Re: Section K

[Delores234]

Now you are into my disagreement with a previous CMS interpretation of coding chewing and swallowing.  For years we coded this [if] it applied to a mechanically altered diet.  Then CMS published a Q&A stating that if the intervention was successful we shouldn't code the c&S difficulty.  So..........for a year we did not; and for that year I argued with CMS. 

Think about it, if all of the care plan interventions 'were successful' then on subsequent MDS assessments there would be no evidence that the resident required skilled care.  If the resident continues to require the intervention, in this case the mechanically altered diet, then the condition is still present.  If not give her filet mignon and improve the quality of her life.

Then the new manual was published, See page 3-149 K1a ...Code swallowing problem even when interventions have been successfully introduced.  Same is stated for chewing

Delores

Dawn you are correct. If the diet is changed/ Mech etc, then it is d/t a chewing or swallowing problem. On our state site for transmittals, this statement continues to be posted, around 2 years ago I believe in July. Not at work, so can't give exact date. I personally feel that if the diet is altered so that the resident doesn't experience difficulty w/eating their foods and the intervention worked---there is not a problem.

Delores L. Galias, RN, RHIT

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