Understanding and Coding MDS 3.0 Item K0520D1: Nutritional Approaches – Therapeutic Diet at Admission

Introduction

Purpose:
MDS Item K0520D1, Nutritional Approaches – Therapeutic Diet at Admission, is used to document whether a resident was on a therapeutic diet at the time of admission to the facility. A therapeutic diet is designed to manage specific medical conditions such as diabetes, hypertension, or kidney disease. Accurate coding of this item ensures that the resident’s dietary needs are properly documented upon entry, helping the care team plan appropriate interventions. This article outlines how to correctly code MDS Item K0520D1 based on MDS 3.0 guidelines.

What is MDS Item K0520D1?

Explanation:
MDS Item K0520D1 refers to whether the resident was prescribed a therapeutic diet at the time of admission. A therapeutic diet is designed to address a resident’s specific medical needs, such as:

• Low-sodium diet for hypertension,
• Diabetic diet for blood sugar control,
• Renal diet for kidney disease,
• Cardiac diet for heart conditions.

This item helps track whether the resident’s nutritional needs were managed through a prescribed therapeutic diet at the time of their admission.

Guidelines for Coding K0520D1

Coding Instructions:
To accurately code Item K0520D1, follow these steps:

1. Review the Resident’s Admission Records:

   • Check the resident’s admission documentation and care plan to determine if a therapeutic diet was prescribed at the time of entry into the facility.

2. Confirm That a Therapeutic Diet Was Prescribed at Admission:

   • Ensure that the therapeutic diet was part of the resident’s care plan when they were admitted to the facility. This could include dietary recommendations provided by a doctor or dietitian.

3. Code Based on the Resident’s Diet at Admission:

   • Code “1” for Therapeutic Diet at Admission if the resident was on a therapeutic diet upon entering the facility.
   • If the resident was not on a therapeutic diet at admission, leave this item unmarked and code any other nutritional approach that applies.

4. Enter the Response in Item K0520D1:

   • If the resident was placed on a therapeutic diet at admission, enter “1” in K0520D1.

Example Scenario 1:
A resident with chronic kidney disease was prescribed a renal diet upon admission to the facility. In this case, “1” would be entered in Item K0520D1 to reflect that a therapeutic diet was required at admission.

Example Scenario 2:
A resident with diabetes was placed on a diabetic diet to manage their blood sugar levels at the time of admission. In this case, “1” would be entered in Item K0520D1 to document the therapeutic diet prescribed at admission.

Best Practices for Accurate Coding

Documentation:

• Ensure that the prescribed therapeutic diet is clearly documented in the resident’s admission records and care plan, including the medical reason for the diet.
• Include any instructions provided by the resident’s healthcare provider or dietitian regarding dietary restrictions or modifications.

Communication:

• Communicate the resident’s dietary needs to the interdisciplinary care team, including dietitians, nurses, and physicians, to ensure the therapeutic diet is followed from the start of the resident’s stay.
• Share dietary instructions with the resident and their family to promote adherence to the prescribed diet and avoid complications.

Monitoring and Follow-Up:

• Regularly monitor the resident’s response to the therapeutic diet and assess whether it is effectively managing the medical condition for which it was prescribed.
• Adjust the resident’s care plan if needed based on dietary assessments and clinical evaluations.

Conclusion

Summary:
MDS Item K0520D1 tracks whether a resident was placed on a therapeutic diet at the time of admission. Correct coding of this item ensures that the resident’s nutritional needs are documented and addressed from the start of their stay in the facility. By following the guidelines and best practices outlined in this article, healthcare professionals can ensure that residents’ dietary needs are accurately tracked and managed.

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 therapeutic diets at admission.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item K0520D1: Nutritional Approaches – Therapeutic Diet at Admission 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.