Step-by-Step Coding Guide for Item Set: K0520Z2. Nutritional Approaches: None of the Above - Not a Resident

1. Review of Medical Records

   • Begin with a comprehensive examination of the resident's medical records throughout their stay, excluding the admission phase. Look for documentation related to dietary orders, assessments from dietitians or nutritionists, and care team notes. The goal is to identify any periods where specialized nutritional approaches (e.g., parenteral/IV feeding, feeding tube, mechanically altered diets, therapeutic diets) were not used after the resident's admission.

2. Understanding Definitions

   • None of the Above: Indicates that the resident was not on any specialized nutritional approaches listed in the MDS item sets (e.g., parenteral/IV feeding, feeding tube, mechanically altered diets, therapeutic diets) for a period during their stay, excluding the admission phase.
   • Not a Resident: Refers to the timeframe after the initial admission and before discharge, highlighting periods when the resident did not require specialized nutritional approaches.

3. Coding Instructions

   • Code 0: No - If the resident received any of the specialized nutritional approaches during their stay, excluding the admission phase.
   • Code 1: Yes - If, at any point after admission and before discharge, the resident was not on any of the specialized nutritional approaches.
   • Base your coding on the absence of documented orders or recommendations for specialized nutritional approaches in the medical records during the specified period.

4. Coding Tips

   • Thoroughly review the resident’s dietary history to ensure that no specialized nutritional approach was overlooked during the non-admission phases of their stay.
   • Consult with dietary and healthcare staff to confirm the absence of specialized nutritional approaches during the resident’s stay.

5. Documentation

   • Accurately document the coding decision in the MDS. Include detailed notes in the resident’s care plan and medical record confirming periods when the resident was not on any specialized nutritional approaches, highlighting the regular diet or standard nutritional management provided.
   • Document any dietary assessments, team meetings, or consultations that support the decision regarding the resident’s nutritional management.

6. Common Errors to Avoid

   • Incorrectly coding the resident as not on any specialized nutritional approaches without confirming through a comprehensive review of the dietary history and medical records.
   • Failing to update the resident’s dietary status in the MDS and care plan if a specialized nutritional approach is initiated or discontinued during their stay.

7. Practical Application

   • Example: During her six-month stay, Ms. Anderson was initially on a therapeutic diet for diabetes management. After three months, her blood sugar levels stabilized, and she transitioned back to a regular diet with general diabetic management principles. For the remaining three months before discharge, she was not on any of the specialized nutritional approaches. For K0520Z2, Ms. Anderson is coded as "1" for Yes, indicating a period during her stay when she was not on any specialized nutritional approaches. Her care documentation includes notes from the dietitian outlining the transition to a regular diet and ongoing monitoring of her nutritional status and blood sugar levels.

The Step-by-Step Coding Guide for item K0520Z2 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.