CMS SOM App. H, Tag V509

The patient’s comprehensive assessment must

include, but is not limited to, the following: (6) Evaluation of nutritional status by a

dietitian.

Interpretive Guidance §494.80(a)(6):

The evaluation of each patient’s nutritional status must be conducted by a qualified dietitian as

defined in these regulations at V689 and V690. Examples of nutritional parameters to be

addressed include, but are not limited to:

• Nutritional status;

• Hydration status;

• Metabolic parameters such as glycemic control (if diabetic) and cardiovascular health;

• Anthropometric data such as height, weight, weight history, weight changes, volume

status, amputations;

• Appetite and intake;

• Ability to chew and swallow;

• Gastrointestinal issues;

• Use of prescribed and over-the-counter nutritional, dietary, or herbal supplements;

• Previous diets and/or nutrition education;

• Route of nutrition;

• Self-management skills;

• Attitude to nutrition, health, and well-being; and,

• Motivation to make changes to meet nutrition and other health goals.

The assessment may include information from the person that cooks and provides meals for the

patient, whether this is the patient, family, caregiver, or a nursing home/long-term care (LTC)

facility. Before interviewing family members or caregivers, the dietitian should obtain the

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patient’s permission to conduct the interview with the relevant individual(s). If the patient is a

resident of a LTC facility, the dietitian should contact the staff of the LTC facility as part of the

assessment and to provide continuity of care.

Other members of the IDT may contribute to portions of the comprehensive assessment which

correlate with the nutritional evaluation (e.g., medical history/co-morbid conditions at V502,

fluid management at V504, laboratory profile at V505, medication history at V506, CKD mineral

and bone disorder at V508, psychosocial factors at V510, and adequacy of the patient’s dialysis

prescription at V518).

Recognition and evaluation of nutritional needs is critically important in pediatric patients. A

facility treating pediatric patients should adhere to current, professionally accepted clinical

practice standards for evaluating and monitoring the pediatric patient population. The dietitian

must consider the special nutritional needs of this patient population.

Citation should not be based solely on the patient’s clinical laboratory results for nutrition

management (for example, serum albumin levels). Any deficiency in nutritional management

must be supported by the facility’s failure to identify and assess the patient’s nutritional status

and/or its inability to develop or implement an appropriate plan to meet the patient’s needs.

Requirements for the plan of care related to nutritional status are outlined at V545.