Section K in MDS 3.0 has wording clarifications and revisions to data elements and assessment steps.
On October1, 2023, the new MDS 3.0 will become effective and present major changes tomany sections and revised coding procedures. Facilities will need to preparenow for the changes occurring in various sections. This blog is part of PolarisGroup's Decoding the MDS 3.0 series which will explore the changes occurring inspecific MDS sections.
What’s new in Section K?
Changes in MDS 3.0 for Section K: Swallowing and Nutritional Status include new data elements, revisions to assessment steps, and wording changes.
- New data elements. The new data element (Nutritional Approaches: K0520) will replace the current K0510 item in Section K. New columns for this item capture data on admission and again at discharge. Previously, Nutritional Approaches (K0510), had two columns for coding: while a resident and while not a resident. Now, assessment for PPS stays will only assess on admission and at discharge.
- Revisions to assessment steps. In the MDS 3.0 revised assessment steps for K05020, facilities will review the intake records within the last 7 days to determine actual intake and calculate the proportion of total calories received. Facilities will need to review the medical record to determine if any nutritional approaches (e.g. parenteral/IV feeding, feeding tube, mechanically altered diet, or therapeutic diet) were performed during the 7-day look-back period. If none apply, facilities should check K0520Z: none of the above. Another new change to assessment steps in MDS 3.0 is revised coding instructions for a PPS stay which include: On admission: all nutritional approaches performed during the first three days of the stay need to be documented and coded. While not a resident: all nutritional approaches performed prior to admission and within the 7-day look-back period need to be coded. While a resident: check all nutritional approaches performed after admission and within the 7-day look-back period. At discharge: check all nutritional approaches performed within the last 3 days of the PPS stay. TIP: Only feeding tubes that are used to deliver nutritive substances and/or hydration during the assessment period are coded in K0520B. Assessors should not capture a trial of a mechanically altered diet (e.g., pureed food, thickened liquids) during the observation period in K0520C.
- Wording changes. To improve consistency and clarity, MDS 3.0 has language and terminology changes that align with the latest dental and medical practices. Another goal of these changes is to facilitate better communication to improve accuracy of data collection, leading to improved care decisions. One example of wording changes is the definition of therapeutic diet. CMS has clarified the definition to one that is a “diet intervention prescribed by a physician or other authorized non-physician practitioner that provides food or nutrients via oral, enteral, and/or parenteral routes as part of treatment of disease or clinical conditions to modify, eliminate, decrease, or increase identified micro- and macro-nutrients in the diet.”
What to expect
Changes to Section K are perhaps more minor compared with changes to other sections. However, one of the benefits to the changes in this change is a linkage to care planning. For example, on K0710, if a resident had more than substantial oral intake than sips of fluid, nursing staff should consult with the dietician.
Recommendations from Polaris
To be well-prepared for MDS 3.0, facilities should ensure they stay updated on the proposed changes to the Resident Assessment Instrument (RAI), participate in CMS webinars, and seek guidance from Polaris Group consultants. Consultants can assist in readying your facility for the upcoming changes.
If your current MDS coordinator could improve coding or lacks the time and resources to train others, Polaris Group offers a helping hand. Our outsourced MDS can conduct chart audits, provide intensive coding training to enhance the accuracy of your MDS submissions, and can offer your facility an experienced coder who possess excellent communication, documentation, and collaborative skills to support your team effectively.
