Long-Term Care Survey Alert

Question: I’m an MDS nurse and was debating the issue of IV meds with another MDS nurse. The RAI Manual states that you can NOT use IV fluids as a med, but the nurse I was speaking with said that you could use IV fluids (normal saline) if you had a diagnosis of dehydration and the lab results to prove it. Is she right?

Answer: You can include IV fluids if they are given as part of a hydration or nutritional program, answers Marilyn Mines, senior manager of clinical services for FR&R Healthcare Consulting, Inc. in Deerfield, IL. You must have documentation in the clinical record that clearly reflects the dietary need for the fluids.

Mines points to Section K of the MDS 3.0, pages 11 and 12 (emphasis added):

Check all that apply. If none apply, check K0510Z, None of the above

• K0510A, parenteral/IV feeding;
• K0510B, feeding tube — nasogastric or abdominal (PEG); 
• K0510C, mechanically altered diet — require change in texture of food or liquids (e.g., pureed food, thickened liquids);
• K0510D, therapeutic diet (e.g., low salt, diabetic, low cholesterol);
• K0510Z, none of the above.  

Coding Tips for K0510A 

K0510A includes any and all nutrition and hydration received by the nursing home resident in the last 7 days either at the nursing home, at the hospital as an outpatient or an inpatient, provided they were administered for nutrition or hydration.

• Parenteral/IV feeding —The following fluids may be included when there is supporting documentation that reflects the need for additional fluid intake specifically addressing a nutrition or hydration need. This supporting documentation should be noted in the resident’s medical record according to State and/or internal facility policy:

— IV fluids or hyperalimentation, including total parenteral nutrition (TPN), administered continuously or intermittently 

— IV fluids running at KVO (Keep Vein Open) 

— IV fluids contained in IV Piggybacks 

— Hypodermoclysis and subcutaneous ports in hydration therapy.