MDS Section K: A Beginner’s Guide for Dietitians

The minimum data set (MDS) is a federally mandated assessment of all residents in Medicare or Medicaid-certified long-term healthcare facilities.

It provides a comprehensive assessment of each resident’s functional capabilities and helps members of the interdisciplinary team identify health problems and develop individualized care plans.

Section K is one of the 21 sections of the MDS that covers swallowing disorders, height and weight, weight loss, and nutritional approaches.

This article serves as a beginner’s guide for dietitians and dietary managers on the components of MDS Section K.

MDS Section K: Swallowing and Nutritional Status

The items in MDS Section K are intended to assess conditions that could affect the resident’s ability to maintain adequate nutrition and hydration.

Poor nutritional and hydration status can prolong wound healing and increase the risk of pressure ulcers.

MDS Section K covers (1):

K0100: Swallowing Disorder

Alterations in the ability to swallow safely can cause choking and aspiration, which can increase the resident’s risk of malnutrition, dehydration, and aspiration pneumonia.

The purpose of K0100 is to assess for signs and symptoms of swallowing difficulties during the 7-day look-back period.

To assess swallowing:

• Ask the resident about each of the symptoms in A through D.
• Observe the resident during meal and snack times.
• Interview all staff on all shifts that work with the resident.
• Review all notes and medical records.

Do not check a swallowing problem when interventions have been successful in treating the problem and therefore the signs and symptoms of the problem did not occur during the 7-day look-back period.

However, if one of the problems occurs, you will still need to code that sign or symptom.

K0200: Height and Weight

Height and weight measurements assist staff with assessing the resident’s nutrition and hydration status over time.

To assess height:

• Base on most current height.
• Measure and record height to the nearest whole inch.
• Measure height consistently over time with the facility policy and procedure.
• Always obtain height on admission, every readmission, and annually.

To assess weight:

• Base on the most recent weight in the last 30 days. Weight cannot be after the assessment reference date (ARD).
• Round weight to the nearest whole pound.
• Measure weight consistently over time and in accordance with facility policy and procedure.
• If the last weight was recorded more than one month ago, measure and record a new weight.

K0300: Weight Loss

Unplanned weight loss can negatively affect a resident’s health, safety, and quality of life. For those who are obese or have fluid overload, however, weight loss may improve their health status.

To assess weight loss:

• For new admissions, ask the resident or their family about weight loss over the past 30–180 days.
• For subsequent assessments, compare the resident’s weight in the current observation period to their weight in the observation period 30 days ago.
• Calculate weight loss percentage using rounded weights.

A physician-prescribed weight loss regime is when a physician or registered dietitian orders a weight-reduction plan. It also includes planned diuresis.

K0310: Weight Gain

Weight gain can negatively affect many aspects of life and therefore should be monitored on a continuing basis.

To assess weight gain:

• For new admissions, ask the resident or their family about weight gain over the past 30–180 days.
• For subsequent assessments, compare the resident’s weight in the current observation period to their weight in the observation period 30 days ago.
• Calculate weight gain percentage using rounded weights.

K0510: Nutritional Approaches

Nutritional approaches that include any mechanically altered diet or that rely on enteral or parenteral nutrition can diminish a resident’s quality of life. That said, alternative nutritional approaches should be monitored to validate effectiveness.

To assess nutrition approaches:

• Review the resident’s medical record to determine if any of the nutritional approaches A through D were performed during the 7-day look-back period.

You can code IV fluids in KO510A when the following fluids have supporting documentation that reflects the need for additional fluid based on a resident’s nutritional status:

• IV fluids, including total parenteral nutrition (TPN), administered continuously or intermittently
• IV fluids running at keep vein open (KVO)
• IV fluids contained in IV piggybacks
• Hypodermoclysis and subcutaneous ports in hydration therapy

However, you should not code the following items in KO510A:

• IV medications
• IV fluids used to reconstitute or dilute medications for IV administration
• IV fluids administered as a routine part of an operative or diagnostic procedure
• IV fluids administered solely as flushes
• Parental/IV fluids administered in conjunction with chemotherapy or dialysis.

If a resident was on a therapeutic diet in the hospital to manage specific conditions, like diabetes, you will also need code K0510D.

Similarly, if an enteral formula is used to manage a condition like diabetes or chronic kidney disease, you can also code it as K0510D.

You can code food elimination diets related to food allergies or intolerances as a therapeutic diet.

K0710: Percent Intake by Artificial Route

Complete this only if Column 1 or Column 2 or both are checked for K0510A or K0510B or both.

To assess percent intake by artificial route:

• Review intake records and determine intakes through parenteral or tube feeding routes.
• Calculate the proportion of total calories received from those routes.

The bottom line

MDS Section K focuses on assessing residents’ swallowing and nutritional status.

The components of Section K are intended to assess conditions that could affect a resident’s ability to maintain adequate nutrition and hydration.

It covers swallowing disorders, height and weight, weight loss, and nutritional approaches.