K0710A2. Prop calories parental/ tube feed: while a resident, Step-by-Step

Step-by-Step Coding Guide for Item Set: K0710A2. Proportion of Total Calories from Parenteral/Tube Feeding: While a Resident

1. Review of Medical Records

   • Begin with a comprehensive review of the resident's medical records, focusing on nutritional management documentation during their stay. Look for dietitian assessments, physician orders related to parenteral or tube feeding, and nursing notes that detail the administration of these nutritional methods.

2. Understanding Definitions

   • Parenteral/Tube Feeding: The delivery of nutrition directly into the gastrointestinal tract (tube feeding) or the bloodstream (parenteral feeding) for individuals who cannot meet their nutritional needs through oral intake.
   • Proportion of Total Calories: The percentage of a resident's total daily caloric intake that is delivered through parenteral or tube feeding.
   • While a Resident: Refers to the period after the resident's admission and before their discharge, focusing on the time when the resident is actively living and receiving care in the facility.

3. Coding Instructions

   • Calculate the proportion of total calories the resident received from parenteral or tube feeding based on the nutritional formulations and the frequency of feeding documented in the medical records.
   • Code 0: No nutritional support received through parenteral or tube feeding.
   • Code 1-7: Select the code that corresponds to the proportion of total daily calories received from parenteral or tube feeding, ranging from 1 (25% or less) to 7 (more than 75%).

4. Coding Tips

   • Collaborate with the dietary department or consult a dietitian to accurately determine the caloric content of the parenteral or tube feedings and the resident's total caloric intake.
   • Review daily nursing logs or feeding administration records to ensure all instances of parenteral or tube feeding are accounted for in the calculation.

5. Documentation

   • Document the coding decision in the MDS accurately. In the resident's care plan and medical record, include detailed information on the parenteral or tube feeding regimen, including the type of nutrition provided, the frequency of feedings, and the calculated proportion of total calories.
   • Ensure documentation reflects any changes in the feeding regimen or the resident’s nutritional status during their stay.

6. Common Errors to Avoid

   • Overlooking changes in the nutritional regimen that could affect the proportion of total calories from parenteral or tube feeding.
   • Failing to account for all sources of calories, including oral intake and snacks, which may lead to an inaccurate calculation of the proportion of calories from parenteral or tube feeding.

7. Practical Application

   • Example: Mr. Hernandez, with severe dysphagia following a stroke, received the majority of his nutrition through a PEG tube. The dietitian calculated that his tube feedings provided approximately 1500 calories per day, with an additional 250 calories from oral intake of specially prepared snacks. His total caloric intake was thus approximately 1750 calories per day, making the proportion of calories from tube feeding about 85%. For K0710A2, Mr. Hernandez would be coded as "7" (more than 75% of total calories from parenteral/tube feeding). The care plan includes this calculation, along with monitoring for tolerance and adjustments to his feeding regimen as needed.

The Step-by-Step Coding Guide for item K0710A2 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.