MDS Alert

"You could code a mechanical diet as a therapeutic diet on the MDS 3.0," if it meets the RAI manual definition, Richardson says. The definition is as follows:

"A therapeutic diet is a diet intervention ordered by a health care practitioner as part of the treatment for a disease or clinical condition manifesting an altered nutritional status, to eliminate, decrease, or increase certain substances in the diet (e.g. sodium, potassium) (ADA, 2011)."

Thus, says Richardson, "you can't just assume because someone is on a mechanical or soft or dental diet (whatever the facility calls it), that it's part of their dietary intervention. We have some residents who just want a soft diet but they don't really have a clinical condition that requires it," she says.

Coding tip: "If a resident receives a mechanical diet that also qualifies as a therapeutic diet, then you would code both in Section K0500," advises Ron Orth, RN, RAC-MT, CPC, president of Clinical Reimbursement Solutions in Milwaukee, Wis. (See a picture of Section K0500 below.)

Another issue: "Generally, if a nursing home resident is on a renal diet or a 2 gm sodium diet related to kidney or cardiac disease, that's certainly a therapeutic diet," says Richardson. But "you could have a resident on a consistent carbohydrate diet," which would be coded as a therapeutic diet, if it's related to part of their treatment for diabetes, says Richardson. "No-one is going to argue about that," she adds. "But what if you have a younger older resident who says he or she just wants to eat healthy and be on consistent carbs for that reason? Is that therapeutic for them? There are still many questions out there" about this issue. "Yes, the diet is being modified -- however, is it a therapeutic diet for that individual?"

What the SOM says: "Sometimes, a resident or resident's representative decides to decline medically relevant dietary restrictions. In such circumstances, the resident, facility and practitioner collaborate to identify pertinent alternatives."