nutrition/dietary and related...

2014 MDS 3.0

Nutrition/Dietary and Related Sections

Presenters:

Janine Lehman, RN, RAC-CT, CLNC®Director of Clinical Services

Wells Health Systems

Brenda Richardson, MA, RDN, LD, CDLTC Nutrition Expert

Business Development/Relations-Dietary Consultants Inc.

Janine Lehman, RN, RAC-CT, CLNC

Presenter

• Managing Partner & Nurse Consultant/Director

of Clinical Services for KY Nursing Facilities.

• Consulting services for overall quality

assurance of nursing departments.

• Provides nursing training, policy formulation/

revision, documentation auditing, survey

support, interviewing/orientation of DON’s,

medical-legal consulting, Informal Dispute

Resolution, Case Mix management.

• Client base includes attorneys, state health

associations, software vendors, and health

care providers.

Disclosures

There are no disclosures for this

webinar

2

Brenda Richardson, MA, RDN, LD, CD

Presenter

• A known leader in the field of dietetics.

• National acclaimed speaker, author, LTC

nutrition-legal expert and consultant to health

care providers.

• Head of Business Development/Relations for

Dietary Consultants, Inc.

• President of Brenda Richardson Associates, Inc.

• Current Chair of the Academy of Nutrition and

Dietetics Political Action Committee (ANDPAC)

and serves on the Academy CMS Workgroup.

Disclosures

There are no disclosures for this

webinar

3

Objectives:• Discuss current key revisions from the Center of Medicare and Medicaid's

(CMS's) for MDS 3.0

• Present MDS 3.0 Revisions Related to Nutrition/Dietary

• Review and clarify common areas of confusion related to coding for nutrition

Current MDS 3.0 and Key Revisions

Interviews are more successful if the resident can hear you!

Sonic Super Ear - ActiveForever.com (free shipping)

MDS 3.0 Item-By-Item• F0400: Interview for Daily Preferences

• Please note that one question in this interview should be noted by Dietary.

• D. How important is it to you to have snacks available between meals?

8

MDS 3.0 Item-By-Item• Section K: Swallowing/Nutritional Status

• K0100: Swallowing Disorder (√ all that apply, even if only once during the 7 day look back)

• Interview Resident

• Interview Staff

• Review the Medical Record

– Do not code if interventions successful – no symptoms


• K0100: Swallowing Disorder (√ all that apply)– A. Loss of liquids/solids from mouth when

eating or drinking (falling out of mouth or dribbling of food or fluids)

– B. Holding food in mouth/cheeks or residual food in mouth after meals (pocketing)

– C. Coughing or choking during meals or when swallowing medications


• K0100: Swallowing Disorder (√ all that apply)

– Contd.

– D. Complaints of difficulty or pain with swallowing

• Please note difficulty chewing and mouth pain is coded in section L with the oral exam.

– Z. None of the above

– Remember, do not code if interventions successful – no symptoms during the look back period.

MDS 3.0 Item-By-Item• K0200: Height and Weight

• While measuring, if the number is X.1 –X.4, round down; X.5 – or greater round up (mathematical rounding)

• A. Height (in inches) Record most recent height measure since admission/entry or reentry.– (Must be re-measured if over 1 year ago.)

ADDRESSING COMMON AREAS OF CONFUSION

• Do we use weight during the ARD?

• What weight do we use?

• Use weight during observation?

WEIGHT?????

MDS 3.0 Item-By-Item

• K0200: Height and Weight

• B. Weight (in pounds). Base weight on most recent measure in last 30 days of the ARD. – If the last recorded weight was more than 30

days prior to the ARD, or previous weight is not available, weigh the resident again.

– If taken more than once during the last month, record most recent.


• K0300 Weight Loss

• This item compares the resident’s weight in the current observation period with his or her weight at two snapshots in time:

– • At a point closest to 30-days preceding the current weight.

– • At a point closest to 180-days preceding the current weight.


• K0300: Weight Loss

• Loss of 5% or more in the last month or loss of 10% or more in the last 6 months

– Multiple by .95 (5%) and .90 (10%)

– Weight should be continuously monitored (addressed), but only the 30 day and 180 day periods are coded on the MDS.


• Loss of 5% or more in the last month or loss of 10% or more in the last 6 months– 0. No or unknown

– **1. Yes, on physician-prescribed weight-loss regimen

– 2. Yes, not on physician-prescribed weight-loss regimen


• Physician-prescribed weight loss program:– Weight reduction plan ordered by physician

– Care plan goal of weight reduction

– Can Include:• Calorie restricted diet or other weight loss diets and

exercise

• Planned diuresis

• Weight loss must be intentional!


• K0310: Weight Gain

• Gain of 5% or more in the last month or 10% or more in the last 6 months.– 0. No or unknown

– 1. Yes, on physician-prescribed weight-gain regimen (weight-gain was planned and pursuant to physician’s order)

– 2. Yes, not on physician-prescribed weight-gain regimen (not planned and prescribed by a physician)


• K0510: Nutritional Approaches (√ all that apply)

• 2 column format – 1. While NOT a Resident (Only check column

1. if resident entered (admission or reentry) in the last 7 days. If resident entered 7 or more days ago, leave column 1 blank

– 2.While a Resident

ADDRESSING COMMON AREAS OF CONFUSION

• Does use of a supplement make it therapeutic?

• Does there have to be a physician order?

• What about food allergies?

Therapeutic Diet????


• A. Parenteral/IV feeding*** (pg. K-11)

• B. Feeding-tube (NG or PEG)

• C. Mechanically altered diet (Change in texture)

• D. Therapeutic diet (low fat, diabetic, etc.)– Enteral feedings coded here if meet definition

• Z. None of the above

Parenteral/IV feeding Tips

• Include: Those administered for nutrition or hydration

• All in the last 7 days (INCLUDING IN HOSP.!)– IV fluids or hyperal given continuously or

intermittently

– IV fluids running at KVO

– IV fluids contained in IV piggybacks

– Hypodermoclysis and sub q ports in hydration therapy

Parenteral/IV feeding Tips

• Do NOT Include:– IV medications

– IV fluids used to reconstitute and/or dilute

– IV fluids given as part of operative/diagnostic procedure/recovery room stay

– IV fluids administered solely as flushes

– Parenteral/IV fluids administered in conjunction with chemotherapy or dialysis

MDS 3.0 Item-By-Item• K0710: Percent Intake by Artificial Route

• Complete only if K0510A or K0510B is checked in column 1 or 2.

• Section has 3 columns now!!!!– 1. While NOT a Resident

– 2. While a Resident

– ****3. During Entire 7 Days

– ****Resident must receive on all 7 days to code column 3, which is only column reimbursable.

MDS 3.0 Item-By-Item• K0710A. Proportion of total calories the

resident received through parenteral or tube feeding– 1. 25% or less

– 2. 26 – 50%

– 3. 51% or more (if no PO food/fluids code this)

– Add all days received during look back and ÷ by 7 even if not received on all 7 days)


• K0710B: Percent Intake by Artificial Route

• Complete only if K0500A or K0500B is checked in column 1 or 2.

• B. Average fluid intake per day by IV or tube feeding– 1. 500 cc/day or less 2. 501 cc/day or

more

– Add all days received during look back and ÷by 7 even if not received on all 7 days)


• M 1200 Skin and Ulcer Treatments

• M1200D Nutrition or Hydration Intervention to Manage Skin Problems– Dietary measures received by the resident for

the purpose of preventing or treating specific skin conditions (i.e., high calorie or high protein with supplementation to promote wound healing, wheat free diet to prevent allergic dermatitis, etc.)


• M1200D Nutrition or Hydration Intervention to Manage Skin Problems

– Must have the following to support:

• Individualized nutritional assessment

• Nutritional deficiencies are confirmed or suspected

• Cannot be just because it is facility protocol.

CAA Process

• Each facility software may vary slightly in format

• Can complete narrative note for each section or as a final summary narrative note.

• Information in parenthesis indicates section of MDS answer is found. Other sections trigger nutrition CAA! All sections should be completed before doing the CAA process.

• Should ‘paint the picture’ of the issue for the resident, and determine if needs to be on careplan.

Questions/Thank You

Contact Information:

Janine Lehman, RN, RAC-CT, CLNC

[email protected]

Brenda Richardson, MA, RDN, LD, CD

[email protected] or [email protected]

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