Teresa: Hello, and welcome to
the Home Health Training part one.
I'm Teresa Mota and I will be presenting this training
for Section K Swallowing Nutritional Status.
I've been a registered nurse for 30 years
and I have experienced in direct patient care, education,
nursing administration, quality improvement and measurement,
as well as the development of post-acute care
patient resident assessment instruments.
My experience includes inpatient care
in long-term care facilities and assisted living
as well as a nurse consultant at the
Centers for Medicare and Medicaid Services
assisting with the implementation of the IMPACT Act.
Currently, I am a nurse researcher
and health research and evaluation associate
at Abt Associates in Cambridge, Massachusetts.
At the conclusion of this session
you should be able to, describe the new and revised
data elements in Section K, discuss the intent,
coding instructions and definitions
for the Section K items, and explain the changes
to coding instructions for other Section K items.
These are the new data elements that are found in Section K.
The first is a new standardized post-acute care
or PAC assessment item added to the Outcome Assessment
and Information Set version E
or OASIS-E, K0520 nutritional approaches.
The other items are M1060 Height and Weight
which was retained from the OASIS-D1
but has been incorporated into Section K
to align with the other PAC settings.
For additional information please refer
to the OASIS-E manual available on CMS's
OASIS user manual's webpage.
Now let's take a closer look
at what is included in this section
starting with K0520 Nutritional Approaches.
The intent of K0520 is that there are many conditions
that can impact a patient's ability
to maintain adequate nutrition and hydration.
The items in this section are intended to assess this.
And here is the rationale for this item.
When patients must rely on mechanically altered food
or other methods for their nutrition, such as feeding tubes,
this can diminish their sense of dignity and self-worth
and certainly the pleasure and enjoyment
one gets from eating real foods.
However, based on the patient's clinical condition
they may benefit from various nutritional approaches
that are included in this section.
Here are just a few definitions to get us started.
While I will not read the entire definition
since most of you would be quite familiar with these
I will just say that parenteral or IV feeding
is nutrition that avoids the GI tract,
while a feeding tube delivers nutrition
directly into the GI system.
And here are a few more definitions to differentiate
a therapeutic diet from a mechanically altered diet.
A therapeutic diet would be a diet
prescribed as part of a treatment
for a particular disease or condition.
For example, a low sodium diet.
And a mechanically altered diet
is one that alters the texture or consistency of the food
to facilitate oral intake
like pureed foods or thickened liquids.
And this is a screenshot of this data element
as seen on the OASIS-E.
You can see that at Start Of Care, or SOC,
or Resumption Of Care, ROC,
one would be assessing whether there are
any of these nutritional approaches being used.
This is a check all that apply data element.
So you would check all that apply for parenteral
or IV feeding, feeding tube, mechanically altered diet,
therapeutic diet, or you would check Z, none of the above.
K0520 looks a little bit different on discharge from agency.
While you are assessing these same data elements,
you're going to check the first column labeled number four
for all nutritional approaches that apply
in the last seven days.
And you're going to check in the second column,
labeled number five, all the nutritional approaches
that still apply at discharge.
You would check Z if none of these apply for either column.
Now, let's look at some of the coding guidance
for this new item.
To determine any of the listed nutritional approaches apply
you consult with the patient, family or caregiver
and or review the clinical record
or other available documentation to determine
if any of the listed nutritional approaches apply
during the time period under consideration
for the SOC or ROC assessment.
Here is a list of some of the data sources
that can be used to complete these items.
These might include the medical record,
whether it be paper or electronic health record
from wherever the patient received care,
other available documentation or notes
from pharmacy, nursing staff,
or the physician or physician designee
or perhaps other clinical staff, such as the dietician.
And you might also include discussions with hospital staff.
And at discharge, you would be looking back
into the data sources available
to reference the last seven days.
So here are the response specific instructions
related to K0520 on SOC, ROC.
You are going to review the medical record
or available documentation to determine
if any of these apply.
And then at discharge, look to see if any were applicable
for the last seven days to complete column one
and at discharge for column two.
and here are additional coding instructions.
As was stated previously,
this is a check all that apply data element
that has one column to complete at SOC and ROC
and two columns to complete on discharge,
column four in the last seven days
and column five at discharge.
You can also check Z none of the above
if none of the nutritional approaches apply.
A dash, meaning no information,
is a valid response for this item.
However, CMS expects dash use to be a rare occurrence.
So let's just walk through
a general coding tip for K0520.
If a patient is gonna receive one
of the listed nutritional approaches
as a result of the SOC or ROC assessment
the agency will check the applicable nutritional approach.
Examples might include IV hydration that will be started
at this visit or a specified subsequent visit,
or the physician is contacted for an enteral order.
Here are some coding tips
for parenteral IV feeding for K0520A.
Parenteral or IV fluids include those provided
for nutrition or hydration.
If there is supporting documentation,
that is documentation defined by your facility policy
and noted in the patient's record,
and this indicates the need for additional fluid intake
specifically to address a nutrition or hydration need
the fluids mentioned here in the yellow box may be included.
And so these examples might be IV fluids
for hyperalimentation, including total parenteral nutrition,
whether it's continuous or intermittent,
hypodermoclysis and subcutaneous ports for hydration.
And if additional fluid intake is specifically needed
for nutrition and hydration
IV fluids can be coded in this item.
K0520 excludes fluids provided solely
to maintain access and patency.
So here are some items that would not be coded in K0520A.
IV medications, those would actually be coded,
when appropriate, in O0110H IV medications,
IV fluids used to reconstitute or dilute medications
for administration purposes,
IV fluids that are a routine part
of an operative or diagnostic procedure,
or IV fluids administered to flush an IV line.
You would also not include parenteral IV fluids
administered in conjunction with chemotherapy or dialysis.
And here is a coding tip for K0520B Feeding Tube.
Feeding tubes are only used
if they are used to deliver nutritive substances
and or hydration during the time period under consideration.
And here are some coding tips for therapeutic diet
which is K0520D.
Enteral feeding formulas can only be coded
as a therapeutic diet when used to manage
problematic health conditions, such as diabetes.
You do not code enteral feeding formulas
as a mechanically altered diet.
And here's one last coating tip for therapeutic diet.
Food elimination diets that are related to food allergies
can be coded as a therapeutic diet
such as a peanut allergy.
Supplements are only coded here
if they're being taken as part of a therapeutic diet
to manage problematic health conditions.
One example might be a supplement
for protein calorie malnutrition.
A nutritional supplement does not constitute
a therapeutic diet but they may be used
as part of a therapeutic diet
although supplements may be given as part
of the treatment for a disease or condition.
Now let's review M1060 Height and Weight.
Please note that this is an existing data element
that was updated to include
the use of a dash as a valid response
if the patient falls outside
of these height or weight parameters.
For height parameters less than 50 inches
or greater than 80 inches,
and for weight parameters, less than 65 pounds
or greater than 440 pounds.
A dash can also be used
if a patient's height or weight cannot be measured
during the assessment timeframe and no agency obtained
height or weight from a documented visit
conducted within the previous 30 day window is available.
For additional information on this data element
please refer to the OASIS-E manual.
So in summary, we've described K0520
the new data element for Section K
at SOC, ROC, and discharge from agency.
We also reviewed the intent, the coding instructions,
and some definitions for Section K.
And we learned about the updates
to the coding instructions for M0160 Height and Weight.
In closing, if you would like to submit a question
regarding this presentation, please send it to
PACTraining@EconometricaInc.com
by August 31st, 2022.
As a reminder, a practice coding workshop
will be held in September of 2022.
And we do encourage you to attend.
Select questions will be answered in a Q&A session
during this virtual live event.
Thank you for reviewing this presentation.
And we look forward to your attendance
at the coding workshop.