So let's go into Section K.
So I'm Brenda Karkos and I'll be presenting this workshop
about Section K, Swallowing and Nutritional Status.
I'm a registered nurse with experience
in direct patient care, education,
and nursing administration.
And my experience includes inpatient care,
outpatient oncology, home health, and hospice settings.
And currently I'm an associate at Abt Associates
in Cambridge, Mass.
So we're gonna review some practice scenarios.
Then we'll walk through some of the coding
for this one item, K0520 Nutritional Approaches.
So here's our first scenario.
Upon admission to the post-acute care PAC setting,
the patient was placed on a therapeutic diet
to lower their salt intake due to high blood pressure,
which was exacerbated following a car accident.
Prior to this admission, the patient was on a regular diet.
With the low sodium diet, the high blood pressure improved.
And this was continued throughout the entire two weeks
of the rehab stay.
This diet was also ordered upon discharge to home.
So how would you code K0520 for this patient
on the admission assessment?
Is it K0520Z, none of the above.
Or B, K0520D, therapeutic diet would be checked.
Or C, K0520C, mechanically altered diet
and K0520D therapeutic diet.
I'll give you a minute for the polling.
Okay, and most of you chose B, which is the correct answer.
So, actually 88% chose B.
And let's just look at the rationale.
This patient was placed on the low sodium diet
on admission to help manage the high blood pressure.
Now let's look at this same patient on discharge.
The discharge item requires two different columns
to be completed.
One is for the last seven days and one was for the actual
status at a discharge.
So recall that the scenario states that this same diet
was also ordered upon discharge to home.
So how would you code K0520 for this patient on discharge?
Would it be A, both columns, four and five would have K020Z
none of the above.
Or B, for column four, you would choose therapeutic diet.
And for column five, you would put none of the above.
Or C, for both columns you would choose therapeutic diet.
Or would it be D, K0520C, mechanically-altered diet
and K0520D, therapeutic diet would be checked.
And most of you chose C, which was the correct answer.
Let's go to the rationale.
So, the rationale is that this patient was on
a therapeutic diet during the last seven days
and also at the time of discharge.
Okay, so now let's look at scenario number two.
This patient was admitted to the PAC facility
after a stroke and placement of a feeding tube.
Since admission, they've been receiving tube feedings daily,
while receiving therapy to improve swallowing
and progress to intake by mouth.
The patient also has a peripheral line and is receiving some
IV medications, as well as IV fluids.
There is no supporting documentation indicating
that additional fluid intake is to support
nutrition and hydration.
So let's look at the coding question.
How would you code K0520 for the patient
on the admission assessment?
Is it A, K0520Z, none of the above.
Or B, both K0520A, peripheral IV feeding
and feeding tube would be checked.
Or C, just feeding tube would be checked.
Or D, K0520A, parenteral/IV feeding, feeding tube,
and K0520C, mechanically-altered diet would also be checked.
Give you a minute.
Okay, so for those of you answered C, which is 68% of you,
that was the correct answer.
And the rationale is that this patient does have
a peripheral IV line for some medications and IV fluids.
However, in the absence of documentation
supporting that need for additional fluid intake,
specifically addressing a nutrition or hydration need,
the presence of a peripheral line for medications and fluids
would not support checking K0520A for parenteral/IV feeding.
Okay, now let's look at the same patient again
and add a bit more information so that we can see
how to code this one at discharge.
So during the PAC stay, the patient slowly progressed
on a mechanically-altered diet.
Four days before discharge,
there was no further need for the tube feeding
since the oral intake was nutritionally sufficient,
and the patient progressed to a regular diet.
A decision was made to remove the feeding tube
two days prior to discharge.
So how would you code this patient
for K0520 column four, last seven days
on the discharge assessment?
Is it A, check none of the above.
B, check B, feeding tube and C, mechanically-altered diet.
Or C, feeding tube would be checked.
Or D, mechanically-altered diet.
Okay.
So it looks like most of you chose B, 72%.
And if you answered B, that would be correct.
And let's go to the rationale,
which is that within the last seven days,
the patient was still receiving tube feedings,
was still on a mechanically-altered diet.
And even though beginning four days before discharge,
the tube feedings were no longer required
and the mechanically-altered diet was discontinued.
So within those last seven days,
those two things were still happening.
So, how would you code K0520 for the patient,
the same patient in column five on the discharge assessment?
Would you A, leave it blank.
B, both K0520C, mechanically-altered diet and Z,
none of the above would be checked.
Or only C, K0520Z, none of the above.
Okay, I think we can close the polling.
And if you answered C, none of the above,
you would be correct.
And the rationale is that both the tube feedings
and the mechanically-altered diet had been discontinued
four days before that discharge.
So the actual feeding tube was removed two days
before the discharge 'cause the patient was doing well
on the regular diet.
And at the time of discharge,
they were no longer receiving any nutritional approaches
for that patient.
Okay.
Now let's do one more quick scenario
surrounding number three.
The patient is admitted to the PAC setting
and is receiving an IV antibiotic for symptoms of a UTI.
Notes from the acute hospitalization include documentation
of inadequate fluid intake with signs and symptoms
of dehydration, despite an oral intake.
And the patient is on a mechanically-altered diet
due to swallowing issues.
Orders are updated to include IV hydration intervention
and to ensure adequate fluid intake.
So how would you code K0520 for the patient
on the admission assessment?
Would it be A, parenteral/IV feeding.
Or B, K0520C, mechanically-altered diet.
Or C, K0520Z, none of the above.
Or for D, both K0520A, parenteral/IV feeding
and K0520C, mechanically-altered diet would be checked.
Okay, and if you answered D, that would be correct.
And looks like most of you got that answer correct.
Terrific.
Okay, and the rationale is that the patient
is on a mechanically-altered diet,
but is also receiving IV fluids.
And the use of IV fluids for nutritional purposes
is supported by the documentation that we mentioned,
and that reflects the need for those fluids
to address hydration issues.
So just to wrap this up for Section K on Discharge,
remember to review the medical record
or available documentation to determine
if any nutritional approaches were received
in the last seven days for column one
and the discharge in column two.
IV fluids can be coded if needed to prevent dehydration,
but only if the additional fluid intake is specifically
needed for nutrition and hydration.
And this supporting documentation should be noted
in the patient's medical record.
And that's all for this section.
Thank you so much for your attention.