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Mechanically Altered Diets & Swallowing Disorders under PDPM

Under the new Patient-Driven Payment Model or PDPM, CMS has admitted to keeping an eye on a potential increase in mechanically altered diets.

Why, you ask?

Great question. Having a swallowing disorder or a mechanically altered diet increases the Speech Pathology case mix index under the proposed PDPM. CMS will monitor for an increase in the use of mechanically altered diets for financial gain vs. clinical need.

What does this mean for me?

Glad you asked. Review your provider impact file for the 2017 data showing your resident population trends. What we are seeing is 72.3% Medicare skilled residents nationally without a swallowing disorder or mechanically altered diet, which doesn’t make much sense (according to the CMS provider impact file from April 2018). It’s most likely due to the fact that we are not coding everything correctly on the MDS because it doesn’t affect payment… today. However, make sure your MDS is coding swallowing disorders and mechanically altered diets on the MDS today (see Table 1.0 below) and begin to educate the IDT to make sure you have documentation to support either or both of those, if they are in fact coded on the MDS.

Here’s the big deal:

CMS will be looking at what you’re doing today and comparing it to tomorrow. So even if your MDS today isn’t fully affecting your payment, it will tomorrow.

Table 1.0 On the MDS, look under K0510CA Mechanically Altered Diet While a Resident.

K0510C2 Mechanically Altered Diet While a Resident
Swallowing Disorder (Check All That Apply) 

K0100A Loss of liquids/solids from mouth when eating or drinking
K0100B Holding food in mouth/cheeks or residual food in mouth after meals
K0100C Coughing or choking during meals or when swallowing medications
K0100D Complaints of difficulty or pain with swallowing
K0100Z None of the above

Information based on Proposed Rule released by CMS on April 27, 2018.

Written by: Kristy Yoskey, MOT, OTR/L,  Senior Vice President of Clinical Strategies
Kristy's #HigherCalling: "Everyone has a significant purpose in life, mine is to help others become aware of that purpose - every nurse, CNA, rehab professional, one person at a time." 


Tags: skilled nursing facility, CMS, snf, RCS-1, Patient-Driven Payment Model, PDPM