Step-by-Step Coding Guide for Item Set: K0520B3. Nutritional Approaches: Feeding Tube - While a Resident

1. Review of Medical Records

   • Start by thoroughly reviewing the resident's medical records to identify any documentation of feeding tube usage for nutrition during their stay, excluding the admission phase. Look for physician's orders, nutritional assessments, nursing care plans, and notes from dietitians or speech-language pathologists that detail the implementation and management of feeding tube nutrition.

2. Understanding Definitions

   • Feeding Tube: A medical device used to provide nutrition directly to the stomach or intestine when oral intake is not adequate or possible. This includes nasogastric tubes, gastrostomy tubes (including PEG tubes), and jejunostomy tubes.
   • While a Resident: This category applies to residents who are currently using a feeding tube for nutrition or have used a feeding tube at any point during their stay in the facility, except during the initial admission phase.

3. Coding Instructions

   • Code 0: No - If the resident has never used a feeding tube for nutrition while at the facility, or if the use was only during the admission phase.
   • Code 1: Yes - If the resident is currently using a feeding tube for nutrition or has used one at any point during their stay in the facility, after the admission phase.
   • Base your coding on documented evidence of feeding tube usage for nutritional purposes during the resident's stay.

4. Coding Tips

   • Confirm the type of feeding tube used and the specific nutritional formula or regimen provided through the tube, as this information may be relevant for accurate coding and care planning.
   • Collaborate with the interdisciplinary team to gather comprehensive information on the initiation, maintenance, and any discontinuation of feeding tube nutrition.

5. Documentation

   • Accurately document the coding decision in the MDS. In the resident's medical record, include detailed notes on the feeding tube usage, such as the type of tube, start and end dates (if applicable), nutritional formula provided, and any related clinical observations or adjustments to the regimen.
   • Ensure that the care plan reflects the current status of feeding tube nutrition, including goals, monitoring strategies, and any interventions aimed at transitioning the resident to oral feeding if appropriate.

6. Common Errors to Avoid

   • Coding a resident as using a feeding tube "While a Resident" without verifying that its use extends beyond the admission phase or is current at the time of the MDS assessment.
   • Failing to update the resident's medical records and the MDS if the feeding tube is discontinued or if there are significant changes to the nutritional approach.

7. Practical Application

   • Example: Mr. Allen has been a resident for six months following a severe stroke. Due to dysphagia, he was started on a PEG tube feeding regimen one month after his admission. His care team closely monitors his nutritional status, adjusts his feeding formula as needed, and regularly evaluates his potential for oral feeding rehabilitation. For K0520B3, Mr. Allen is coded as "1" for Yes, indicating that he has been using a feeding tube for nutrition while a resident, beyond the initial admission phase. His care plan includes detailed information on his feeding regimen, ongoing assessments of his swallowing ability, and targeted interventions to support his nutritional health and potential recovery of oral feeding.

The Step-by-Step Coding Guide for item K0520B3 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.