Step-by-Step Coding Guide for Item Set: K0520C3. Nutritional Approaches: Mechanically Altered Diet - While a Resident

1. Review of Medical Records

   • Begin by thoroughly reviewing the resident’s medical records, focusing on dietary assessments, speech-language pathology evaluations, and nutritional plans documented during their stay. Look for mentions of a mechanically altered diet being implemented after admission and prior to the current MDS assessment period.

2. Understanding Definitions

   • Mechanically Altered Diet: This diet modifies the texture of foods to facilitate easier chewing and swallowing. It includes pureed, minced, or softly cooked foods and is typically prescribed for residents with dysphagia or significant chewing difficulties.
   • While a Resident: Indicates the period after the initial admission phase up until the current assessment, not including the admission or discharge phases.

3. Coding Instructions

   • Code 0: No - If the resident has not required a mechanically altered diet during their stay, apart from any initial assessment period.
   • Code 1: Yes - If the resident has been on a mechanically altered diet at any point while being a resident, as documented in their care plans or medical records.
   • Determine this based on consistent documentation of dietary modifications to address swallowing or chewing issues.

4. Coding Tips

   • Confirm the diet's presence through multiple sources within the resident’s care documentation to ensure accuracy.
   • Understand the specific characteristics of mechanically altered diets to differentiate them from other dietary modifications.

5. Documentation

   • Document the coding decision in the MDS accurately. In the resident’s care plan and medical record, include detailed notes about the mechanically altered diet, specifying when it was initiated, the specific type of diet (e.g., pureed, minced), and the healthcare professional's recommendations leading to its implementation.
   • Note any changes or progressions in the diet, including reasons for alterations and resident responses.

6. Common Errors to Avoid

   • Confusing temporary dietary changes for specific health interventions with a consistently required mechanically altered diet.
   • Failing to update the resident’s dietary status in the MDS and care plan when a mechanically altered diet is initiated or discontinued.

7. Practical Application

   • Example: Mr. Williams, a long-term resident with progressive Parkinson’s disease, developed increased difficulties with chewing and swallowing over time. After an evaluation by a speech-language pathologist, a mechanically altered diet was recommended and initiated. This included pureed foods and thickened liquids to reduce the risk of aspiration. The dietetic service documented this change, and his care plan was updated accordingly. For K0520C3, Mr. Williams is coded as "1" for Yes, indicating that he has been on a mechanically altered diet while a resident. The documentation includes details about the diet's initiation, ongoing assessments, and any adaptations made in response to his changing needs.

The Step-by-Step Coding Guide for item K0520C3 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.