Understanding and Coding MDS 3.0 Item K0100C: Swallow Disorder – Coughing or Choking with Meals or Medications

Introduction

Purpose:
MDS Item K0100C, Swallow Disorder – Coughing or Choking with Meals or Medications, is used to document whether a resident coughs or chokes while eating or taking medications. This symptom may indicate an underlying swallowing disorder, or dysphagia, which can increase the risk of aspiration, malnutrition, and other serious health complications. Accurate coding of this item ensures that the resident receives appropriate interventions to manage their swallowing difficulties. This guide provides a step-by-step process on how to code MDS Item K0100C according to the MDS 3.0 guidelines.

What is MDS Item K0100C?

Explanation:
MDS Item K0100C documents whether a resident experiences coughing or choking during meals or while taking medications. This is a common sign of dysphagia, which is associated with difficulty swallowing. When a resident coughs or chokes while eating or drinking, it indicates that food or liquid may be entering the airway instead of the esophagus, putting the resident at risk of:

• Aspiration pneumonia (where food or liquid enters the lungs),
• Choking,
• Malnutrition or dehydration,
• Poor medication adherence.

By coding this item, healthcare professionals can initiate interventions such as modifying the resident's diet, adjusting medication forms, or referring the resident to a speech-language pathologist for further evaluation.

Guidelines for Coding K0100C

Coding Instructions:
To accurately code Item K0100C, follow these steps:

1. Observe the Resident During Meals and Medication Administration:

   • Watch the resident closely during meals and while they take medications. Pay attention to whether they cough, choke, or gag when swallowing food, liquids, or medications.

2. Interview the Resident or Family Members:

   • Ask the resident or their family members if the resident frequently coughs or chokes while eating or taking medications. This could provide additional insight into less obvious symptoms.

3. Review the Resident’s Medical Records:

   • Check the resident’s medical records for any reports from previous assessments or speech therapy evaluations that may document signs of coughing or choking during meals or medication administration.

4. Code Based on the Resident’s Symptoms:

   • Code “1” for Coughing or Choking with Meals or Medications if the resident has experienced these symptoms during meals or while taking medications.
   • If the resident does not cough or choke during meals or medications, leave this item unmarked.

5. Enter the Response in Item K0100C:

   • If coughing or choking is observed or reported, enter “1” in K0100C.

Example Scenario 1:
A resident is observed coughing frequently while eating solid foods and taking large pills. This coughing often leads to gagging and occasional choking. In this case, “1” would be entered in Item K0100C to document the symptoms.

Example Scenario 2:
The resident reports occasional coughing when drinking water, and their family confirms that this happens frequently during meals. “1” would be entered in K0100C to document the swallowing difficulties.

Best Practices for Accurate Coding

Observation and Assessment:

• Observe the resident during meal times and medication administration to determine if they are coughing or choking when swallowing.
• Check for other signs of dysphagia, such as drooling, pocketing food, or taking a long time to swallow.

Documentation:

• Document the resident’s coughing or choking episodes in their medical records, including details such as the type of food or medication involved and the frequency of the symptoms.
• Record any interventions or referrals, such as diet modifications or speech therapy assessments, to ensure the care plan addresses the swallowing difficulties.

Communication:

• Share the resident’s symptoms with the interdisciplinary care team, including speech-language pathologists, nurses, and dietitians, to ensure appropriate interventions are implemented.
• Inform the resident and their family about the risks of coughing and choking, and discuss steps that can be taken to reduce these risks, such as modifying the resident’s diet or changing medication forms (e.g., liquid medications or crushable pills).

Conclusion

Summary:
MDS Item K0100C is used to document whether a resident experiences coughing or choking during meals or medication administration. Correctly coding this item ensures that swallowing disorders are identified and addressed, reducing the risk of complications such as aspiration pneumonia or malnutrition. By following the guidelines and best practices outlined in this article, healthcare professionals can ensure accurate documentation and timely intervention for residents experiencing swallowing difficulties.

Click here to see a detailed step-by-step on how to complete this item set

Reference

CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. Refer to [Chapter 3, Page 3-88] for detailed guidelines on coding swallowing disorders, including coughing or choking during meals or medication administration.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item K0100C: Swallow Disorder – Coughing or Choking with Meals or Medications was originally based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. Every effort will be made to update it to the most current version. The MDS 3.0 Manual is typically updated every October. If there are no changes to the Item Set, there will be no changes to this guide. This guidance is intended to assist healthcare professionals, particularly new nurses or MDS coordinators, in understanding and applying the correct coding procedures for this specific item within MDS 3.0. The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.