✓
Checked
Condition applies under the item instruction.
Manual page K-11DiraChart MDS item reference
K0520C1Section Kv1.20.1Manual page K-11
Nutritional approaches: Mechanically Altered Diet - Adm
This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.
Quick coding
Answer Codes
Use the item-specific response choices below when structured codes apply.
Response format: Check all that apply
—
Not checked
Condition does not apply under the item instruction.
Manual page K-11Item-specific instructions
Coding Guidance
Review what the item asks, how to choose the response, and what should be verified before submission.
Steps for Assessment
•
Review the medical record to determine if any of the
listed nutritional approaches were performed during the
look-back period.
•
If none apply, check K0520Z. None of the above.
Coding Instructions
Check all that apply. If none apply, check K0520Z, None of the
above
•
K0520A, parenteral/IV feeding.
•
K0520B, feeding tube – nasogastric or abdominal
(PEG).
•
K0520C, mechanically altered diet – require change in
texture of food or liquids (e.g., pureed food, thickened
liquids).
•
K0520D, therapeutic diet (e.g., low salt, diabetic, low
cholesterol).
•
K0520Z, none of the above.
Coding Instructions for Column 1
•
Check all nutritional approaches performed during the
first 3 days of the SNF PPS Stay.
Coding Instructions for Column 2
•
Check all nutritional approaches performed prior to
admission/entry or reentry to the facility and within the 7-day look-back period. Leave
Column 2 blank if the resident was admitted/entered or reentered the facility more than 7
days ago.
•
When completing the Interim Payment Assessment (IPA), the completion of items
K0520A, K0520B, and K0520Z is required.
Coding Instructions for Column 3
•
Check all nutritional approaches performed after admission/entry or reentry to the facility
and within the 7-day look-back period.
Coding Instructions for Column 4
•
Check all nutritional approaches performed within the last 3 days of the SNF PPS Stay.
DEFINITIONS
MECHANICALLY
ALTERED DIET
A diet specifically prepared to
alter the texture or
consistency of food to
facilitate oral intake.
Coding Tips
for K0520A
K0520A includes any and all nutrition and hydration received by the nursing home resident
during the observation period either at the nursing home, at the hospital as an outpatient or an
inpatient, provided they were administered for nutrition or hydration.
•
Parenteral/IV feeding—The following fluids may be included when there is supporting
documentation that reflects the need for additional fluid intake specifically
addressing a nutrition or hydration need. This supporting documentation should be
noted in the resident’s medical record according to State and Federal Regulations
and/or internal facility policy:
— IV fluids or hyperalimentation, including total parenteral nutrition (TPN),
administered continuously or intermittently
— IV fluids running at KVO (Keep Vein Open)
— IV fluids contained in IV Piggybacks
— Hypodermoclysis and subcutaneous ports in hydration therapy
— IV fluids can be coded in K0520A if needed to prevent dehydration if the additional
fluid intake is specifically needed for nutrition and/or hydration. Prevention of
dehydration should be clinically indicated and supporting documentation should be
provided in the medical record.
•
The following items are NOT to be coded in K0520A:
— IV Medications—Code these when appropriate in O0110H, IV Medications.
— IV fluids used to reconstitute and/or dilute medications for IV administration.
— IV fluids administered as a routine part of an operative or diagnostic procedure or
recovery room stay.
— IV fluids administered solely as flushes.
— Parenteral/IV fluids administered in conjunction with chemotherapy or dialysis.
•
Enteral feeding formulas:
— Should not be coded as a mechanically altered diet.
— Should only be coded as K0520D, Therapeutic Diet when the enteral formula is
altered to manage problematic health conditions, e.g. enteral formulas specific to
residents with diabetes.
Coding Tip for K0520B
•
Only feeding tubes that are used to deliver nutritive substances and/or hydration during
the assessment period are coded in K0520B.
K0520: Nutritional Approaches (cont.)
Coding Tips for K0520C
•
Assessors should not capture a trial of a mechanically altered diet (e.g., pureed food,
thickened liquids) during the observation period in K0520C, mechanically altered diet.
Coding Tips for K0520D
•
Therapeutic diets are not defined by the content of what is provided or when it is served,
but why the diet is required. Therapeutic diets provide the corresponding treatment that
addresses a particular disease or clinical condition which is manifesting an altered
nutritional status by providing the specific nutritional requirements to remedy the
alteration.
•
A nutritional supplement (house supplement or packaged) given as part of the treatment
for a disease or clinical condition manifesting an altered nutrition status, does not
constitute a therapeutic diet, but may be part of a therapeutic diet. Therefore, supplements
(whether given with, in-between, or instead of meals) are only coded in K0520D,
Therapeutic Diet when they are being administered as part of a therapeutic diet to manage
problematic health conditions (e.g. supplement for protein-calorie malnutrition).
•
Food elimination diets related to food allergies (e.g. peanut allergy) can be coded as a
therapeutic diet.
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