K0520B4. Nutritional approaches: Feeding Tube- At Discharge, Step-by-Step

• Step-by-Step Coding Guide for Item Set, K0520B4. Nutritional approaches: Feeding Tube- At Discharge

  1. Feeding Tube: A medical device used to provide nutrition directly to the stomach or intestine when oral intake is not sufficient or possible. This includes nasogastric tubes, gastrostomy tubes (PEG), and jejunostomy tubes.
  • At Discharge: This refers to the resident's status regarding feeding tube use at the time they are discharged from the facilityCoding Instructions
    • Code 0: No - If the resident was not using a feeding tube for nutrition at the time of discharge.
    • Code 1: Yes - If the resident was using a feeding tube for nutrition at the time of discharge.
    • Determine the resident’s feeding tube status based on the most recent and relevant documentation.

• Coding Tips

  • Ensure that the use of the feeding tube is for nutritional purposes, distinguishing it from tubes used solely for medication administration.
  • Collaborate with the interdisciplinary team to verify the continuity of feeding tube use until discharge, ensuring accurate coding.

• Documentation

  • Document the coding decision in the MDS. In the resident’s medical record, include detailed notes regarding the feeding tube, such as the type, duration of use, nutritional formula provided, and any complications or adjustments made up to the point of discharge.
  • Outline any discharge planning that involves the feeding tube, including patient and caregiver education, follow-up care, and any coordination with home health services or other facilities.

• Common Errors to Avoid

  • Misinterpreting temporary removal or non-use of a feeding tube for procedures or testing as discontinuation of feeding tube nutrition.
  • Overlooking documentation from the days immediately leading up to discharge, which might indicate changes in the feeding tube status.

• Practical Application

  • Example: Mr. Brown, who suffered a severe stroke resulting in dysphagia, had been receiving nutrition through a PEG tube for several months. As his discharge approached, despite some improvement in swallowing function, he continued to rely on the PEG tube for supplemental nutrition. The care team worked with Mr. Brown and his family to ensure they were prepared to manage the PEG tube at home, including providing training on tube care, feeding procedures, and signs of complications. For K0520B4, Mr. Brown is coded as "1" for Yes, indicating that he was using a feeding tube for nutrition at the time of discharge. Detailed documentation in his discharge summary includes the care instructions provided to Mr. Brown and his family, ensuring a safe transition to home care.

The Step-by-Step Coding Guide for item K0520B4 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.