Long-Term Care Survey Alert

To Code or Not to Code Recent or Planned Weight Loss in Section K

Question: When evaluating residents' weight change for coding the MDS, should we look back specifically at the 30-day point (and 180-day point) to assess weight loss or gain? For example, if we see a resident has lost a significant amount of weight as of 14 days ago, would we be right not to count that as weight loss because the evaluation point is 30 days? We'd be addressing the weight loss in the care plan but wonder if we should code it on the MDS.

Answer: "The weight calculation specifically looks at two sets of two points in time," says Rena Shephard, MHA, RN, RAC-MT, C-NE, president and CEO of RRS Healthcare Consulting and founding chair and executive editor of the American Association of Nurse Assessment Coordinators.

"For the 5 percent calculation, compare the weight in the current observation period with the weight in the 30-day period prior to this one. For the 10 percent calculation, compare the weight in the current observation period to the weight ... six months ago," advises Shephard. "Those are the only weights that are used for the weight change item."

For new admissions, the RAI User's Manual directs staff to "ask the resident or family about weight changes over the last 30 and 180 days," adds Marilyn Mines, RN, RAC-CT, BC, manager of clinical services for FR&R Healthcare Consulting in Deerfield, Ill. "Consult physician, review transfer documentation and compare with admission weight," the manual directs.

Question: Should a nursing facility code significant weight loss in Section K if it's a planned weight loss for someone who is overweight and voluntarily participates in a weight-reduction plan?

Answer: The facility must code a weight loss that meets the criteria for coding in Section K regardless of the reason for the weight loss, says Shephard. "The weight loss will trigger the Resident Assessment Protocol (RAP), and the reasons for the weight loss will be captured in that further, in-depth assessment." The care plan can be adjusted accordingly, as necessary, Shephard says.