OASIS · CMS Q&As
K0520: CMS OASIS Q&As
6 questions CMS has answered, quoted whole from the CMS OASIS Q&As and the 2026 quarterlies.
K0520 on the OASIS item lookup
K0520. If a patient is placed on a full liquid diet for a bowel cleanse should this be considered a mechanically altered diet when coding K0520 - Nutritional Approaches?
The intent of K0520 - Nutritional Approaches is to assess and report which of the listed nutritional approaches apply to the patient on admission and/or discharge. K0520C - Nutritional Approaches; Mechanically altered diet reports if the patient requires a mechanically altered diet. Mechanically altered diet is defined as a diet specifically prepared to alter the texture or consistency of food to facilitate oral intake. Examples include soft solids, puréed foods, ground meat, and thickened liquids for patients having trouble chewing and/or swallowing foods or thin liquids. If, in your scenario, the diet texture is altered for a reason other than to facilitate oral intake, it would not be considered a mechanically altered diet when coding K0520C.
[Q&A ADDED 10/23; Previously CMS Qtrly Q&A 01/23 Q8]
K0520. If a patient has an order to be NPO in anticipation of a procedure/surgery is this considered either a mechanically altered diet or a therapeutic diet when coding K0520 - Nutritional Approaches?
No. The intent of K0520 - Nutritional Approaches is to assess and report which of the listed nutritional approaches apply to the patient on admission and/or discharge. NPO related to a procedure/surgery is not considered a nutritional approach for the purposes of coding K0520C - Nutritional Approaches; Mechanically altered diet and/or K0520D - Nutritional Approaches; Therapeutic diet.
[Q&A ADDED 10/23, Previously CMS Qtrly Q&A 07/23 Q5]
K0520, N0415, & O0110. Please provide guidance as to the accurate response for K0520Z - Nutritional Approaches; None of the Above in the following scenario: K0520A - Parenteral/IV Feeding = checked K0520B - Feeding Tube = not checked K0520C - Mechanically altered diet = Dash to indicate there was no available information K0520D - Therapeutic diet = not checked Should K0520Z - None be unchecked because K0520A is checked, or dashed because K0520C is dashed?
When one or more items for K0520A - K0520D is checked, to indicate that the specified nutritional approach applies to the patient, then K0520Z should be left unchecked. This is true even if one of the other items K0520A - K0520D is dashed. This same concept applies to N0415 - High Risk Drug Classes: Use and Indication and O0110 Special Treatments, Procedures, and Programs.
[Q&A ADDED 10/23; Previously CMS Qtrly Q&A 04/23 Q7]
K0520, N0415, & O0110. What is the look back or time period under consideration for the new OASIS items K0520 - Nutritional Approaches, N0415 - HighRisk Drug Classes: Use and Indication, and O0110 - Special Treatments, Procedures, and Programs? Is it the day of assessment, which may include medications, nutritional approaches, and/or treatments, procedures, or programs the patient may have taken/received in an inpatient facility before they were discharged home, or is coding just based on what is part of the current reconciled drug regimen and/or current care/treatment plan at the time of the assessment?
The general OASIS convention “Day of Assessment” which is defined as the 24 hours immediately preceding the home visit and the time spent by the clinician in the home does not apply to K0520 - Nutritional Approaches, N0415 - High-Risk Drug Classes: Use and Indication, and O0110 - Special Treatments, Procedures, Programs. These items are coded based on what is part of the patient’s current reconciled drug regimen and/or care/treatment plan during the SOC/ROC (or discharge) assessment.
[Q&A ADDED 10/23; Previously CMS Qtrly Q&A 04/23 Q8]
Since the February 2026 release: April 2026 CMS Quarterly OASIS Q&As and July 2026 CMS Quarterly OASIS Q&As
Would double portions of meals that are required as part of treatment of a disease or clinical condition be considered a therapeutic diet when coding K0520D - Nutritional Approaches; Therapeutic Diet?
K0520D - Nutritional Approaches; Therapeutic diet, defines a therapeutic diet as a diet intervention prescribed by a physician or other authorized non-physician practitioner that provides food or nutrients via oral, enteral, and parenteral routes as part of treatment of disease or clinical condition to modify, eliminate, decrease, or increase identified micro- and macro-nutrients in the diet. Therapeutic diets are not defined by the content of what is provided nor when it is served but why the diet is required. If, in the scenario, the “double portions” are prescribed by a physician or other authorized non-physician practitioner to manage a disease or clinical condition, then yes, a “double portions” diet meets the definition of a therapeutic diet when coding K0520D.
If a patient is receiving a mechanically altered diet (e.g., chopped or soft food) for reasons other than a swallowing impairment, would this still be considered a mechanically altered diet for K0520C - Nutritional Approaches; Mechanically altered diet? If the patient chooses to use a mechanically altered diet, not to facilitate oral intake but because it is their preference, would this also be considered when coding K0520C?
If the patient’s diet texture or consistency of food is altered for any reason to facilitate oral intake (e.g., swallowing difficulties, dexterity or functional limitations), it would be considered a mechanically altered diet when coding K0520C - Nutritional Approaches; Mechanically altered diet. For the purposes of coding K0520C, a mechanically altered diet is defined as a diet specifically prepared to alter the texture or consistency of food to facilitate oral intake. Examples include soft solids, puréed foods, ground or chopped meat, and thickened liquids. If the texture or consistency of food is not altered, or if the diet texture is altered for a reason other than to facilitate oral intake (e.g., due to patient preference or a prep for a procedure/surgery), it would not be considered a mechanically altered diet when coding K0520C.
Source: CMS OASIS Q&As: Category 4 - OASIS Data Set: Forms and Items (March 2026) and April 2026 CMS Quarterly OASIS Q&As (April 2026) and July 2026 CMS Quarterly OASIS Q&As (July 2026), text extracted from the PDF with pdftotext, retrieved 2026-10-09. Works of the US Government are in the public domain.
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