MDS Alert

Heed expert advice on how to calculate for column 3.

Since the October 2013 RAI manual update, there have been many questions circulating about how to properly code K0710 — Percent Intake by Artificial Route. And specifically, the newly added column 3 (During Entire 7 Days) has proven particularly baffling to many.

To code column 3, you first need to review the intake records to determine the resident’s actual intake through parenteral or tube feeding routes, according to a recent issue of the California Department of Public Health’s (CDPH’s) CA MDS Nuggets provider newsletter.

Stop here: If the resident took no food or fluids orally, or took just sips of fluids, stop here and code K0710A as 3 — 51% or more, CDPH instructed. But if the resident had more substantial oral intake of food or fluids, you’ll need to consult with the dietitian.

When you’re coding column 3, keep in mind that you can use the same rationale for coding both K0710A — Proportion of total calories the resident received through parenteral or tube feeding and K0710B — Average fluid intake per day by IV or tube feeding, noted the Kansas Department for Aging and Disability Services (KDADS) in its January 2014 Sunflower Connection provider newsletter.

Consider This Example to Understand Tricky Column 3 Coding

Problem: One of the biggest stumbling blocks for items K0710A and K0710B is how to code column 3 in cases where the past seven days includes time in both the hospital and the nursing home. KDADS offers the following illustrative example:

Scenario: Mr. Brown has been able to take some fluids orally, but due to dysphagia associated with his progressing multiple sclerosis, he is not remaining hydrated enough. So Mr. Brown received the following fluid amounts over the last seven days via supplemental tube feedings while in the hospital and after admission to the nursing home:

While in the hospital: While in the nursing home:

Get Started: How to Code Columns 1 & 2

First, you’ll code K0710B, column 1 (While NOT a Resident). Calculate the average fluid intake per day by IV or tube feeding while not a resident of your facility, CDPH stated. Divide the total amount of fluids the resident received daily by the number of days the resident was in the hospital or other facility during the entire seven-day look-back period.

In this example, you would add together the fluid intake for Monday through Thursday, when Mr. Brown was in the hospital. So the total fluid intake within the last seven days while Mr. Brown was not a resident was 1,900 cc, KDADS said. You would divide the total intake by four days, which would give you the average fluid intake of 475 cc (1,900 cc / 4 days = 475 cc).

Answer: Because 475 cc is less than 500 cc, you would code K0710B1 as 1 — 500 cc/day or less, KDADS instructed.

Then for K0710B, column 2, calculate the average fluid intake daily for IV or tube feeding and divide by how many days the resident was in your facility, CDHP stated.

In the example, you would add together Mr. Brown’s fluid intake on Friday, Saturday and Sunday. This gives you a total fluid intake within the last seven days while a resident in the nursing home of 1,520 cc. Divide this total fluid intake by three days to get the average fluid intake (1,520 cc / 3 days = 507 cc).

Answer: Because 507 cc is greater than 500 cc, you would code K0710B2 as 2 — 501 cc/day or more, KDADS said.

Understand the Right Way to Calculate for Column 3

Now you can move on to column 3, where you’ll calculate the average fluid intake in the last seven days while not a resident and while a resident. Add columns 1 and 2 together, and then divide the result by seven days. You must divide by seven even if the resident did not receive IV fluids and/or tube feeding on each of the seven days, CDPH stressed.

Add together Mr. Brown’s total fluid intake during the last seven days while he was in the hospital and while a resident of your facility (1,900 cc + 1,520 cc = 3,420 cc), KDADS instructed. Then, divide the sum by seven days to get the average fluid intake during the entire seven days (3,420 cc / 7 days = 489 cc). 

Solution: Your answer is 489 cc, which is less than 500 cc, so you would code column 3 as 1 — 500 cc/day or less.