Step-by-Step Coding Guide for Item Set: K0710A3. Proportion of Total Calories from Parenteral/Tube Feeding: Last 7 Days

1. Review of Medical Records

   • Start by meticulously reviewing the resident's medical records focusing on the most recent week. Look for detailed information on parenteral or tube feeding, including dietitian assessments, physician orders, and nursing logs that document the administration of these nutritional methods.

2. Understanding Definitions

   • Parenteral/Tube Feeding: The administration of nutrition either directly into the gastrointestinal tract via a tube (tube feeding) or into the bloodstream (parenteral feeding) for those unable to meet their nutritional needs orally.
   • Proportion of Total Calories: The percentage of the resident's overall daily calorie intake provided through parenteral or tube feeding over the last 7 days.

3. Coding Instructions

   • Determine the average daily calorie intake from parenteral or tube feeding compared to the resident's total calorie intake over the last 7 days.
   • Code 0: No nutritional support received through parenteral or tube feeding.
   • Code 1-7: Select the code that best represents the average proportion of total daily calories received from parenteral or tube feeding, from 1 (25% or less) to 7 (more than 75%).

4. Coding Tips

   • Work closely with the dietary department or a dietitian to accurately determine both the caloric content of the parenteral or tube feedings and the resident's total caloric intake.
   • Ensure all instances of parenteral or tube feeding are captured, including any changes in the feeding regimen within the last 7 days.

5. Documentation

   • Document the coding decision in the MDS precisely. Also, record in the resident's care plan and medical records the detailed parenteral or tube feeding regimen, specifying the type of nutritional formula, frequency of feedings, and the calculated proportion of total calories from these feedings over the last 7 days.
   • Update the resident’s care documentation to reflect any changes in their nutritional approach, particularly any transitions or adjustments in parenteral or tube feeding.

6. Common Errors to Avoid

   • Failing to consider the entire 7-day period, which might result in inaccurate calculations if only part of the week is reviewed.
   • Overlooking oral intake or other sources of nutrition that could affect the total daily calorie calculation.

7. Practical Application

   • Example: Mrs. Wilson, recovering from severe gastrointestinal surgery, has been receiving both parenteral nutrition and limited oral intake. Over the last 7 days, her parenteral feedings provided an average of 1200 calories per day, while her oral intake contributed around 300 calories per day, totaling an average daily intake of 1500 calories. Therefore, 80% of her calories came from parenteral feeding. For K0710A3, Mrs. Wilson would be coded as "7" (more than 75% of total calories from parenteral/tube feeding). Her medical record includes notes on monitoring her nutritional status, with detailed records of both parenteral nutrition and oral intake over the past week.

The Step-by-Step Coding Guide for item K0710A3 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.