Understanding and Coding MDS 3.0 Item K0520Z1: Nutritional Approaches – None of the Above at Admission

Introduction

Purpose:
MDS Item K0520Z1, Nutritional Approaches – None of the Above at Admission, is used to document that a resident did not require any specialized nutritional interventions (such as parenteral nutrition, tube feeding, or mechanically altered diets) at the time of admission to the facility. This item is essential for accurately recording the resident’s nutritional status at the point of entry, ensuring proper care planning and documentation. This article outlines how to correctly code MDS Item K0520Z1 based on MDS 3.0 guidelines.

What is MDS Item K0520Z1?

Explanation:
MDS Item K0520Z1, Nutritional Approaches – None of the Above at Admission, refers to residents who did not receive any of the following nutritional interventions at the time of admission:

• Parenteral nutrition,
• Tube feeding,
• Mechanically altered diets, or
• Any other specialized nutritional approaches.

This item is used when the resident was able to follow a regular diet or did not require specific nutritional interventions upon entering the facility.

Guidelines for Coding K0520Z1

Coding Instructions:
To accurately code Item K0520Z1, follow these steps:

1. Review the Resident’s Nutritional Status at Admission:

   • Check the resident’s admission records and care plan to determine whether any specialized nutritional interventions, such as parenteral nutrition or tube feeding, were required at the time of admission.

2. Confirm That No Specialized Nutritional Approaches Were Used at Admission:

   • If the resident was able to follow a regular diet and did not require any specialized nutritional support, you can code Item K0520Z1 as "None of the Above at Admission."

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

   • Code “1” for None of the Above at Admission if the resident did not require parenteral nutrition, tube feeding, or any other specialized nutritional interventions at the time of admission.
   • If the resident required any specialized nutritional support at admission, this item should remain unmarked, and the appropriate nutritional approach should be coded instead.

4. Enter the Response in Item K0520Z1:

   • If the resident did not require any nutritional interventions at admission, enter “1” in K0520Z1.

Example Scenario 1:
A resident was admitted to the facility on a regular diet with no need for parenteral nutrition, tube feeding, or mechanically altered diets. In this case, “1” would be entered in Item K0520Z1 to indicate that no specialized nutritional approaches were needed at admission.

Example Scenario 2:
A resident was admitted with no dietary restrictions and did not require any additional nutritional support. After reviewing the care plan, it is confirmed that the resident did not receive any specialized nutritional interventions at the time of admission. In this case, “1” would be entered in Item K0520Z1.

Best Practices for Accurate Coding

Documentation:

• Clearly document the resident’s nutritional status at admission in their medical records, including whether or not any specialized nutritional approaches were needed.
• If there were changes to the resident’s diet or nutritional approach after admission, document these changes clearly and update the care plan.

Communication:

• Share the resident’s nutritional approach at admission with the interdisciplinary care team, including nurses, dietitians, and physicians, to ensure accurate documentation and proper care planning.
• Include the resident’s admission dietary information in care planning meetings to ensure that the nutritional status is appropriately addressed.

Nutritional Monitoring:

• Even if no specialized nutritional approaches were required at admission, ensure that the resident’s nutritional status is regularly monitored to prevent potential issues such as malnutrition or changes in dietary needs.
• Adjust the resident’s care plan as needed if their nutritional needs change during their stay in the facility.

Conclusion

Summary:
MDS Item K0520Z1 is used to document that no specialized nutritional approaches were required for a resident at the time of admission. Accurate coding of this item ensures that the resident’s nutritional status is clearly recorded from the start of their stay, allowing for better care planning and monitoring. By following the guidelines and best practices outlined in this article, healthcare professionals can ensure proper nutritional care and documentation for residents upon admission.

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 nutritional approaches at admission.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item K0520Z1: Nutritional Approaches – None of the Above 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.