Verbal guidance from CMS on coding Section K that is beyond what is published in the current RAI Manual

From the AANAC LTC Leader dated 1/23/14  (NOTE FROM JUDY:  THIS IS NOT IN THE CURRENT RAI MANUAL)

Officials with the Centers for Medicare and Medicaid Services (CMS) discussed several issues at the Jan. 16 Skilled Nursing Facility/Long-term Care Open Door  Forum (SNF/LTC ODF).

K07010 coding example

CMS officials provided an example to illustrate the proper coding of MDS 3.0 item K0710 (percent intake by artificial route) when the look-back period includes time prior to and after admission or reentry:

Mr. K has been able to take some fluids orally. However, due to his progressing multiple sclerosis, his dysphaghia is not allowing him to remain hydrated. Therefore, he received the following fluid amounts over the last seven days via supplemental tube feedings while in the hospital and after he was admitted to the nursing home.

Over four days in the hospital, Mr. K received the following:

• Monday, 400 cc;

• Tuesday, 520 cc;

• Wednesday, 500 cc; and

• Thursday, 480 cc.

Over three days in the nursing home, Mr. K received the following:

• Friday, 510 cc;

• Saturday, 520 cc; and

• Sunday, 490 cc.

In this scenario, K0710B (average fluid intake per day by IV or tube feeding) would be coded as follows:

• K0710B1 (while NOT a resident) would be coded 1, indicating 500 cc per day or less.

• K0710B2 (while a resident) would be coded 2, indicating 501 cc per day or more.

• K0710B3 (during entire seven days) would be coded 1, also indicating 500 cc per day or less.

“The rationale for this is that the total fluid intake in the last seven days while Mr. K was not a resident was 1,900,” said officials. “That is the sum of 400 on Monday, 520 on Tuesday, 500 on Wednesday, and 480 on Thursday. The average fluid intake while not a resident totaled 475 cc. Because that is less than

500, the correct coding is 1 for K0710B1 (while NOT a resident).” The total fluid intake within the last seven days while Mr. K was a resident of the nursing home was 1,520 cc, said officials. “That is the sum of 510 on Friday, 520 on Saturday, and 490 on Sunday. The average fluid intake was 507 cc for those three days. Since it is greater than 500, the correct coding for K0710B2 (while a resident) would be 2.”

Finally, “the total fluid intake during the entire seven days, and that includes while he was in the nursing home and prior to being in the nursing home while he was in the hospital, was 3,420 cc,” said officials. “The average for that entire seven-day period was 489 cc (dividing the total of 3,420 cc by those 7 days).

Because that 489 is less than 500, the correct code for K0710B3 (during entire seven days) would be 1.”