K0520B1. Nutritional approaches: Feeding Tube- Adm, Step-by-Step

Step-by-Step Coding Guide for Item Set: K0520B1. Nutritional Approaches: Feeding Tube - Admission

1. Review of Medical Records

   • Begin by carefully reviewing the resident's medical records, particularly focusing on the period around admission. Look for documentation that indicates the use of a feeding tube for nutrition, such as physician orders, nursing assessments, and nutritional care plans. This may include notes from hospital transfers, initial assessments by the facility's staff, or consultations with dietitians and speech-language pathologists.

2. Understanding Definitions

   • Feeding Tube: A medical device used to provide nutrition to individuals who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. The tube can be placed in various locations, such as the nose (nasogastric), stomach (gastrostomy), or small intestine (jejunostomy).
   • Admission: Refers to the time frame when the resident first entered the facility, typically the first few days of their stay.

3. Coding Instructions

   • Code 0: No - If the resident was not receiving nutrition via a feeding tube at the time of admission.
   • Code 1: Yes - If the resident was receiving nutrition via a feeding tube at admission.
   • Determine the presence of feeding tube use based on documentation within the admission period.

4. Coding Tips

   • Ensure that the feeding tube was indeed used for nutritional purposes at admission, as tubes may also be used for medication administration or decompression.
   • Clarify the type of feeding tube used (e.g., nasogastric, gastrostomy, jejunostomy) for more accurate care planning and documentation.

5. Documentation

   • Document the coding decision in the MDS accurately. In addition, include detailed notes in the resident’s medical record about the type of feeding tube used, the rationale for its use, nutritional formula prescribed, and any relevant observations from the admission assessments.
   • Note any initial complications or concerns addressed at admission related to the feeding tube.

6. Common Errors to Avoid

   • Misinterpreting temporary use of a feeding tube for medication administration as nutritional support.
   • Failing to document the specific type of feeding tube and its purpose clearly, which can lead to confusion in care planning and execution.

7. Practical Application

   • Example: Mr. Hernandez was transferred to the facility with a gastrostomy tube in place following surgery for esophageal cancer, which left him unable to swallow. Upon admission, the nursing team confirmed the placement and integrity of the gastrostomy tube, and the dietitian prescribed a specific enteral nutrition formula to meet his nutritional needs. For K0520B1, Mr. Hernandez is coded as "1" for Yes, indicating that he was receiving nutrition via a feeding tube at the time of admission. The care plan includes detailed monitoring of his tube site, feeding schedule, and nutritional intake to ensure his needs are met and to prevent complications.

The Step-by-Step Coding Guide for item K0520B1 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.