K0520A2. Nutritional approaches: Parental/IV Feeding-Not a Res, Step-by-Step

Step-by-Step Coding Guide for Item Set: K0520A2. Nutritional Approaches: Parenteral/IV Feeding - Not a Resident

1. Review of Medical Records

   • Start with a comprehensive review of the resident's medical records, particularly focusing on the period after the initial admission. Look for physician's orders, nursing notes, and dietician consultations that indicate the use of parenteral or IV feeding as part of the resident's care plan beyond the admission phase.

2. Understanding Definitions

   • Parenteral/IV Feeding: The delivery of nutrition directly into the bloodstream, bypassing the gastrointestinal tract. It's used when a resident is unable to ingest or absorb nutrition orally or enterally.
   • Not a Resident: This category is selected when parenteral or IV feeding was used at some point during the resident's stay in the facility but not at the time of the MDS assessment, indicating that the resident has transitioned off this nutritional approach.

3. Coding Instructions

   • Code 0: No - If parenteral or IV feeding has never been used beyond the admission phase or is currently in use at the time of the MDS assessment.
   • Code 1: Yes - If parenteral or IV feeding was used at some point during the resident's stay but has been discontinued by the time of the MDS assessment.
   • Determine the use based on a detailed timeline of the resident’s nutritional management documented in the medical records.

4. Coding Tips

   • Carefully differentiate between parenteral/IV feeding used for hydration or medication delivery and its use specifically for nutritional support.
   • Ensure accurate documentation of the start and end dates of parenteral/IV feeding to appropriately code its discontinuation.

5. Documentation

   • In the MDS and the resident’s medical record, document the period during which parenteral or IV feeding was utilized for nutrition, including the rationale for initiation and the transition plan or reason for discontinuation.
   • Note any significant outcomes or changes in the resident's condition related to the use and cessation of parenteral nutrition.

6. Common Errors to Avoid

   • Incorrectly coding ongoing parenteral/IV feeding as "Not a Resident" due to misunderstanding the item's definition.
   • Failing to update the MDS and care plans when parenteral/IV feeding is discontinued, leading to outdated information.

7. Practical Application

   • Example: Mrs. Rivera was started on parenteral nutrition due to severe malabsorption issues following a major abdominal surgery. As her condition improved and she was able to tolerate enteral nutrition, the parenteral nutrition was gradually reduced and ultimately discontinued. By the time of the MDS assessment, Mrs. Rivera was receiving all her nutrition enterally. For K0520A2, Mrs. Rivera is coded as "1" for Yes, indicating that while parenteral/IV feeding was a part of her care plan post-admission, it was not in use at the time of the assessment. Documentation in her medical record details the progression from parenteral to enteral nutrition, including the rationale and monitoring for tolerance and nutritional adequacy.

The Step-by-Step Coding Guide for item K0520A2 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.