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Updated: Jun 4, 2019


The implementation of PDPM on 10/1/19 will bring with it a wave of change and new significance to how items on the MDS are coded.  This puts a spotlight on the clinical documentation in the medical record, the data collection process, and the accuracy of the information reported on the MDS.  One particular area that is going to be highlighted under PDPM is Section K: Swallowing/Nutritional Status of the MDS and how it ties into the Speech Therapy payment component of PDPM.

While no changes are being made to the questions in Section K, multiple items that previously did not impact reimbursement are now going to be directly tied to payment under PDPM. ​

K0100. Swallowing Disorder This question asks if there are any signs or symptoms of a possible swallowing disorder during the seven-day look-back period of the MDS.  This infers that the person completing the MDS must address the following steps for assessment:Asking the resident if he or she had any difficulty swallowingObserving the resident during meals or while eating or drinkingInterviewing staff on all shifts who worked with the residentReviewing the medical record, including but not limited to physician, dietician, and therapy notes. 

K0510: Nutritional Approaches Another MDS item that historically has not impacted payment is the item K0510C2. Mechanically altered diet, while a resident.  Under PDPM if it is indicated that the resident had a mechanically altered diet during the seven-day look-back period of the MDS, it will positively impact reimbursement under the Speech Case Mix component of PDPM.  The definition of a Mechanically Altered diet in the RAI Manual is, “A diet specifically prepared to alter the texture or consistency of food to facilitate oral intake.  Examples include soft solids, pureed foods, ground meat, and thickened liquids…”

Prepare for PDPM implementation It is essential to bring education and awareness to your staff providing care to residents on how to thoroughly assess, monitor and document these key areas.  Here are a few key steps you can take to help prepare your facility to ensure that you are accurately being paid for the care that is delivered:

  • Provide education and training to floor nurses and nursing assistants to accurately monitor for and document the four signs and symptoms of swallowing disorders identified above.

  • Bring awareness to the person responsible for completing section K of the MDS so that a thorough assessment of each of these areas is occurring.  Is he or she taking time to interview the resident, observe the resident eating/drinking, interview staff on all shifts, and thoroughly review the medical record (including therapy notes)?   

  • Interdisciplinary communication: Be sure your therapy partner is aware of the significance of these items and that they have a way to communicate to the MDS Nurse/IDT team when a resident displays signs and symptoms of a swallowing disorder during treatment or the trialing of a mechanically altered diet.  ​