Step-by-Step Coding Guide for Item Set: K0520A3. Nutritional Approaches: Parenteral/IV Feeding - While a Resident

1. Review of Medical Records

   • Initiate by thoroughly reviewing the resident's medical records for any indications of parenteral or IV feeding usage during their stay. Focus on physician orders, nutritionist or dietician notes, and nursing documentation that details the implementation, monitoring, and adjustments of parenteral or IV feeding as a nutritional approach.

2. Understanding Definitions

   • Parenteral/IV Feeding: The administration of nutrition directly into the bloodstream, bypassing the digestive system. It's used for residents who cannot meet their nutritional needs through oral or enteral routes due to various health conditions.
   • While a Resident: This refers to the period during which the resident is actively receiving care in the facility and excludes the admission phase.

3. Coding Instructions

   • Code 0: No - If the resident has not received parenteral or IV feeding for nutrition while at the facility beyond the admission phase.
   • Code 1: Yes - If the resident is currently receiving, or has received, parenteral or IV feeding as a primary or supplementary form of nutrition at any point during their stay, excluding the admission phase.
   • Determine this based on documented evidence of parenteral/IV feeding usage after the resident's initial admission process.

4. Coding Tips

   • Verify the specific timeframe during which parenteral or IV feeding was administered to ensure it falls within the "While a Resident" period and not just at admission.
   • Collaborate with the interdisciplinary team for accurate information regarding the initiation, continuation, or cessation of parenteral nutrition.

5. Documentation

   • Document your coding decision in the MDS. Additionally, ensure the resident's medical record and care plan clearly outline the details of the parenteral or IV feeding, including start and end dates (if applicable), the composition of the nutrition provided, and the clinical rationale for its use.
   • Update the care plan to reflect any changes in the resident's nutritional approach, emphasizing the goals and expected outcomes of parenteral or IV feeding.

6. Common Errors to Avoid

   • Misclassifying the initiation of parenteral or IV feeding during the admission phase as "While a Resident."
   • Overlooking the discontinuation of parenteral/IV feeding if it was ceased before the MDS assessment period, leading to inaccurate coding.

7. Practical Application

   • Example: Mr. Cooper, with advanced Crohn's disease, was unable to meet his nutritional needs orally or enterally due to severe gastrointestinal complications. Two weeks after his admission, a decision was made to commence parenteral nutrition. Throughout his stay, his condition and nutritional intake were closely monitored, with adjustments made to the parenteral nutrition as needed. For K0520A3, Mr. Cooper is coded as "1" for Yes, indicating he has received parenteral/IV feeding while a resident, not just at admission. His care plan includes detailed information on the nutritional formula, monitoring parameters, and a strategy for potential transition back to enteral nutrition as his condition improves.

The Step-by-Step Coding Guide for item K0520A3 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.