Making sense of CMS guidelines is more challenging than ever after the launch of OASIS-E and the abundance of changes that go along with it. KanTime’s OASIS Spotlight series will spotlight specific OASIS items to simplify the ruling and help clinicians significantly improve their understanding of OASIS so they can move forward with accuracy.
K0520: Nutritional Approaches
The intent of K0520 is to identify if any nutritional approaches listed in the item are used by the patient. As per CMS “Nutritional approaches such as mechanically altered food or those that rely on alternative methods (e.g.,parenteral/IV or feeding tubes) can diminish an individual’s sense of dignity and self-worth as well as diminish pleasure from eating.”
Time points:
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- Start of Care
- Resumption of Care
- Discharge from Agency
For K0520 there are variances in the time period to be evaluated, depending on the timepoint the OASIS is completed.
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- SOC/ROC evaluates the presence of any of the listed approaches on admission
- Discharge evaluates the presence of any of the listed approaches
- In the last 7 days
- At Discharge
Additional CMS guidance includes the following:
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- Consult the patient, family, or caregiver and/or review the clinical record or other available documentation to determine if any of the listed nutritional approaches apply during the time period(s) under consideration.
- If a patient will receive one of the listed nutritional approaches as a result of this SOC/ROC assessment(for example, IV hydration will be started at this visit or a specified subsequent visit; the physician is contacted for an enteral order, etc.), mark the applicable nutritional approach.
- At SOC/ROC and discharge check all of the nutritional approaches that are part of the patient’s current care/treatment plan during the time period under consideration for SOC/ROC and discharge, even if not used during the time period under consideration for SOC/ROC and discharge, and whether or not it is expected to be used after discharge.
- Parenteral/IV feeding includes parenteral or IV fluids provided for nutrition or hydration.
- Excludes fluids provided solely to maintain access and patency
- 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 diabetes.
- A nutritional supplement 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 when they are being taken 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.
Stay tuned for next Monday’s spotlight so your practice can continue to stay ahead of the curve and provide elite patient care through the Oasis E changes.
We provide clinicians that are part of the Kantime enterprise system with links to the guidance from CMS for each individual OASIS item.
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