»» Gina Waltos: Okay. So now we’re going
to move onto Section K, which is Swallowing
and Nutrition Status, which is going to make
us all hungry and want lunch. Okay. So again
we have the objectives for this presentation.
We’re going to illustrate a working knowledge
of Section K, Swallowing and Nutritional Status.
Articulate the intent of Section K, interpret
the coding options for the new item, K0100
and when they would be applied and apply coding
instructions in order to accurately code practice
Section K is a new item and Section K is assessed
on admission only and is used for…can anybody
answer that question? What do you think it’s
used for? Yes, that’s right. Risk adjustments
with the pressure ulcers. The intent of Section
K is to assess a patient’s swallowing or nutritional
So let’s look at K0100. Reduced hydration
in a nutritional status can have a significant
impact on wound healing and can increase a
patient’s risk for developing pressure ulcers.
Many disease processes can affect a patient’s
ability to swallow safely. Apparent swallowing
can cause choking and aspiration as well as
place a patient at increased risk for dehydration,
aspiration pneumonia and malnutrition. Let’s
look at steps for assessment of Section K.
The following steps are how we would assess
it. During the three-day assessment period
ask the patient if he or she has any difficulty
swallowing. Observe the patient during meals
or at times when he or she is eating, drinking
or swallowing. Think about when the nurses
are giving medications; that could also be
a time where you’re assessing the patient’s
ability to swallow. If the patient is not
able to report swallowing deficits, speak
with family or significant others.
You also want to review your medical record.
Look at nursing, physician, dietitian and
speech language pathologist notes that assess
and document swallowing status. Dental history
or problems with dentition can also cause
issues with swallowing. Including poor-fitting
dentures, mouth sores, tumors or any pain
with food consumption. You want to also observe
their dental history.
Here are the coding instructions for section
K0100. Section K is a multiselect assessment.
So you would check all that apply. So A is
regular food; solids and liquids swallowed
safely without supervision or modified food
or liquid consistency. B is modified food
consistency or supervision; the patient requires
modified food or liquid consistency such as
a pureed diet or the patient requires supervision
during eating for safety reasons. And C is
tube or parenteral feeding; tube or parenteral
feeding used wholly or partially as a means
of sustenance. I just want to kind of point
out that item number 27, which you fill out
on the front page of the IRF-PAI, has similar
questions. So please note that number 27 on
the IRF-PAI does ask for the same information
but K0100 is only asked on admission. And
it’s important to complete both sections as
they’re going to be used for different purposes.
So that’s the section that we currently fill
out right now, the section we can actually
see improvement. So if a patient comes in
and they’re on tube feed, they would be a
one on admission and you see the progression.
The other one is going to be used Section
K for risk adjustment.
Okay. So let’s try a practice coding scenario.
Mr. L has significant dysphagia. He only takes
in about 25% of a pureed diet with pudding
thick liquids. He receives nocturnal tube
feeds to meet his caloric needs. Go ahead
and grab your devices. So Mr. L. is A, regular
food. B, modified food. C, tube or parenteral
feeding or D, both. You’re going to use your
devices for this. I’ll start your timer. All
right. I think we’re ready to show the answer.
Okay. So the answer is, D. Remember this is
a multiselect section. So if you have a patient
that’s on tube feeds in the evening, but they
eat during the day, you can check both of
All right. So let’s summarize Section K. Section
K is a new section and it’s completed on admission.
It’s a multiselect section so more than one
box can be checked. And it’s similar to item
27 on the IRF-PAI but will be used for different
purposes. So both must be completed.
Okay. So I’m sure you all have your Action
Plan out from five minutes ago when we talked
about the last section. So let’s review your
Action Plan. How do you currently assess somebody’s
swallowing status in your facility now? In
our facility, our PPS coordinator, our outcomes
coordinator, she sits through team rounds,
she’s listening to somebody– is somebody
on tube feeds? She’s looking at the medical
records. So she’s pretty used to doing this
practice. We don’t feel there’s going to be
much change that needs to be made to this
practice for her. But think about your facility
and how you’d do this at your facility. Just
look at your documentation and make sure that
you’re going to be able to gather this information
from your chart. And if you haven’t figured
out now, since this is my third time speaking,
I’m the quote person. I love quotes, I start
my day off with a quote, so i’m going to leave
you with a quote as Aristotle said, “for the
things we have to learn before we can do them,
we learn by doing them”. So practice, practice,
practice. Okay. Questions? Who has a question
»» On that, let’s say that tube feeding
and then modified food you check. Would you
put a dash in the regular food or is it going
to gray out? Like since it’s multichoice?
»» Yeah, so so you would just check off
the ones that apply. You don’t need to dash
»» You wouldn’t put anything in the other
boxes, just leave them blank?
»» Correct. Good. Anybody else have another
»» I’m Jason from University Hospital. From
my understanding item number 27 swallowing
status is an optional in the current IRF-PAI,
we don’t have to fill it out when we send
it. Is that going the change with the new
IRF-PAI? We are going to have to fill out
»» I would refer to the manual. I didn’t
— we fill it on ours at all times. If you’re
saying it’s optional now, there isn’t anything
in the manual that says that that’s changing.
Just refer to the most current manual for
all other sections.
»» If the tube is only being used for flushes
or just for medication does that still count
against them because of the swallowing nutritional
status. Either they’re just flushing because
you can’t pull it, or we’re just putting medications
down the tube.
»» Let me confer with the table, and we’ll
get you a finalized answer, just to make sure
that it’s consistent across all —
»» All right, thanks.
»» Sure. I just want to make sure you’re
not using the flushes for hydration at all,
correct? just to keep it —
»» Okay. Okay. All right. We will get you
an answer on that one. All right. Thank you.