V0200A13B: CAA - Feeding Tubes: Plan, Step-by-Step

Step-by-Step Coding Guide for Item Set V0200A13B: CAA - Feeding Tubes: Plan

1. Review of Medical Records

• Objective: Ensure all documentation accurately reflects the resident's use of a feeding tube and related care decisions.
• Actions:
  • Examine the resident’s medical records, focusing on the nutritional assessments, care plans, and physician orders related to the feeding tube.
  • Verify that the feeding tube usage, type, and related interventions are clearly documented.
  • Review any assessments or evaluations that have triggered the CAA process for feeding tube usage.

2. Understanding Definitions

• V0200A13B: CAA - Feeding Tubes: Plan: This item captures whether a care plan has been developed in response to the CAA process identifying the use of a feeding tube as an area of concern.
• Feeding Tube: A medical device used to provide nutrition to individuals who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation​.

3. Coding Instructions

• Step-by-Step:
  • Step 1: Confirm if the CAA process has identified feeding tube usage as a concern.
  • Step 2: Determine if a comprehensive care plan addressing the use of the feeding tube has been developed, including goals for nutritional support and monitoring.
  • Step 3: If a care plan exists, code "1" to indicate that a plan has been developed. If no plan has been made, code "0".
  • Step 4: Document the specifics of the plan, including any goals for the reduction of feeding tube dependency, monitoring of nutritional status, and reassessment schedules.

4. Coding Tips

• Documentation: Ensure the care plan is detailed and aligns with the resident’s overall care goals. It should be consistent with dietary, medical, and nursing documentation.
• Interdisciplinary Approach: Engage the entire care team, including dietitians, nurses, and physicians, in the development and review of the care plan.
• Regular Reassessment: The care plan should include provisions for regular reassessment of the resident's nutritional needs and the continued appropriateness of the feeding tube.

5. Documentation

• Objective: Maintain thorough records that support the rationale for the feeding tube plan and document all related decisions.
• Actions:
  • Record the reason for feeding tube use, the type of feeding tube, and the nutritional goals.
  • Ensure that the care plan is updated regularly and includes documentation of any changes in the resident’s condition or nutritional needs.
  • Include all interdisciplinary input and any discussions with the resident or their family regarding the use of the feeding tube.

6. Common Errors to Avoid

• Incomplete Care Plans: Failing to develop a comprehensive care plan for feeding tube management can lead to poor nutritional outcomes and regulatory non-compliance.
• Inadequate Documentation: Not adequately documenting the reasons for feeding tube use, the type of tube, or the care plan details can lead to care discrepancies.
• Lack of Reassessment: Ensure that the care plan includes regular reassessment to determine if the feeding tube remains the best option for the resident.

7. Practical Application

• Example 1: A resident with a new PEG tube requires a detailed care plan to monitor nutritional intake and prevent complications. The care team develops a plan that includes specific goals for maintaining adequate hydration and nutrition. The V0200A13B field is coded "1" to indicate that a plan is in place.
• Example 2: A resident who has been on a feeding tube for several months shows signs of being able to take some oral nutrition. The care plan is updated to reflect goals for gradually reducing tube feedings and increasing oral intake. The plan is documented, and V0200A13B is coded accordingly.

The Step-by-Step Coding Guide for item V0200A13B in MDS 3.0 Section V is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Please note that healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, it is crucial for healthcare professionals to 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.