K0520A1. Nutritional approaches: Parental/IV Feeding- Adm, Step-by-Step

Step-by-Step Coding Guide for Item Set: K0520A1. Nutritional Approaches: Parenteral/IV Feeding - Admission

1. Review of Medical Records

   • Begin by thoroughly reviewing the resident's medical records, focusing on nutrition and hydration management. Look for physician's orders, nursing notes, and nutritionist or dietician consultations that document the use of parenteral or IV feeding at or around the time of admission.

2. Understanding Definitions

   • Parenteral/IV Feeding: A method of delivering nutrients directly into the bloodstream through an intravenous line, bypassing the digestive system. This approach is used when a resident cannot or should not receive food or fluids by mouth.
   • Admission: Refers to the period surrounding the resident's entry into the facility, typically within the first few days of arrival.

3. Coding Instructions

   • Code 0: No - If parenteral or IV feeding was not used for nutrition and hydration management at admission.
   • Code 1: Yes - If parenteral or IV feeding was initiated or continued for nutrition and hydration management at or around the time of admission.
   • Determine the use of parenteral or IV feeding based on medical documentation from the time of admission.

4. Coding Tips

   • Verify the initiation date and purpose of parenteral or IV feeding to ensure it was specifically for nutrition and hydration management.
   • Distinguish between temporary IV hydration for conditions like dehydration and ongoing parenteral nutrition as a primary nutritional approach.

5. Documentation

   • Document the coding decision in the MDS accurately. Also, include detailed notes in the resident’s medical record about the parenteral or IV feeding, noting the start date, specific nutrients or fluids administered, and any related medical justifications or goals.

6. Common Errors to Avoid

   • Confusing short-term IV hydration or medication administration with parenteral nutrition.
   • Failing to recognize parenteral nutrition that was initiated just prior to admission and continued into the admission period.

7. Practical Application

   • Example: Mr. Thompson was admitted to the facility after an extended hospital stay where he was started on parenteral nutrition due to severe gastrointestinal issues that precluded oral intake. Upon admission, the facility continued the parenteral nutrition as his primary nutritional approach while planning for a gradual transition to enteral nutrition as his condition improved. For K0520A1, Mr. Thompson is coded as "1" for Yes, indicating that parenteral/IV feeding was used at admission for nutrition and hydration management. The care plan reflects this approach, detailing the composition of the parenteral nutrition, monitoring protocols, and transition plans.

The Step-by-Step Coding Guide for item K0520A1 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.