Q: Our reimbursement specialist says we’ve missed several opportunities to code IV fluids given at the hospital on the 5-day PPS assessment. How is this information reported and supported?
A:IV fluids administered in the hospital for hydration/nutrition are coded in Section K of the MDS, specifically item K0520A2. Unlike Section O of the MDS, Section K still has a column for coding services received “while not a resident of this facility and within the last 7 days.” Note: If the ARD of the 5-day MDS is day 8 of the stay, this column would be left blank.
The ability to accurately code IV fluids administered during a hospital stay on the Medicare PPS 5-day can have a significant impact on the nursing case mix, amounting to an increase of almost $85 per diem.
It is important to review hospital documentation to determine whether IV fluids were administered, and the date last received when scheduling the ARD. Many facilities choose to schedule the ARD on day 7 of a Medicare Part A stay, but that could lead to hospital IV fluids being missed on the MDS.
Supportive documentation must reflect the need for additional fluid intake specifically addressing a nutrition or hydration need and not administered as a routine part of an operative and/or diagnostic procedure. Opportunities to be aware of include residents who are hospitalized for conditions such as a UTI or other inflection, AKI, or other documentation from a hospital physician indicating the need for “gentle hydration.”
Keep in mind that IV fluids are coded in Section K while IV medications are coded in Section O. Section O does not impact the CMI unless the services are received “while a resident of this facility and within the last 14 days.”
Please send your payment-related questions to Eleisha Wilkes at [email protected].
