Understanding and Coding MDS 3.0 Item K0520B4: Nutritional Approaches – Feeding Tube at Discharge

Introduction

Purpose:
MDS Item K0520B4, Nutritional Approaches – Feeding Tube at Discharge, documents whether a resident was discharged with a feeding tube in place. A feeding tube provides nutrition for residents who are unable to eat orally due to medical conditions like swallowing difficulties, gastrointestinal issues, or severe malnutrition. Proper coding of this item ensures accurate tracking of the resident’s nutritional needs at discharge and supports continuity of care after they leave the facility. This article provides a step-by-step guide on how to code MDS Item K0520B4 according to the MDS 3.0 guidelines.

What is MDS Item K0520B4?

Explanation:
MDS Item K0520B4 refers to whether a resident was using a feeding tube at the time of discharge from the facility. Feeding tubes are used for residents who are unable to consume enough nutrients orally. Common types of feeding tubes include:

• Nasogastric tubes (NG),
• Gastrostomy tubes (G-tubes),
• Jejunostomy tubes (J-tubes).

This item is crucial in documenting the nutritional interventions required for residents who need long-term nutritional support post-discharge.

Guidelines for Coding K0520B4

Coding Instructions:
To accurately code Item K0520B4, follow these steps:

1. Review the Resident’s Discharge Plan:

   • Check the discharge records and care plan to determine if the resident was discharged with a feeding tube in place.
   • Ensure that feeding tube use is documented as part of the discharge instructions.

2. Confirm That the Feeding Tube Was in Use at Discharge:

   • If the resident had a feeding tube in place when they were discharged, you should proceed to code this item.

3. Code Based on the Resident’s Nutritional Status at Discharge:

   • Code “1” for Feeding Tube at Discharge if the resident had a feeding tube in use at the time of discharge.
   • If the resident did not have a feeding tube at discharge, leave this item unmarked and code the appropriate nutritional approach instead.

4. Enter the Response in Item K0520B4:

   • If the resident was discharged with a feeding tube, enter “1” in K0520B4.

Example Scenario 1:
A resident with severe dysphagia was discharged with a gastrostomy tube (G-tube) for long-term nutritional support. In this case, “1” would be entered in Item K0520B4 to document that the resident had a feeding tube at discharge.

Example Scenario 2:
A resident recovering from a stroke was discharged with a nasogastric tube for feeding due to difficulty swallowing. In this case, “1” would be entered in Item K0520B4 to indicate that the resident was using a feeding tube at discharge.

Best Practices for Accurate Coding

Documentation:

• Ensure that the resident’s discharge summary includes detailed information about the type of feeding tube used, the feeding regimen, and instructions for ongoing care.
• Record any additional care instructions, such as how to maintain the feeding tube, signs of infection, and when to seek medical help.

Communication:

• Provide clear discharge instructions to the resident’s caregivers, family, or home healthcare providers about how to manage the feeding tube.
• Communicate with the interdisciplinary care team to ensure that all members are aware of the resident’s feeding tube use and nutritional requirements post-discharge.

Monitoring and Follow-Up:

• Schedule follow-up appointments with the resident’s healthcare provider to monitor feeding tube usage and ensure that the resident’s nutritional needs are met.
• Ensure proper training for caregivers on how to administer feeding through the tube and how to monitor for potential complications.

Conclusion

Summary:
MDS Item K0520B4 tracks whether a resident was discharged with a feeding tube in place. Proper coding of this item ensures that the resident’s need for ongoing nutritional support is accurately documented, helping to provide continuity of care after discharge. By following the guidelines and best practices outlined in this article, healthcare professionals can ensure that residents with feeding tubes receive appropriate post-discharge care.

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 3-184] for detailed guidelines on coding feeding tube use at discharge.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item K0520B4: Nutritional Approaches – Feeding Tube at Discharge 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.