps:

1. Review the Resident’s Admission Records:

   • Check the resident’s admission records and care plan to determine if they were using a feeding tube at the time of admission to the facility.

2. Confirm Feeding Tube Use at Admission:

   • Ensure that the feeding tube was in place and providing nutrition at the time the resident was admitted to the facility. This could involve reviewing any physician orders or medical notes from prior care settings.

3. Code Based on Feeding Tube Use:

   • Code “1” for Feeding Tube at Admission if the resident was using a feeding tube when they were admitted.
   • If the resident was not using a feeding tube at the time of admission, leave this item unmarked and code the appropriate nutritional approach.

4. Enter the Response in Item K0520B1:

   • If a feeding tube was in place at the time of admission, enter “1” in K0520B1.

Example Scenario 1:
A resident with advanced dementia was admitted to the facility using a gastrostomy (G-tube) for nutritional support. In this case, “1” would be entered in Item K0520B1 to document that the feeding tube was in place at admission.

Example Scenario 2:
A resident recovering from a stroke was admitted with a nasogastric (NG) tube for feeding due to difficulty swallowing. In this case, “1” would be entered in K0520B1 to indicate feeding tube use at the time of admission.

Best Practices for Accurate Coding

Documentation:

• Ensure that the admission records clearly document the type of feeding tube in use, the reason for the feeding tube, and the feeding regimen followed.
• Record any physician’s orders related to the feeding tube, including the method and schedule of feedings and any medications administered through the tube.

Communication:

• Share information about the resident’s feeding tube with the interdisciplinary care team, including nurses, dietitians, and physicians, to ensure that proper feeding protocols are followed.
• Communicate with the resident’s family or caregivers about the importance of the feeding tube and how it will be managed during their stay.

Monitoring and Follow-Up:

• Regularly assess the resident’s response to the feeding tube to ensure it is functioning correctly and meeting their nutritional needs.
• Schedule follow-up evaluations with the healthcare provider or dietitian to adjust the feeding regimen as needed and monitor for complications, such as infection or tube displacement.

Conclusion

Summary:
MDS Item K0520B1 is used to document whether a resident was using a feeding tube at the time of admission. Correct coding of this item ensures that the resident’s nutritional needs are identified and addressed from the start of their stay. By following the guidelines and best practices outlined in this article, healthcare professionals can ensure that residents requiring enteral nutrition receive the appropriate care and support.

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 3-184] for detailed guidelines on coding feeding tube use at admission.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item K0520B1: Nutritional Approaches – Feeding Tube at Admission 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.