MDS 3.0 Coding Section K

Section K requires input from several team members to assure accuracy in coding and care planning. The intent of the Swallowing / Nutritional Status section is stated in the RAI manual as such:

The items in this section are intended to assess the many conditions that could affect the resident's ability to maintain adequate nutrition and hydration. This section covers swallowing disorders, height and weight, weight loss, and nutritional approaches.

The manual recommends collaboration in this section from the dietitian and dietary staff to ensure that items have been assessed and calculated accurately.

Section K has a 7 day look-back for identification of among other things swallowing problems. The manual instructs to code symptoms even if they only occurred once in the 7 day look-back period. Additionally, the manual states not to code a swallowing problem when interventions have been successful in treating the problem and therefore the signs/symptoms of the problem did not occur during the 7-day look-back period. Information is gathered through Assessment, Asking the Resident, Observation and Consultation with interdisciplinary team members and family.

The MDS 3.0 RAI manual contains new details regarding the types swallowing problems.

K0100A, loss of liquids/solids from mouth when eating or drinking. When the resident has food or liquid in his or her mouth, the food or liquid dribbles down chin or falls out of the mouth.
K0100B, holding food in mouth/cheeks or residual food in mouth after meals. Holding food in mouth or cheeks for prolonged periods of time (sometimes labeled pocketing) or food left in mouth because resident failed to empty mouth completely.
K0100C, coughing or choking during meals or when swallowing medications. The resident may cough or gag, turn red, have more labored breathing, or have difficulty speaking when eating, drinking, or taking medications. The resident may frequently complain of food or medications "going down the wrong way."
K0100D, complaints of difficulty or pain with swallowing. Resident may refuse food because it is painful or difficult to swallow.

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Link to CMS page, RAI Manual for MDS 3.0: http://www.cms.hhs.gov/NursingHomeQualityInits/25_NHQIMDS30.asp

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