- Section K: we're gonna review Section K,
swallowing and nutritional status.
Similar to the objectives of all of our sessions today,
the primary objective of this section
is to review changes
from the LTCH Care Dataset version 2.01, to 3.0,
explain the intent of Section K,
highlight specific coding instructions,
and present a scenario
as an example of how to code this section.
As you know, there are no new items
or changes in this section,
so what I'll be doing is a review
of how to code this section.
The intent of Section K
is to assess the patient's body mass index, BMI,
using the patient's height and weight.
These data elements are important
because malnutrition in hospital patients
is associated with multiple complications
and increased cost.
Complications include delayed wound healing,
increased rate of infections,
increased length of stay,
increased risk of pressure ulcers,
decreased quality of life, confusion, agitation,
and muscle weaknesses.
Patients who are coming from ICUs to LTCHs
can lose approximately 2% muscle mass
during the illness, owing to a combination
of primary muscle catabolism and atrophy,
secondary to neuropathic degeneration.
Strahan, in a study in 2003,
followed patients Post-ICU discharge,
and found that 39% of those patients reported
had no appetite,
11% were on a soft diet, and 4% were on tube feeding.
So, you can see what some of the implications are.
The goals of nutrition support, as we all know,
are to prevent starvation, associated malnutrition,
preserve lean tissue mass,
support metabolic functions and improve clinical outcomes.
Height and weight measures, and BMI calculation
assist staff in assessing the patient's nutrition
and hydration status,
by providing a mechanism for monitoring stability of weight
and BMI over a period of time.
The measure of height and weight for the calculation of BMI
is one guide for determining nutritional status.
This slide shows the LTCH Care Dataset items
for height and weight.
This item only applies only to the admission assessment.
An important part of completing this section
is that when you're reporting height
for a patient with a bilateral lower extremity amputation,
you should measure and record the patient's current height;
in other words, the patient's height
after the surgical procedure.
So what you're going to do is measure the height,
in accordance with your particular organization's
policies and procedures,
and you're going to measure and record the height in inches.
You are going to record the patient's height
to the nearest whole inch.
And you will use -- you should use mathematical rounding
as shown on the slide.
If the height measurement is x.5 inches or greater,
round the height upward to the nearest whole inch.
If the height measurement is x.1 to x.4 inches,
round down to the nearest whole inch.
An example is shown on the slide.
So a patient who is 62.5 inches tall,
should be rounded to 63 inches.
And a patient who is 62.4 inches should be rounded to 62 inches.
The second item in Section K is weight.
Again, you would measure the patient's weight
in accordance with your particular organization's
policies and procedures,
and you're going to measure and record
the patient's weight in pounds.
If the patient has been weighed multiple times
during the assessment period,
you should use the first weight.
You should complete this item
only if it is an admission to the LTCH.
You should base the weight on the most recent measure
in the last three days.
Like height, you're going to record the patient's weight
to the nearest whole pound and you're going to use
mathematical rounding as shown on the slide.
So if the weight measurement is x.5 pounds or greater,
you're going to round the weight upward
to the nearest whole number.
If the weight measurement number is x.1 to x.4 pounds,
round down to the nearest whole pound.
An example is shown on the slide.
A patient who weighs 152.5 pounds
should be rounded up to 153 pounds.
And a patient who weighs 152.4 pounds
should be recorded as weighing 152 pounds.
An important point to remember for this section
is to use the default response of a dash
if the patient cannot be weighed.
Next, we'll go through one scenario.
Mrs. G has terminal breast cancer,
and is receiving palliative care.
She is at risk for a pathological fracture,
due to metastatic bone disease.
She is pain-free at rest
but experiences discomfort when she moves.
Daily weights are not part of her prescribed medical care,
and they do not affect her end-of-life care.
With a show of one of your cards in your deck,
how would you code this particular scenario?
That is correct. -- the default symbol or the dash.
If a patient cannot be weighed,
for example, because of extreme pain,
Immobility, or risk of pathological fractures,
it is appropriate to use the default response, dash,
and document the rationale on the patient's medical record.
As you know, a warning will be issued by the QIES-ASAP system
to notify the LTCH providers that a dash was answered
for a required item, and the warning is generated
every time a default response, in this case, a dash,
is entered for a required item.
While the use of the dash for this item
may affect your annual payment update,
and hence the warning that LTCH providers receive in the system,
when a dash is entered for a quality item
which is required; CMS takes this into account
that there are instances when a dash is appropriate.
In summary, you should record the height in inches
and use mathematical rounding.
You should record weight in pounds,
and use mathematical rounding.
You should record the most recent weight
and you can use the default response of a dash
when unable to weigh a patient.
And you should record the height of a bilateral amputee patient
after the surgical procedure.
This slide shows my recommendations
for what content to review with your staff
when you return to your hospital.
I would recommend that you emphasize
how obtaining a patient's height and weight
is an important component of their overall care.
This is an opportunity to review risk factors
for malnutrition in this patient population
and discuss preventive nursing care.
Review coding of these items in mathematical rounding.
Review the scenario
when using the default response is appropriate,
with special emphasis of documenting
why the patient cannot be weighed.
Present coding scenarios for your staff
to practice accurate coding of this section.
This ends the presentation on Section K.